Pronunciation(me PIV a kane)
U.S. Brand NamesCarbocaine®; Polocaine®; Polocaine® MPF
SynonymsMepivacaine Hydrochloride
Generic AvailableNo
Canadian Brand NamesCarbocaine®; Polocaine®
UseNot for use in spinal anesthesia
Use - DentalLocal anesthesia by nerve block, infiltration in dental procedures
Pregnancy Risk FactorC
LactationExcretion in breast milk unknown/compatible
ContraindicationsHypersensitivity to mepivacaine, any component of the formulation, or other amide anesthetics; allergy to sodium bisulfate
Warnings/PrecautionsUse 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 ReactionsDegree 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/ToxicologySymptoms 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 ActionMepivacaine 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/KineticsOnset 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)
DosageChildren and Adults: Injectable local anesthetic: Varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient
AdministrationBefore injecting, withdraw syringe plunger to ensure injection is not into vein or artery
Patient EducationYou 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 InformationPeripheral 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 ConsiderationsPeripheral 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 TreatmentKey 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 siteHigh 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 PrecautionsNo information available to require special precautions
Mental Health: Effects on Mental StatusMay rarely cause anxiety, restlessness, confusion, drowsiness
Mental Health: Effects on Psychiatric TreatmentNone reported
Dosage FormsInjection, 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)
ReferencesDodson 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.
International Brand NamesCarbocaina® (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)
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