Mepivacaine

CARBOCAINE

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Mepivacaine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Mepivacaine ballicule

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.

Mepivacaine molecular structure (skeletal formula) — Molecular structure: Mepivacaine

FDA-approved for

local/regional anesthesia (1960)

FDA label

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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.

Instructions

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.

Available strengths

inj 10, 15, 20, 30 mg/mL

Contraindications

Known hypersensitivity to amide-type local anesthetics

Cautions

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.

Adverse reactions

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.

Cost

Mepivacaine (CARBOCAINE)

Strength		#/mo	CostPlus
10 mg/mL	inj	per unit	not offered
15 mg/mL	inj	per unit	not offered
20 mg/mL	inj	per unit	not offered
30 mg/mL	inj	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Mepivacaine is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskAvoided in obstetric anesthesia

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk3 / 4

Defining liabilitySystemic local-anesthetic seizures and cardiovascular collapse

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