Mepivacaine

CARBOCAINE

What it isAmide sodium-channel-blocking local anesthetic; dental and regional anesthesia.

Why this oneLess vasodilation than lidocaine lets it provide useful dental anesthesia without epinephrine.

What limits itIts duration is shorter than bupivacaine’s; neonatal toxicity makes it unsuitable for obstetric anesthesia.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Dental infiltration / nerve block anesthesia	Adults	1 cartridge (1.7 mL = 34 mg of 2% or 51 mg of 3%) PRN per site	5.3 cartridges (180 mg of 2% or 270 mg of 3%) anesthetizes entire oral cavity	3 mg/lb body weight; total ≤400 mg per dental sitting (all sites combined)
Dental infiltration / nerve block anesthesia	Pediatric	1 cartridge (1.7 mL) PRN per site	Weight-based: 3 mg/lb (e.g. 40 lb = 120 mg; 60 lb = 180 mg)	Child's weight (lb) × 400 mg ÷ 150; and ≤5.3 cartridges per sitting (≤270 mg of 3%, ≤180 mg of 2%)

Renal Undefined

Hepatic Undefined

Total for ALL injected sites at a single dental sitting must not exceed 400 mg in adults.

Use the lowest dose producing effective anesthesia; dose varies with site, tissue vascularity, individual tolerance, and technique.
Inject slowly with frequent aspiration.
Inspect for particulate matter and discoloration before use; discard any unused portion of a cartridge.
Calculate maximum dose by weight whenever a larger dose seems needed for an extensive procedure; pediatric maximum must be carefully calculated.

Systemic CNS/cardiovascular toxicity from high plasma levels — excessive dose, rapid absorption, inadvertent intravascular injection, or slow metabolism.
Persistent paresthesia of lip/tongue/oral tissues reported, chiefly after mandibular nerve blocks (trigeminal nerve and branches), with slow, incomplete, or no recovery.
Vasovagal reaction is common in dental practice, especially seated patients — watch for sweating, faintness, pulse or sensorium change; place recumbent and give oxygen.
Great care with concentrations and doses in pedodontic administration.

CNS excitation then depression: nervousness, dizziness, blurred vision, tremors → drowsiness, convulsions, unconsciousness, respiratory arrest
Cardiovascular depression
Persistent oral paresthesia (lips, tongue)
Allergic reactions (rare): delayed cutaneous lesions, urticaria, edema; anaphylactoid reactions rarely
Localized puffiness and swelling

Pregnancy Category C — animal reproduction studies not conducted; use only if clearly needed.

Lactation Unknown whether excreted in human milk; use with caution in nursing women.

NO BOXED WARNINGS

Principal riskAvoided in obstetric anesthesia

Direct muscarinic antagonism0 / 4