Artikain. Instructions for use

Articaine refers to local anesthetics, which are often used in dentistry for pain relief during dental treatment. The drug has a vasoconstrictive effect.

What is the action of Articain?

Local anesthetic Articaine of the amide type of the thiafene series. Its mechanism of action is directly due to the stabilization of the neuron membrane, as a result of which the occurrence and conduction of a nerve impulse is prevented.

The anesthetic effect of the drug on the body develops already after sixty seconds, the maximum occurs after eleven minutes, while the duration of action can last for an hour or three.

The drug is completely metabolized in the liver. Elimination of Articaine directly from the tissues occurs rather quickly. The main excretion of the drug is carried out by the kidneys in six hours.

What are the indications for Articaine?

The drug is indicated for infiltration or conduction anesthesia during surgical or diagnostic interventions in obstetric and dental practice, as well as in the presence of pain syndromes.

What are the contraindications for Articaine?

The drug Articaine instructions for use prohibits the use in a fairly large case of conditions, I will list them:

Do not use a local anesthetic in the presence of meningitis;
With tumor processes;
If you have a history of poliomyelitis;
The agent is contraindicated for administration with intracranial bleeding;
With septicemia;
In the presence of osteochondrosis;
You can not use it for tuberculosis;
With spondylitis and metastatic lesions of the spine;
A contraindication is pernicious anemia, which occurs with severe neurological symptoms;
With severe ascites;
Do not use the remedy for heart failure occurring in the decompensation phase;
A massive pleural effusion is also a contraindication, as a result of which intra-abdominal pressure may increase;
The presence of tumor processes in the abdominal cavity;
Arterial hypotension of a pronounced nature, for example, cardiogenic shock or hypovolemic;
Artikain is contraindicated in the presence of pustular lesions of the skin directly at the injection site;
In case of violation of blood coagulation or during therapeutic measures with any anticoagulants.

In addition to the large number of listed contraindications, Articaine is not used for hypersensitivity to local anesthetics, especially of the amide type.

What is the use and dosage of Articaine?

The use of the drug is strictly individual, and it depends directly on the indications, as well as on the applied dosage form. It should be noted that the maximum single dose of Articaine should not exceed 6 mg/kg.

Tricyclic antidepressants may enhance the hypotensive effect of this local anesthetic to some extent. When used in obstetric practice, fetal bradycardia may occur.

Articaine can be excreted in breast milk in acceptable insignificant amounts, therefore, lactation is not required to be interrupted, but, nevertheless, you should first consult a doctor.

What are Artikain side effects?

From the side nervous system The patient may note the following side effects: will join headache, visual impairment develops, there may be a tremor of the limbs. In addition, a slight twitching of the muscles, in some cases developing into convulsions. Quite rarely there is diplopia, impaired consciousness, as well as the so-called blurred vision.

On the part of the digestive system, side effects can also be noted, they are mainly manifested by nausea, but vomiting is not excluded, in addition, the patient may complain of diarrhea.

From the side of the cardiovascular system: arterial pressure may decrease, tachycardia or bradycardia joins.

Allergic reactions can be expressed in the form of a skin rash, often it is itchy, in addition, rhinitis occurs, angioedema joins, and the development of anaphylactic shock is also possible. If symptoms persist, the use of the anesthetic should be discontinued.

special instructions

With caution, Articaine is recommended for use in pseudocholinesterase deficiency, and only under strict indications, as well as in vegetative-vascular dystonia, in certain diseases of the nervous system, in a history of pernicious anemia, and in conditions of chronic hypoxia.

This local anesthetic can be used with epinephrine as well as glucose solution.

Preparations containing Articaine (analogues)

Artifrin, Articaine hydrochloride, Alfacaine SP, Brilocaine-adrenaline, Cytocartin, Ultracaine, Articaine DF, Primacaine with adrenaline, Articaine inibsa, Articaine, Ubistesin forte, Artifrin forte, Septanest with adrenaline, Ultracaine D-S, Brilocaine-adrenaline forte.

Listed medications produced in a solution for injection, which is placed in special cartridges; in substance-powder, packaged in bags; as well as in solution in ampoules.

Conclusion

When using drugs, you should pay attention to the appearance of side effects, and of course, you should consult a doctor.

The active substance is 40 mg Articaine hydrochloride.

Auxiliary ingredients: 2.1 mg sodium chloride and up to 1 ml of water for injection.

Release form

Patriotic pharmaceutical industry produces the drug Articaine in the form of a solution for injection containing 40 mg / 1 ml of the active substance.

One package contains 5 or 10 ampoules of 2 ml solution.

pharmachologic effect

Local anesthetic.

Pharmacodynamics and pharmacokinetics

Articaine is a derivative thiophene and has a local anesthetic effect. Is used for conductive and infiltration . Articaine exposed hydrolysis in a slightly alkaline environment of tissues with the release of a base with lipophilic properties, and therefore, it easily penetrates through the cell membrane into the nerve fiber.

