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Pronunciation: AR-ti-kane HYE-droe-KLOR-ide/EP-i-NEF-rin
Class: Local anesthetic, Vasoconstrictor
- Injection, solution articaine 4% with epinephrine 1:100,000 (0.018 mg/mL)
- Injection, solution articaine 4% with epinephrine 1:200,000 (0.009 mg/mL)
Stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.Epinephrine
Stimulates both alpha- and beta-receptors within sympathetic nervous system; relaxes smooth muscle of bronchi and iris and is an antagonist of histamine.
Indications and Usage
For local, infiltrative, or conductive anesthesia in both simple and complex dental procedures.
Hypersensitivity to products containing sulfites.
Dosage and AdministrationDental anesthesia
Submucosal infiltration/nerve block For infiltration, 0.5 to 2.5 mL (20 to 100 mg of articaine); for nerve block, 0.5 to 3.4 mL (20 to 136 mg of articaine); for oral surgery, 1 to 5.1 mL (40 to 204 mg of articaine). Max, 7 mg/kg (0.175 mL/kg) of articaine.Children 4 y and older
Submucosal infiltration/nerve block / The quantity of articaine should be determined by the age and weight of the child and the magnitude of the operation. For simple procedures, 0.76 to 5.65 mg/kg (0.9 to 5.1 mL) of articaine was administered safely to 51 patients. For complex procedures, 0.37 to 7.48 mg/kg (0.7 to 3.9 mL) of articaine was administered safely to 10 patients. Max, 7 mg/kg (0.175 mL/kg) of articaine.Elderly
Dose reduction may be required.
- For submucosal infiltration or nerve block.
- The smallest dose that will produce the desired result should be given.
- Caution should be exercised when employing large volumes because the incidence of adverse effects may be dose-related.
- For most routine dental procedures, articaine containing epinephrine 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field is required, articaine containing epinephrine 1:100,000 may be used.
- For chemical disinfection of the carpule, either isopropyl alcohol (91%) or ethyl alcohol (70%) is recommended. Many commercially available brands of isopropyl (rubbing) alcohol, as well as solutions of ethyl alcohol not of USP grade, contain denaturants that are injurious to rubber and therefore are not to be used.
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Store at 77°F, with brief excursions permitted between 59° and 86°F. Protect from light. Do not freeze.
Drug InteractionsButyrophenones (eg, haloperidol) and phenothiazines (eg, thioridazine)
The pressor effects of epinephrine, which is present in articaine intraoral injection, may be reduced or reversed. Concomitant use should generally be avoided. If concurrent use cannot be avoided, carefully monitor the patient.Monoamine oxidase inhibitors (eg, phenelzine), nonselective beta-adrenergic blockers (eg, propranolol), or tricyclic antidepressants (eg, amitriptyline)
Because articaine intraoral injection contains epinephrine, the risk of severe, prolonged hypertension may be increased. Concomitant use should generally be avoided. If concurrent use cannot be avoided, carefully monitor the patient.
Headache (5%); numbness and tingling, paresthesia, sleepiness (1%); hypoesthesia, persistent paresthesia of the lips, tongue, and oral tissues (postmarketing).
Ear symptoms (eg, earache, otitis media) (1%); paralysis of ocular muscles (eg, diplopia, mydriasis, ptosis, difficulty in abduction of the affected eyes) (postmarketing).
Nausea and emesis (2%); gingivitis (1%).
Ischemic injury and necrosis (postmarketing).
Pain (13%); swelling (3%); trismus (2%); cough, face edema, infection, palpitation (1%).
Constant and careful monitoring of CV and respiratory (adequacy of ventilation) vital signs and the patient's state of consciousness should be performed after each injection.
Category C .
Undetermined. Breast-feeding women may choose to pump and discard breast milk for approximately 4 hours following an injection of articaine and then resume breast-feeding.
Safety and effectiveness in pediatric patients younger than 4 years have not been established.
Give reduced doses to commensurate with their age and physical condition.
Use with caution in patients with severe hepatic disease.
Special Risk Patients
Use with caution in patients with heart block, impaired CV function, peripheral vascular disease, hypertensive vascular disease, or acute illness, and in debilitated patients.
Use caution in sulfite-sensitive patients.
Accidental intravascular injection may be associated with convulsions, followed by CNS or cardiorespiratory depression and coma, progressing to respiratory arrest. To avoid accidental intravascular administration, preform aspiration before injection.
May cause methemoglobinemia; do not use in patients with congenital or idiopathic methemoglobinemia or in patients who are receiving treatment with methemoglobin-inducing agents.
Small doses of local anesthetics injected in dental blocks may produce adverse reactions similar to systemic toxicity (eg, confusion, convulsions, respiratory depression, and/or respiratory arrest) seen with unintentional intravascular injections of larger doses.
Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.
May exhibit exaggerated vasoconstrictor response and ischemic injury or necrosis may result.
Convulsions, CV depression (eg, hypoxia, acidosis, bradycardia, arrhythmias, and/or cardiac arrest).
- Inform patients in advance of the possibility of temporary loss of sensation and muscle function.
- Instruct patients not to eat or drink until normal sensation returns.
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