Prilocaine

Prilocaine is a prescription medication used as local anesthesia during dental procedures. 

• Prilocaine is available under the following different brand names: Citanest

Common side effects of Prilocaine include:

• Swelling around the lips, and
• Numbness or tingling of the lips or mouth

Serious side effects of Prilocaine include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Rash,
• Itching,
• Red, swollen, blistered, or peeling skin with or without fever,
• Wheezing,
• Tightness in the chest or throat,
• Trouble swallowing or talking,
• Unusual hoarseness,
• Blue or gray color of the lips, nails, or skin,
• Fluttering in the chest,
• Seizures,
• Severe dizziness,
• Fainting,
• Severe headache,
• Drowsiness,
• Weakness,
• Tiredness,
• Shortness of breath,
• Fast breathing,
• Fast or slow heart rate,
• Stomach pain,
• Upset stomach,
• Vomiting,
• Burning, numbness, or tingling around the mouth,
• Lightheadedness,
• Confusion,
• Blurry vision,
• Sweating,
• Ringing in the ears,
• Depression,
• Nervousness,
• Anxiety,
• Shakiness,
• Twitching,
• Poor coordination,
• Restlessness,
• Excitement, and
• Feeling hot or cold

Rare side effects of Prilocaine include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out. 

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Injectable solution (cartridge for dental use)

• 4%
• 4% with epinephrine 1:200,000

Local Anesthesia

Adult dosage

• Dental infiltration: 40-80 mg (1-2 mL) of 4% solution prilocaine or prilocaine with epinephrine
• Not to exceed 600 mg (8 mg/kg) within 2 hours

Pediatric dosage

• Below 10 years
  • Dental infiltration: 40 mg of (1 mL) 4% solution; not to exceed 8 mg/kg within 2 hours  
• Above 10 years
  • Dental infiltration: 40-80 mg (1-2 mL) of 4% solution prilocaine or prilocaine with epinephrine; not to exceed 600 mg (8 mg/kg) within 2 hours

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Prilocaine has severe interactions with no other drugs.
• Prilocaine has serious interactions with the following drugs
  • bupivacaine implant
• Prilocaine has moderate interactions with the following drugs
  • nadolol
  • phenazopyridine
  • pindolol
  • propranolol
  • timolol
• Prilocaine has minor interactions with the following drugs
  • hyaluronidase

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to prilocaine, amide-type local anesthetics, sulfites, parabens
• Idiopathic or congenital methemoglobinemia

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Prilocaine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Prilocaine?”

Cautions

• Administration of above 600 mg to adults causes non-acute 15% methemoglobinemia via the formation of o-toluidine metabolite
• Use preservative-free preparations for spinal or epidural anesthesia
• DO NOT use solutions with epinephrine in distal areas of the body (.g. digit, nose, ear, etc)
• History of malignant hyperthermia
• Respiratory arrest reported with local anesthetics
• Seizures reported with systemic toxicity
• Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase the duration of action
• 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 the 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 Bicillin C-R and any other oxidizing agents; depending on the 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 and Lactation

• Use with caution if the benefits outweigh the risks during pregnancy.
• Lactation
  • Not known if excreted in breast milk