mepivacaine (Rx)

Brand and Other Names:Carbocaine, Polocaine, more...Polocaine-MPF
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1%
  • 1.5%
  • 2%
  • 3%

Infiltration Anesthesia

Up to 400 mg (80 mL of 0.5% or 40 mL of 1% solution)

Cervical/Brachial/Intercostal or Pudendal Block

50-400 mg (5-40 mL) of 1% or 100-400 mg (5-20 mL) 2% solution; for pudental block inject one half total dose each side; not to exceed 400 mg

Transvaginal Block

Up to 300 mg (30 mL of 1% solution); inject one half total dose each side; not to exceed 300 mg

Paracervical Block

Up to 200 mg (20 mL of 1% solution); inject one half total dose each side; not to exceed 200 mg

Postherpetic Neuropathy (Orphan)

Orphan indication sponsor

  • Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212

HIV-Associated Neuropathy (Orphan)

Orphan indication sponsor

  • Cinergen, LLC; 146 Medinah Drive; Blue Bell, PA 19422-3212

Administration

Usually no more than 400 mg/dose; doses up to 550 mg has been used but rare & given no more frequently than q1.5hr; no more than 1000 mg in 24 hours

Use preservative-free preparations for spinal or epidural anesthesia

Dosage Forms & Strengths

injectable solution

  • 1%
  • 1.5%
  • 2%
  • 3%

Administration

< 3 years or <13.6 kg: Not to exceed 5-6 mg/kg/dose; administer < 2% concentration solution only  

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Interactions

Interaction Checker

and mepivacaine

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Systemic dose-related toxicity

            • Underventilation/apnea ("Total or High Spinal"),
            • Hypotension
            • Acidosis
            • Systemic diseases which alter protein production/competition of other drugs for protein binding sites

            Angioneurotic edema (including laryngeal edema), syncope, depression of the myocardium, decreased cardiac output, heart block, hypotension (or sometimes hypertension), bradycardia, ventricular arrhythmias, and possibly cardiac arrest

            Excitation and/or depression, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors (possible convulsions), chills, constriction of the pupils, elevated temperature, paralysis of the of consciousness, persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities/sphincter control, headache, septic meningitis, meningismus, cranial nerve palsies due to traction on nerves from of cerebrospinal fluid

            Urticaria, pruritus, erythema, excessive sweating

            Nausea, vomiting

            Backache

            Urinary retention, fecal/urinary incontinence

            Sneezing, respiratory paralysis (secondary to spinal block)

            Loss of perineal sensation and sexual function

            Anaphylactoid-like symptomatology (including severe hypotension)

            Slowing of labor; increased incidence of forceps delivery

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            Warnings

            Contraindications

            Hypersensitivity to mepivacaine or amide anesthetics, sensitivity to parabens

            Cautions

            Some formulations may contain sulfites

            History of malignant hyperthermia

            Monitor patient's state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity

            DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear)

            Respiratory arrest reported with use

            Unintentional intravascular injection may result in seizures

            Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

            Risk of chondrolysis if receiving continuous intra-articular infusion following arthroscopic or other surgical procedures

            Methemoglobinemia

            • Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
            • Advise patients or caregivers to seek immediate medical attention if patient experiences the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue drug and any other oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Not known if excreted in breast milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold

            Pharmacokinetics

            Half-life: 1.9-3.0 hr (adults); 8.7-9 hr (neonates)

            Duration: 2-2.5 hr (route and dose dependent)

            Onset: 3-20 min

            Protein Bound: 75%

            Metabolism: Liver

            Metabolites: Two phenols, which are excreted almost exclusively as their glucuronide conjugates, and the N-demethylated compound (2',6'-pipecoloxylidide)

            Excretion: Urine (90%)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.