Prilocaine Felypressin: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the local prescribing information.

Generic Medicine Info

Indications and Dosage

Injection
Dental infiltration and dental nerve block

Adult: As combination containing prilocaine hydrochloride 30 mg and felypressin 0.03 IU/ml: Usual dose: 1-5 ml, adjust according to response. Max: 10 ml.
Child: As combination containing prilocaine hydrochloride 30 mg and felypressin 0.03 IU/ml: <10 yr: 1-2 ml; 10-18 yr: 1-5 ml, max 10ml. Adjust dose according to response.
Elderly: Dose adjustments may be needed.

Contraindications

Hypersensitivity to local anaesthetics of amide type. Anaemia, congenital or acquired methaemoglobinaemia. Infants.

Special Precautions

Elderly, debilitated patients, liver or kidney impairment, epilepsy, severe or uncontrolled hypertension, impaired cardiac conduction or respiratory function, severe heart disease. Pregnancy and lactation. Avoid IV inj.

Adverse Reactions

Rarely, nervousness, dizziness, blurred vision, tremors, drowsiness, convulsions, unconsciousness, hypotension, myocardial depression, bradycardia. Dose related methaemoglobinaemia.
Potentially Fatal: Rarely, respiratory or cardiac arrest.

Overdosage

Symptoms: Methaemoglobinaemia, convulsions, respiratory and cardiac arrest. Management: Treatment is symptomatic and supportive. Convulsions may be treated by IV inj of thiopentone 100-200 mg or diazepam 5-10 mg. Methaemoglobinaemia may be treated by IV inj of 1% solution of methylene blue over a 5 minute period, at a dose of 1 mg/kg.

Drug Interactions

Increased risk of methaemoglobinaemia with sulfonamides. Additive toxic effects with other local anaesthetics, anti-arrhythmics or drugs structurally related to amide type anaesthetics.

Action

Description: Prilocaine, an amide-type local anaesthetic, acts by preventing impulse transmission along nerve fibres and nerve endings. Compared to lidocaine, it is less toxic with a slower onset of action and slightly longer duration of action. Felypressin, a synthetic analogue of vasopressin, is sometimes used in combination with prilocaine as a vasoconstrictor to reduce absorption and localise the effect of prilocaine.
Onset: 2-3 minutes (infiltration block)
Duration: 45 minutes (infiltration block), ≥2 hr (regional block e.g. mandibular block)
Pharmacokinetics:
Distribution: Prilocaine: Protein binding 55%, crosses placenta and distributes into breast milk.
Metabolism: Prilocaine: Rapidly metabolised in liver and kidneys by amidases. Elimination half life: 1.5 hr (after IV inj).
Excretion: Prilocaine: Excreted in urine mainly as metabolites e.g. o-toluidine.

Storage

Store below 25°C.

MIMS Class

Anaesthetics - Local & General

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