Pronunciation:

(me PIV a kane)

U.S. Brand Names:

Generic Available:

Canadian Brand Names:

Use - Dental:

Pregnancy Risk Factor:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

Cardiovascular: Myocardial effects include a decrease in contraction force as well as a decrease in electrical excitability and myocardial conduction rate resulting in bradycardia and reduction in cardiac output

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.

Gastrointestinal: Nausea and vomiting may occur

Hypersensitivity reactions: May manifest as dermatologic reactions and edema at injection site. Asthmatic syndromes have occurred.

Neuromuscular & skeletal: Tremors

Psychogenic reactions: It is common to misinterpret psychogenic responses to local anesthetic injection as an allergic reaction. Intraoral injection is perceived by many patients as a stressful procedure in dentistry. Common symptoms to this stress are diaphoresis, palpitation, hyperventilation, generalized pallor and a fainting feeling.

Drug Interactions:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Upper jaw: 30-120 seconds; Lower jaw: 1-4 minutes

Duration: Upper jaw: 20 minutes; Lower jaw: 40 minutes

Half-life elimination, serum: 1.9 hours

Dosage:

Children <10 years: Up to 5-6 mg/kg of body weight; maximum pediatric dosage must be carefully calculated on the basis of patient's weight but must not exceed 270 mg (9 mL) of the 3% solution

Children >10 years and Adults:

Dental anesthesia, single site in upper or lower jaw: 54 mg (1.8 mL) as a 3% solution

Infiltration and nerve block of entire oral cavity: 270 mg (9 mL) as a 3% solution; up to a maximum of 6.6 mg/kg of body weight but not to exceed 300 mg per appointment. Manufacturer's maximum recommended dose is not more than 400 mg to normal healthy adults. The effective anesthetic dose varies with procedure, intensity of anesthesia needed, duration of anesthesia required, and physical condition of the patient. Always use the lowest effective dose along with careful aspiration.

The following number of dental carpules (1.8 mL) provide the indicated amounts of mepivacaine dental anesthetic 3%. See table.

Note::

Note: Adult and children doses of mepivacaine dental anesthetic cited from USP Dispensing Information (USP DI), 17th ed, The United States Pharmacopeial Convention, Inc, Rockville, MD, 1997, 138-9.

Dental Health: Effects on Dental Treatment:

Degree of adverse effects in the CNS and cardiovascular system is directly related to the blood levels of mepivacaine.

Frequency not defined: Bradycardia and reduction in cardiac output, nausea, vomiting, tremors, asthmatic syndromes, hypersensitivity reactions (may manifest as dermatologic reactions and edema at injection site)

High blood levels: Anxiety, restlessness, disorientation, confusion, dizziness, tremors 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:

Dosage Forms:

International Brand Names: