CITANEST WITH OCTAPRESSIN DENTAL

In normal healthy adults the usual dose is 1-5 ml. Children under 10 years of age require approximately 1 -2 ml. A dose of 10 ml (5 cartridges) of Citanest with Octapressin Dental should not be exceeded. Elderly or debilitated patients require smaller doses.

In common with other local anaesthetics, adverse reactions to Citanest are extremely rare in dental practice and are usually the result of excessively high blood concentrations due to inadvertent intravascular injection, excessive dosage, rapid absorption or occasionally to hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient.

In such circumstances systemic effects occur involving the central nervous system and/or the cardiovascular system. CNS reactions are excitatory and/or depressant, and may be characterised by nervousness, dizziness, blurred vision and tremors, followed by drowsiness, convulsions, unconsciousness and possibly respiratory arrest, the excitatory reactions may be brief or may not occur at all, in which case the manifestations of toxicity may be drowsiness, merging into unconsciousness and respiratory arrest.

Cardiovascular reactions are depressant and may be characterised by hypotension, myocardial depression, bradycardia and possible cardiac arrest. Allergic reactions are extremely rare. They may be characterised by cutaneous lesions, urticaria, oedema or anaphylactoid reactions.

Detection of sensitivity by skin testing is of doubtful value. This product gives rise to methaemoglobinaemia in a dose related fashion. Clinically significant levels of methaemoglobin may occur with cyanosis when doses of prilocaine exceed 600 mg.

g. sulphonamides, known to cause such conditions. Infants are particularly susceptible, due to a lower activity of the enzyme which reduces methaemoglobin to haemoglobin. Methaemoglobinaemia may be treated by the intravenous administration of a 1% solution of methylene blue at a dose of l mg/kg, over a 5 minute period.

Great caution must be exercised to avoid accidental intravascular injection of this compound, since it may give rise to the rapid onset of toxicity, with marked restlessness, twitching, or convulsions, followed by coma with apnoea and cardiovascular collapse.

In common with other local anaesthetics, Citanest should be used cautiously in the elderly, patients in poor health, in patients with epilepsy, severe or untreated hypertension, impaired cardiac conduction, severe heart disease, impaired respiratory function and in patients with liver or kidney damage, if the dose or site of administration is likely to result in high blood levels.

Facilities for resuscitation should be available when local anaesthetics are administered. Local anaesthetics should be avoided when there is inflammation in the region of the proposed injection. e. essentially ‘sodium free’. This should be taken into consideration in patients who are following a reduced-salt diet.

Known hypersensitivity to anaesthetics of the amide type or to any other component of the solution. Citanest should be avoided in patients with anaemia or congenital or acquired methaemoglobinaemia.