Drugs List

Therapeutic Indications

Uses

Local anaesthetic for dental infiltration anaesthesia
Local anaesthetic for dental nerve block

Administration

For dental injection.

Contraindications

Inflammation of injection site
Anaemia
Methaemoglobinaemia

Precautions and Warnings

Debilitation
Elderly
Shock
Cardiac conduction defects
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Pregnancy
Renal impairment
Respiratory impairment
Severe cardiac disorder
Severe hypertension
Uncontrolled hypertension

Advise ability to drive/operate machinery may be affected by side effects
Avoid local anaesthetics if inflammation in region of proposed injection
Resuscitation facilities must be immediately available

Great caution must be exercised to avoid intravascular administration as this may cause the rapid onset of toxicity with marked restlessness, twitching or convulsions. These symptoms may be followed by coma with apnoea and cardiovascular collapse.

Pregnancy and Lactation

Pregnancy

Use prilocaine with felypressin with caution in pregnancy.

Prilocaine with felypressin should not be administered during early pregnancy unless the benefits are expected to outweigh the risks.

There is no evidence of harm to the foetus, but as with all drugs benefit and risk should be evaluated prior to administration during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Prilocaine with felypressin is considered safe for use in breastfeeding.

Prilocaine enters breast milk, but at recommended doses (i.e. a single dose of prilocaine injected during dental procedure) it is unlikely to adversely affect the breastfed infant. However, an alternative drug may be preferred, especially while nursing a newborn or preterm infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactoid reaction
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular effects
CNS effects
Convulsions
Cutaneous lesions
Cyanosis
Dizziness
Drowsiness
Hypertension
Hypotension
Methaemoglobinaemia
Myocardial depression
Nervousness
Oedema
Respiratory arrest
Tremor
Unconsciousness
Urticaria

Presentation

Solution for injection containing prilocaine hydrochloride and felypressin

Drugs List

Therapeutic Indications

Uses

Local anaesthetic for dental infiltration anaesthesia
Local anaesthetic for dental nerve block

Dosage

Adults

Elderly

Children

Administration

For dental injection.

Contraindications

Inflammation of injection site
Anaemia
Methaemoglobinaemia

Precautions and Warnings

Debilitation
Elderly
Shock
Cardiac conduction defects
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Pregnancy
Renal impairment
Respiratory impairment
Severe cardiac disorder
Severe hypertension
Uncontrolled hypertension

Advise ability to drive/operate machinery may be affected by side effects
Avoid local anaesthetics if inflammation in region of proposed injection
Resuscitation facilities must be immediately available

Great caution must be exercised to avoid intravascular administration as this may cause the rapid onset of toxicity with marked restlessness, twitching or convulsions. These symptoms may be followed by coma with apnoea and cardiovascular collapse.

Pregnancy and Lactation

Pregnancy

Use prilocaine with felypressin with caution in pregnancy.

Prilocaine with felypressin should not be administered during early pregnancy unless the benefits are expected to outweigh the risks.

There is no evidence of harm to the foetus, but as with all drugs benefit and risk should be evaluated prior to administration during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Prilocaine with felypressin is considered safe for use in breastfeeding.

Prilocaine enters breast milk, but at recommended doses (i.e. a single dose of prilocaine injected during dental procedure) it is unlikely to adversely affect the breastfed infant. However, an alternative drug may be preferred, especially while nursing a newborn or preterm infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactoid reaction
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular effects
CNS effects
Convulsions
Cutaneous lesions
Cyanosis
Dizziness
Drowsiness
Hypertension
Hypotension
Methaemoglobinaemia
Myocardial depression
Nervousness
Oedema
Respiratory arrest
Tremor
Unconsciousness
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2014

Reference Sources

Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 9 September 2014.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on 9 September 2014.

Summary of Product Characteristics for Citanest 3% with Octapressin Dental. Dentsply Ltd. Revised December 2011.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Prilocaine. Last revised: 7 September 2013.
Last accessed: 9 September 2014.