Citanest

Name: Citanest

Citanest Dosage and Administration

General

  • Determine dosage based on anesthetic procedure, depth of anesthesia, area to be anesthetized, vascularity of oral tissues, physical condition of the patient, and individual patient response.a c Use smallest dose required to produce the desired effect.a

Administration

Injection

Administer by infiltration or by nerve block.a

Consult specialized references for specific techniques and procedures of administration.a b

Aspirate prior to administration to guard against intravascular injection.c

For maxillary infiltration for short procedures that can be completed within 15 minutes (e.g., procedures involving maxillary anterior teeth), use prilocaine hydrochloride 4% solution without epinephrine.c For long procedures or those involving maxillary posterior teeth, use prilocaine hydrochloride 4% solution with epinephrine 1:200,000.c

For inferior alveolar block, may use prilocaine hydrochloride alone or in fixed combination with epinephrine; no practical clinical differences between these preparations.c

For chemical disinfection of the cartridge unit, use isopropyl (rubbing) alcohol (91%) or ethyl alcohol (70%).c Do not use brands that are not of USP grade, since these preparations may contain denaturants that may be injurious to rubber.c Because certain metallic ions (e.g., mercury, zinc, copper) have been associated with swelling and edema following local anesthesia, do not use chemical disinfectants containing or releasing these ions.c Do not autoclave because solutions of epinephrine and the closures employed in cartridges cannot withstand autoclaving temperatures and pressures.c

Dosage

Available as prilocaine hydrochloride and as fixed combination containing prilocaine hydrochloride and epinephrine bitartrate.c Dosage expressed in terms of prilocaine hydrochloride.c

Pediatric Patients

Dental Anesthesia Infiltration, Nerve Block

Children <10 years of age: 40 mg (1 mL) of prilocaine hydrochloride 4% solution (with or without epinephrine) is adequate for a procedure involving 1 tooth, 2–3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).a c

Adults

Dental Anesthesia Infiltration, Nerve Block

Initially, 40–80 mg (1–2 mL) of prilocaine hydrochloride 4% solution (with or without epinephrine) usually provides adequate infiltration or major nerve block anesthesia for most routine procedures.a c (See Prescribing Limits under Dosage and Administration.)

Prescribing Limits

Pediatric Patients

Dental Anesthesia Infiltration, Nerve Block

For children <10 years of age with normal lean body mass and normal development, maximum dose is determined using standard pediatric drug formulas (e.g., Clark’s rule).a For example, dosage for a 5-year old child weighing 50 lbs should not exceed 150–200 mg (6.6–8.8 mg/kg or 3–4 mg/lb).c

Adults

Dental Anesthesia Infiltration, Nerve Block

Patients weighing <70 kg: Maximum 8 mg/kg within a 2-hour period.c

Patients weighing ≥70 kg: Maximum 600 mg (15 mL) or 8 cartridges per injection and within a 2-hour period.c

Special Populations

Hepatic Impairment

Reduce dosage in patients with hepatic disease.b

Geriatric Patients

Reduce dosage based on age and physical status.b c

Other Populations

Reduce dosage in debilitated or acutely ill patients and in patients with arteriosclerosis or occlusive arterial disease.b c

Stability

Storage

Parenteral

Injection

Room temperature (approximately 25°C).c If preparation contains epinephrine, protect from light.c Discard unused portion.c

(web3)