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Pronunciation:

(me PIV a kane)

U.S. Brand Names:

Carbocaine®; Polocaine®; Polocaine® MPF

Synonyms:

Mepivacaine Hydrochloride

Generic Available:

Canadian Brand Names:

Carbocaine®; Polocaine®

Use:

Not for use in spinal anesthesia

Use - Dental:

Local anesthesia by nerve block, infiltration in dental procedures

Pregnancy Risk Factor:

Lactation:

Excretion in breast milk unknown/compatible

Contraindications:

Hypersensitivity to mepivacaine, any component of the formulation, or other amide anesthetics; allergy to sodium bisulfate

Warnings/Precautions:

Use with caution in patients with cardiac disease, renal disease, and hyperthyroidism; convulsions due to systemic toxicity leading to cardiac arrest have been reported presumably due to intravascular injection

Adverse Reactions:

Degree of adverse effects in the CNS and cardiovascular system is directly related to the blood levels of mepivacaine. The effects below are more likely to occur after systemic administration rather than infiltration.

Cardiovascular: Bradycardia, cardiovascular collapse, edema, heart block, hypotension, myocardial depression, ventricular arrhythmia, angioneurotic edema

Central nervous system: High blood levels result in anxiety, restlessness, disorientation, confusion, dizziness, and seizure. This is followed by depression of CNS resulting in somnolence, unconsciousness, and possible respiratory arrest. In some cases, symptoms of CNS stimulation may be absent and the primary CNS effects are somnolence and unconsciousness.

Dermatologic: Cutaneous lesions, urticaria

Gastrointestinal: Nausea, vomiting

Local: Transient stinging or burning at injection site

Ophthalmic: Blurred vision

Otic: Tinnitus

Respiratory: Respiratory arrest

Miscellaneous: Anaphylactoid reactions

Overdosage/Toxicology:

Symptoms of overdose include dizziness, cyanosis, tremor, and bronchial spasm. Treatment is symptomatic and supportive. Termination of anesthesia by pneumatic tourniquet inflation should be attempted when mepivacaine is administered by infiltration or regional injection.

Mechanism of Action:

Mepivacaine is an amino amide local anesthetic similar to lidocaine; like all local anesthetics, mepivacaine acts by preventing the generation and conduction of nerve impulses

Pharmacodynamics/Kinetics:

Onset of action: Epidural: 7-15 minutes

Duration: 2-2.5 hours; similar onset and duration following infiltration

Protein binding: 70% to 85%

Metabolism: Primarily hepatic via N-demethylation, hydroxylation, and glucuronidation

Half-life elimination: 1.9 hours

Excretion: Urine (95% as metabolites)

Dosage:

Children and Adults: Injectable local anesthetic: Varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient

Administration:

Before injecting, withdraw syringe plunger to ensure injection is not into vein or artery

Patient Education:

You will experience decreased sensation to pain, heat, or cold in the area and/or decreased muscle strength (depending on area of application) until effects wear off; use necessary caution to reduce incidence of possible injury until full sensation returns. Report irritation, pain, burning at injection site; chest pain or palpitations; or respiratory difficulty.

Oral injection: This will cause numbness of your mouth. Do not eat or drink for 1 hour after use. Take small sips of water at first to ensure that you can swallow without difficulty. Your tongue and/or mouth may be numb - use caution to avoid biting yourself. Report irritation, pain, burning at injection site; chest pain or palpitations; or respiratory difficulty.

Pregnancy precaution: Inform prescriber if you are pregnant.

Additional Information:

Peripheral nerve block, caudal/epidural, therapeutic block: 1% or 2% solution

Transvaginal, paracervical block: 1% solution

Infiltration: 0.5% to 1% solution

Dental procedures: Mepivacaine 3% or mepivacaine 2% solution with levonordefrin

Anesthesia and Critical Care Concerns/Other Considerations:

Peripheral nerve block, caudal/epidural, therapeutic block: 1% or 2% solution

Transvaginal, paracervical block: 1% solution

Infiltration: 0.5% to 1% solution

Dental procedures: Mepivacaine 3% or mepivacaine 2% solution with levonordefrin

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Degree of adverse effects in the CNS and cardiovascular system is directly related to blood levels of mepivacaine (frequency not defined; more likely to occur after systemic administration rather than infiltration): Bradycardia, cardiovascular collapse, hypotension, myocardial depression, ventricular arrhythmias, nausea, vomiting, respiratory arrest, anaphylactoid reactions, blurred vision, heart block, transient stinging or burning at injection site

High blood levels: Anxiety, restlessness, disorientation, confusion, dizziness, and seizures, followed by CNS depression resulting in somnolence, unconsciousness, and possible respiratory arrest.

In some cases, symptoms of CNS stimulation may be absent and the primary CNS effects are somnolence and unconsciousness.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May rarely cause anxiety, restlessness, confusion, drowsiness

Mental Health: Effects on Psychiatric Treatment:

None reported

Dosage Forms:

Injection, solution, as hydrochloride:

Carbocaine®: 1% (50 mL); 2% (50 mL)

Polocaine®: 1% (50 mL); 2% (50 mL)

Injection, solution, as hydrochloride [preservative free]:

Carbocaine®: 1% (30 mL); 1.5% (30 mL); 2% (20 mL)

Polocaine® MPF: 1% (30 mL); 1.5% (30 mL); 2% (20 mL)

International Brand Names:

Carbocaina® (IT); Carbocain® Dental (SE); Carbocain® (DK, NO, SE); Carbocaine® (AU, CA); Carbocaïne® (FR); Carbocaine® (ZA); Carboplyin Dental® (DK); Carbosen® (IT); Isogaine® (ES); Meaverin® (DE); Mecain® (DE); Mepibil® (IT); Mepicaton® (TH); Mepident® (IT); Mepidont® (PL); Mepiforan® (IT); Mepihexal® (DE); Mepimynol® (IT); Mepinaest purum® (AT); Mepisolver® (IT); Mepivacaina Angelini® (IT); Mepivacaina Braun® (ES); Mepivacaina Cabon® (IT); Mepivacaina Pulitzer® (IT); Mepivacaina Recordati® (IT); Mepivacain-HCl® (CH); Mepivacain-Injektopas® (DE); Mepivamol® (IT); Mepivastesin® (CZ, DE, PL, RO, YU); Mepivirgi® (IT); Molcain® (IT); Optocain® (IT, RO); Pericaina® (IT); Polocaine® (CA); Scandicain® (AT, CH, DE); Scandicaine® (BE, LU, NL); Scandinibsa® (ES, PT); Scandonest 3% Plaine® (RO); Scandonest 3% senza vasocostrittore® (IT); Scandonest® (AT, AU, CH, DK, NO, SI, ZA); Scandonest sans vasoconstricteur® (PL); Tevacaine® (IL)

References

Dodson WE, Hillman RE, and Hillman LS, "Brain Tissue Levels in a Fatal Case of Neonatal Mepivacaine (Carbocaine®) Poisoning,"J Pediatr, 1975, 86(4):624-7.

Torres MJ, Garcia JJ, del Cano Moratinos AM, et al, "Fixed Drug Eruption Induced by Mepivacaine,"J Allergy Clin Immunol, 1995, 96(1):130-1.

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