Adult Dosing
Infiltration or Nerve Block Anesthesia
- Initial dose: 1 to 2 mL will usually produce adequate infiltration or major nerve block anesthesia
- Maximum recommended dose to be administered within a 2-hour period
- Patients <150 lbs (<70 kg): Do not administer more than 4 mg/lb (8 mg/kg) as a single injection
- Patients
150 lbs (70 kg): Do not administer more than 600 mg (15 mL) or 8 cartridges as a single injection
Notes:- Mostly used for short procedures in the maxillary anterior teeth
- Aspiration prior to injection is recommended to reduce the possibility of intravascular injection, which also helps to minimize the incidence of side effects and anesthetic failure
- Discard any unused portion of the cartridge
Pediatric Dosing
Infiltration or Nerve Block Anesthesia
Children <10 yrs
- Rarely necessary to administer >40 mg injection to achieve local anesthesia for a procedure involving a single tooth
- Maximum recommended dose, in children having a normal lean body mass and normal body development, is determined using one of the standard pediatric drug formulas (e.g., Clark’s rule)
Children >10 yrs
- Initial dose: 1 to 2 mL will usually produce adequate infiltration or major nerve block anesthesia
- Maximum recommended dose to be administered within a 2-hour period
- Patients <150 lbs (<70 kg): Do not administer more than 4 mg/lb (8 mg/kg) as a single injection
- Patients 150 lbs (70 kg): Do not administer more than 600 mg (15 mL) or 8 cartridges as a single injection
Notes:- Aspiration prior to injection is recommended to reduce the possibility of intravascular injection, which also helps to minimize the incidence of side effects and anesthetic failure
- Discard any unused portion of the cartridge
[Outline]
See Supplemental Patient Information
- Emergencies may arise during therapy. Hence, dental practitioners who employ local anesthetics should be well trained in diagnosis and management of such emergencies. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use
- To reduce the risk of intravascular injection, perform aspiration before administering the local anesthetic solution. If blood is aspirated, reposition the needle until no return of blood can be elicited by aspiration. However, absence of blood in the syringe does not assure that intravascular injection will be avoided
- Increased risk of methemoglobinemia has been associated with prilocaine. Very young patients, patients with congenital or idiopathic methemoglobinemia, or patients with glucose-6-phosphate deficiencies are more susceptible to this risk
- Patients receiving drugs associated with drug-induced methemoglobinemia such as acetaminophen, aniline dyes, acetanilid, benzocaine, chloroquine, dapsone, naphthalene, nitrates and nitrites, nitroglycerin, nitroprusside, para-aminosalicylic acid, phenacetin, phenobarbital, phenytoin, pamaquine, primaquine, sulfonamides, and quinine are also at greater risk for developing methemoglobinemia
- Use the lowest dosage that results in effective anesthesia to avoid high plasma levels and serious adverse effects. Repeated doses of prilocaine may cause significant increases in blood levels because of slow accumulation of the drug or its metabolites; tolerance to elevated blood levels varies with the individual patient status. Lower dosage is recommended in debilitated, elderly patients, acutely ill patients, and children. Caution should be advised in patients with severe shock or heart block
- Caution should be advised while administering local anesthetic injections containing vasoconstrictor in areas of the body supplied by end arteries or having compromised blood supply. There is a risk of exaggerated vasoconstrictor response in patients with peripheral vascular disease and those with hypertension; ischemic injury or necrosis may result
- Caution should be exercised while administering preparations containing vasoconstrictor in patients during or following the administration of potent general anesthetic agents due to risk of cardiac arrhythmias
- Monitor cardiovascular and respiratory (adequacy of ventilation) vital signs and the state of consciousness after each local anesthetic injection
- Consider the possibility of CNS toxicity when restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness occur
- If the patient is in an upright position, signs and symptoms of depressed cardiovascular function may occur from a vasovagal reaction
- It is recommended to maintain a standard protocol for the management of malignant hyperthermia as many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia. There may be early unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis prior to temperature elevation
- Use in head and neck area may produce adverse reactions similar to systemic toxicity seen with unintentional intravascular injections of larger doses; caution advised
Cautions: Use cautiously in
- Hepatic disease
- Impaired cardiovascular function
- Known drug sensitivity
Supplemental Patient Information
- Inform patients regarding the possibility of temporary loss of sensation and muscle function following infiltration or nerve block injections
- Advise patients to exert caution to avoid inadvertent trauma to the lips, tongue, cheek mucosae or soft palate when these structures are anesthetized; instruct patients to postpone food ingestion until normal function returns
- Instruct patients to promptly consult the dentist if anesthesia persists, or if a rash develops
Pregnancy Category:B
Breastfeeding: No data available on the use of prilocaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk, a single dose of prilocaine injected during breastfeeding is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/ht mlgen?LACT last accessed 18 July 2011). As per manufacturer's information, it is not known whether prilocaine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised while administering this drug to a nursing woman.
