Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (1)
- bupivacaine liposome
mepivacaine increases toxicity of bupivacaine liposome by Other (see comment). Contraindicated. Comment: Do not admix with other local nonbupivacaine-based local anesthetics; admixing results in a rapid increase in free (unencapsulated) bupivacaine.
Serious - Use Alternative (1)
- bupivacaine implant
mepivacaine, bupivacaine implant. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid additional local anesthetic administration within 96 hr following bupivacaine implantation. If use of additional local anesthetics is unavoidable based on clinical need, monitor for neurologic and cardiovascular effects related to local anesthetic systemic toxicity.
mepivacaine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
Monitor Closely (4)
- nadolol
nadolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- pindolol
pindolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- propranolol
propranolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- timolol
timolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
Minor (1)
- hyaluronidase
hyaluronidase, mepivacaine. Other (see comment). Minor/Significance Unknown. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.
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
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
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.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%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Polocaine injection - | 1 % (10 mg/mL) vial |  | |
| Carbocaine injection - | 2 % vial |  | |
| Carbocaine injection - | 1 % (10 mg/mL) vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
mepivacaine injection
NO MONOGRAPH AVAILABLE AT THIS TIME
USES: Consult your pharmacist.
HOW TO USE: Consult your pharmacist.
SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Consult your pharmacist.
DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: No monograph available at this time.
MISSED DOSE: Consult your pharmacist.
STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.
Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
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