l CONTRA-INDICATIONS Use in child less than 37 weeks
FORTACIN ® Acquired methaemoglobinaemia . anaemia . congenital methaemoglobinaemia
l INTERACTIONS → Appendix 1: anaesthetics, local . antiarrhythmics
▶ Common or very common Sexual dysfunction (in adults)
▶ Uncommon Fever (in adults). headache (in adults). penis
▶ Rare or very rare Methaemoglobinaemia . skin reactions
SIDE-EFFECTS, FURTHER INFORMATION When applied to
the glans penis, side-effects for sexual partners should be
considered. Side-effects reported in female partners
include vaginal candidiasis and dysuria.
l CONCEPTION AND CONTRACEPTION
FORTACIN ® Deterioration of polyurethane-based female
and male condoms has been observed. Manufacturer
advises avoid in patients planning to conceive, or if it is
essential to achieve penetration, then the glans penis
should be washed thoroughly 5 minutes after application
FORTACIN ® Manufacturer advises preferably avoid unless
an effective male barrier contraceptive is used—limited
FORTACIN ® Manufacturer advises caution in severe
impairment (no information available).
l DIRECTIONS FOR ADMINISTRATION
FORTACIN ® Manufacturer advises when using the spray
for the first time, shake and prime the unit with 3 sprays,
and before each subsequent use, shake and prime the unit
Medicines for Children leaflet: EMLA cream for local anaesthesia
www.medicinesforchildren.org.uk/emla-cream-localanaesthesia
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Lidocaine 25 mg per 1 gram, Prilocaine 25 mg per 1 gram Denela
5% cream | 5 gram p £2.84–£3.29 | 25 gram p £12.99 | 30 gram p £14.75 DT = £12.30
▶ Emla (Aspen Pharma Trading Ltd)
Lidocaine 25 mg per 1 gram, Prilocaine 25 mg per 1 gram Emla
5% cream | 5 gram p £2.25–£2.99 | 25 gram p £11.70 | 30 gram p £12.30 DT = £12.30
▶ Nulbia (Glenmark Pharmaceuticals Europe Ltd)
Lidocaine 25 mg per 1 gram, Prilocaine 25 mg per 1 gram Nulbia
5% cream | 5 gram p £1.58 | 25 gram p £7.88 | 30 gram p
▶ Fortacin (Recordati Pharmaceuticals Ltd)
Prilocaine 50 mg per 1 ml, Lidocaine 150 mg per 1 ml Fortacin
150mg/ml / 50mg/ml cutaneous spray | 5 ml P £59.99
Mepivacaine hydrochloride 05-Aug-2018
Infiltration anaesthesia and nerve block in dentistry
▶ Child 3–17 years: Consult expert dental sources
▶ Adult: Consult expert dental sources
DOSES AT EXTREMES OF BODY-WEIGHT
▶ To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
l CONTRA-INDICATIONS Application to the middle ear (can
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block). should not be applied
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Injection site Local anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
l CAUTIONS Cardiovascular disease . children (consider dose
respiratory function . myasthenia gravis . shock
l INTERACTIONS → Appendix 1: anaesthetics, local
SIDE-EFFECTS, FURTHER INFORMATION Toxic effects after
administration of local anaesthetics are a result of
excessively high plasma concentrations; severe toxicity
usually results from inadvertent intravascular injection or
too rapid injection. The systemic toxicity of local
anaesthetics mainly involves the central nervous and
cardiovascular systems. The onset of toxicity can be
unpredictable and delayed. Monitor as per local protocol
for at least 30 minutes after administration.
l ALLERGY AND CROSS-SENSITIVITY
▶ Hypersensitivity and cross-sensitivity Hypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
l PREGNANCY Use with caution in early pregnancy.
l BREAST FEEDING Use with caution.
l HEPATIC IMPAIRMENT Manufacturer advises caution;
increased risk of toxic plasma concentrations in severe
l RENAL IMPAIRMENT Use with caution; increased risk of
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Scandonest plain (Septodont Ltd)
Mepivacaine hydrochloride 30 mg per 1 ml Scandonest plain 3%
solution for injection 2.2ml cartridges | 50 cartridge P £21.95
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, mepivacaine hydrochloride p. 1355,
adrenaline/epinephrine p. 222.
Infiltration anaesthesia and nerve block in dentistry
▶ Adult: (consult product literature)
Adrenaline/epinephrine must be used in a low
concentration when administered with a local
anaesthetic. The total dose of adrenaline should not
exceed 500 micrograms and it is essential not to exceed a
concentration of 1 in 200 000 (5 micrograms/mL) if more
than 50 mL of the mixture is to be injected.
l INTERACTIONS → Appendix 1: anaesthetics, local . sympathomimetics, vasoconstrictor
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Sulfites
▶ Scandonest special (Septodont Ltd)
Adrenaline 10 microgram per 1 ml, Mepivacaine hydrochloride
20 mg per 1 ml Scandonest special 2% solution for injection 2.2ml
cartridges | 50 cartridge P £21.95
DOSES AT EXTREMES OF BODY-WEIGHT
To avoid excessive dosage in obese patients, dose should
be calculated on the basis of ideal body-weight.
Infiltration anaesthesia | Nerve block
▶ Adult: 100–200 mg/minute, alternatively may be given
in incremental doses; dose adjusted according to site of
administration and response, and in elderly and
debilitated patients (smaller doses may be required);
▶ Adult: Usual dose 40–60 mg (max. per dose 80 mg),
dose may need to be reduced in elderly or debilitated
patients, or in late pregnancy
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
ototoxicity). avoid injection into infected tissues . avoid
containing preservatives should not be used for caudal,
epidural, or spinal block, or for intravenous regional
anaesthesia (Bier’s block). should not be applied to
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Injection site Local anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
l CAUTIONS Cardiovascular disease . debilitated patients
(consider dose reduction). elderly (consider dose
reduction). epilepsy . hypovolaemia . impaired cardiac
conduction . impaired respiratory function . myasthenia
gravis . severe or untreated hypertension . shock
l INTERACTIONS → Appendix 1: anaesthetics, local
▶ Rare or very rare Cardiac arrest. methaemoglobinaemia . nerve disorders
▶ Frequency not known Diplopia .respiratory depression
SIDE-EFFECTS, FURTHER INFORMATION Toxic effects Toxic
effects after administration of local anaesthetics are a
result of excessively high plasma concentrations; severe
toxicity usually results from inadvertent intravascular
injection or too rapid injection. The systemic toxicity of
local anaesthetics mainly involves the central nervous and
cardiovascular systems. The onset of toxicity can be
unpredictable and delayed. Monitor as per local protocol
for at least 30 minutes after administration.
Methaemoglobinaemia Methaemoglobinaemia can be
treated with an intravenous injection of methylthioninium
l ALLERGY AND CROSS-SENSITIVITY
▶ Hypersensitivity and cross-sensitivity Hypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
l PREGNANCY Large doses during delivery can cause
neonatal respiratory depression, hypotonia, and
bradycardia after epidural block. Avoid paracervical or
pudendal block in obstetrics (neonatal
methaemoglobinaemia reported).
Dose adjustments Use lower doses for intrathecal use
l BREAST FEEDING Present in milk but not known to be
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments ▶ With intrathecal use Manufacturer
advises consider dose reduction.
l RENAL IMPAIRMENT Use with caution.
Dose adjustments Lower doses may be required for
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
▶ With intrathecal use The Scottish Medicines Consortium has
advised (December 2010) that prilocaine 2% hyperbaric
solution for injection (Prilotekal ®) is accepted for
restricted use within NHS Scotland for use in spinal
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