Dosing and uses of Citanest (prilocaine)
Adult dosage forms and strengths
injectable solution (cartridge for dental use)
- 4%
- 4% with epinephrine 1:200,000
Local Anesthesia
Dental infiltration: 40-80 mg (1-2 mL) of 4% solution
Not to exceed 600 mg (8 mg/kg) within 2 hr
See also combo with lidocaine
Other Indications & Uses
Infiltrative or nerve block anesthesia for dental procedures
Pediatric dosage forms and strengths
injectable solution (cartridge for dental use)
- 4%
- 4% with epinephrine 1:200,000
Local Anesthesia
Dental infiltration: 40 mg of (1 mL) 4% solution
Not to exceed 8 mg/kg within 2 hr
Citanest (prilocaine) adverse (side) effects
Frequency not defined
Anxiety
Apprehension
Restlessness
Nervousness
Disorientation
Confusion
Dizziness
Blurred vision
Tremors
Twitching
Shivering
Seizures
CNS depression manifested by drowsiness, unconsciousness, respiratory arrest, nausea, vomiting, chills, miosis, tinnitus; myocardial depression, bradycardia, cardiac arrhythmias, hypotension, cardiovascular collapse, cardiac arrest; anxiety, palpitation, dizziness, headache, restlessness, tremors, tachycardia, anginal pain, hypertension (epinephrine-containing solutions)
Edema
Status asthmaticus
Anaphylactoid reactions (sometimes fatal)
Warnings
Contraindications
Hypersensitivity to prilocaine, amide-type local anesthetics, sulfites, parabens
Methemoglobinemia
Cautions
Administration of >600 mg to adults causes non-acute 15% methemoglobinemia via formation of o-toluidine metabolite
Use preservative-free preparations for spinal or epidural anesthesia
DO NOT use solutions with epinephrine in distal areas of body (e.g. digit, nose, ear, etc)
History of malignant hyperthermia
Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Citanest (prilocaine)
Mechanism of action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold
Absorption
Duration: the greater the degree of vasodilation produced by the local anesthetic, the faster the rate of absorption & shorter the duration of action (bupivacaine has a long duration of action)
Distribution
Protein bound: highly
Metabolism
Metabolism: liver
Metabolites: ester- & amide-type local anesthetics
Elimination
Excretion: urine (principally)
