articaine and epinephrine

Generic Name: articaine and epinephrine (AR ti kane and EP i NEF rin)
Brand Name: Septocaine

What is articaine and epinephrine?

Articaine and epinephrine are anesthetics (numbing medicines). They work by blocking nerve signals in your body.

Articaine and epinephrine is a combination medicine used to numb your mouth for a dental procedure.

Articaine and epinephrine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about articaine and epinephrine?

You should not receive articaine and epinephrine if you have ever had an allergic reaction to any type of numbing medicine.

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What should I discuss with my health care provider before receiving articaine and epinephrine?

You should not receive this medicine if you are allergic to any type of numbing medicine.

To make sure articaine and epinephrine is safe for you, tell your doctor if you have:

  • a heart rhythm disorder;

  • low or high blood pressure;

  • asthma or a sulfite allergy; or

  • a history of seizures.

FDA pregnancy category C. It is not known whether articaine and epinephrine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether articaine and epinephrine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How is articaine and epinephrine given?

Articaine and epinephrine is given as an injection that is usually placed into the gum area inside your mouth. You will receive this injection in a dentist's office or oral surgical setting.

What happens if I miss a dose?

Since articaine and epinephrine is given as needed before a dental procedure, you are not likely to be on a dosing schedule.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include extreme drowsiness, fainting, seizure (convulsions), shallow breathing, or slow heart rate.

What should I avoid after receiving articaine and epinephrine?

This medication can cause numbness for an extended period of time. Avoid eating, chewing gum, or drinking hot liquids until the feeling in your mouth has returned completely. Chewing while your mouth is numb could result in a bite injury to your tongue, lips, or inside of your cheek.

Articaine and epinephrine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling or puffiness of your face, lips, tongue, or throat.

Tell your caregivers right away if you have:

  • weak or shallow breathing;

  • a slow heart rate;

  • a light-headed feeling, like you might pass out;

  • blurred vision, ringing in your ears; or

  • anxiety, confusion, restless feeling, or tremors.

Call your doctor or dentist at once if you have any swelling, pain, or heavy bleeding after your procedure.

Common side effects may include:

  • tongue pain or swelling, red or swollen gums;

  • mild swelling in your face;

  • headache; or

  • numbness and tingling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Articaine and epinephrine dosing information

Usual Adult Dose for Anesthesia:

Below are the recommended volumes and concentrations of articaine-epinephrine for various types of anesthetic procedures. The dosages suggested below are for normal healthy adults, administered by submucosal infiltration and/or nerve block.

Infiltration: 0.5 mL to 2.5 mL or 20 mg to 100 mg of articaine
Nerve block: 0.5 mL to 3.4 mL or 20 mg to 136 mg of articaine
Oral surgery: 1.0 mL to 5.1 mL or 40 mg to 204 mg of articaine

For most routine dental procedures articaine-epinephrine 1:200,000 is preferred. However, when more pronounced hemostasis is required, articaine-epinephrine 1:100,000 may be used.

The above suggested volumes serve only as a guide. Other volumes may be used provided the total maximum recommended dose is not exceeded. The recommended doses above also serve only as a guide to the amount of anesthetic required for most routine procedures. The actual volumes to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia, degree of muscular relaxation, and condition of the patient. In all cases, the smallest dose that will produce the desired result should be given.

For normal healthy adults, the maximum dose of articaine administered by submucosal infiltration and/or nerve block should not exceed 7 mg/kg (0.175 mL/kg) or 3.2 mg/lb (0.0795 mL/lb) of body weight, e.g. 7 cartridges (11.9 mL) for a 150 lb. patient.

Usual Geriatric Dose for Anesthesia:

In clinical trials, 54 patients between the ages of 65 and 75 years, and 11 patients 75 years and over received articaine-epinephrine 1:100,000. Among all patients between 65 and 75 years, doses from 0.43 mg/kg to 4.76 mg/kg (0.9 to 11.9 mL) were administered safely to 35 patients for simple procedures and doses from 1.05 mg/kg to 4.27 mg/kg (1.3 to 6.8 mL) were administered safely to 19 patients for complex procedures. Among the 11 patients 75 years and over, doses from 0.78 mg/kg to 4.76 mg/kg (1.3 to 11.9 mL) were administered safely to 7 patients for simple procedures and doses of 1.12 mg/kg to 2.17 mg/kg (1.3 to 5.1 mL) were safely administered to 4 patients for complex procedures.

No overall differences in safety or effectiveness were observed between elderly subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

Approximately 6% of patients between the ages of 65 and 75 years and none of the 11 patients 75 years of age or older required additional injections of anesthetic for complete anesthesia compared with 11% of patients between 17 and 65 years old who required additional injections.

Usual Pediatric Dose for Anesthesia:

4 to 10 years of age:
The quantity to be injected should be determined by the age and weight of the child and the magnitude of the operation.

For children of less than 10 years who have a normal lean body mass and normal body development, the maximum dose may be determined by the application of one of the standard pediatric drug formulas. In any case, the maximum dose of 4% articaine should not exceed the equivalent of 7 mg/kg (0.175 mL/kg) or 3.2 mg/lb (0.0795 mL/lb) of body weight.

4 to 16 years of age:
In clinical trials, 61 pediatric patients between the ages of 4 and 16 years received articaine-epinephrine 1:100,000. Among these pediatric patients, doses from 0.76 mg/kg to 5.65 mg/kg (0.9 to 5.1 mL) were administered safely to 51 patients for simple procedures and doses between 0.37 mg/kg and 7.48 mg/kg (0.7 to 3.9 mL) were administered safely to 10 patients for complex procedures. However, there was insufficient exposure to articaine-epinephrine 1:100,000 at doses greater than 7 mg/kg in order to assess its safety in pediatric patients. No unusual adverse events were noted in these patients.

Approximately 13% of these pediatric patients required additional injections of anesthetic for complete anesthesia. Safety and effectiveness in pediatric patients below the age of 4 years have not been established.

What other drugs will affect articaine and epinephrine?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with articaine and epinephrine, especially:

  • an antidepressant--amitriptylline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine;

  • antipsychotic medication--chlorpromazine, droperidol, fluphenazine, haloperidol, perphenazine; or

  • an MAO inhibitor--isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

This list is not complete. Other drugs may interact with articaine and epinephrine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your dentist or pharmacist can provide more information about articaine and epinephrine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.01. Revision Date: 2014-09-17, 8:28:08 PM.

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