Influencing receptors, blocks delivery sodium ions into the cell and conduct impulses along the nerve fibers. The action of the drug is observed immediately after its administration and lasts from 1 to 3 hours. Efficiency is reduced in an acidic environment.

At intramuscular injection Cmax is reached in 20 - 40 minutes.

When injected under the mucosa oral cavity exhibits high diffusion capacity.

It binds to plasma proteins by 95%.

Exposed to metabolism in the liver, T½ approximately 60 - 80 minutes.

Within 6 hours, it is excreted by the kidneys by 54 - 63%.

Can penetrate the placental barrier (to a lesser extent than other local anesthetics), through the blood-brain barrier penetrates in small quantities. It is practically not excreted with breast milk.

Indications for use

Articaine is used for local anesthesia, mainly during dental procedures.

Contraindications

  • childhood up to 4 years;
  • hypersensitivity to local anesthetics of the amide group;
  • paroxysmal;
  • B12 deficiency anemia (megaloblastic);
  • angle-closure glaucoma;
  • atrial tachyarrhythmia;
  • chronic .

Prescribe with caution:

  • with pathologies of the central nervous system;
  • at pseudocholinesterase deficiency;
  • at pernicious anemia;
  • at hypoxia.

Side effects

Peripheral and central nervous system:

  • headaches;
  • dyspnea;
  • visual impairment;
  • muscle twitching;
  • convulsions;
  • diplopia;
  • disturbance of consciousness.

The cardiovascular system:

  • bradycardia;
  • decrease in blood pressure.

Digestive system:

  • nausea;
  • vomit.

Allergic manifestations:

  • itching;
  • skin rash;
  • very rarely - .

Application instruction of Artikain (Way and dosage)

The instruction for Articaine in dentistry suggests an individual dosing regimen, depending on the severity of the procedure, the time of its implementation and the tolerance of the drug by the patient.

The maximum single dose of the drug is 6 mg per kilogram of body weight.

For surgical intervention, which requires more time than Articaine can provide, a combined preparation is used - Articaine Inibsa containing as active ingredients - Artikain and . Epinephrine exhibits a vasoconstrictive effect at the injection site, thereby increasing its absorption time, prolonging the action.

Instructions for use of the drug Articaine Epinephrine in dentistry recommends the following doses of the drug.

During a tooth extraction procedure upper jaw without complications and inflammation - 1.7 ml of the drug per tooth, with inefficiency - 1 ml - 1.7 ml.

With a palatine incision or suturing - 0.1 ml.

When turning teeth to install crowns or prepare cavities, a vestibular injection is made at a dose of 0.5 ml - 1.7 ml for each tooth.

In the procedure for the removal of premolars of the lower jaw without complications, infiltration anesthesia , which acts as a conductive anesthesia.

Maximum dose in dentistry for adult patients - 7 mg per kilogram of body weight. For pediatric patients older than 4 years - 5 mg per kilogram of body weight.

Overdose

In case of overdose, it appears dizziness, loss of consciousness, motor agitation, lowering blood pressure, bradycardia, tachycardia.

If the first symptoms of an overdose are detected during the administration of the drug, it is necessary to interrupt the injection, put the patient in horizontal position, monitor airway patency, as well as control blood pressure and heart rate.

With increasing bradycardia and vascular collapse give intravenous injection Epinephrine (0.1 mg) with slow administration. If necessary, continue to enter epinephrine in the form of infusion under the control of blood pressure and heart rate.

Interaction

Local anesthetics enhance the effects of drugs that depress the central nervous system.

When Articaine is administered to patients who are receiving Acetylsalicylic acid or, increased risk of local bleeding.

Narcotic potentiate the action of local anesthetic drugs and can lead to respiratory depression.

Dosage form:  injection Composition:

Active substance: articaine hydrochloride - 40.0 mg.

Excipients: sodium chloride - 2.1 mg, water for injection - up to 1.0 ml.

 Description: Colorless transparent liquid. Pharmacotherapeutic group:Local anesthetic ATX:  

N.01.B.B.08 Articaine

Pharmacodynamics:

Articaine is an amide-type local anesthetic used for infiltration and conduction anesthesia in dentistry. has a local anesthetic effect due to the blockade of voltage-dependent sodium channels in the cell membrane of neurons, which leads to a reversible inhibition of the conduction of impulses along the nerve fiber and a reversible loss of sensitivity. The action of the drug begins quickly, within 1-3 minutes. The duration of anesthesia is approximately 20 minutes. The drug does not contain and is used when the addition of epinephrine to the local anesthetic is not necessary or the use of epinephrine is contraindicated.

 Pharmacokinetics:

Articaine is quickly and almost immediately after administration metabolized (by hydrolysis) by nonspecific plasma esterases in tissues and blood (90%); the remaining 10% dose of articaine is metabolized by microsomal liver enzymes. The resulting main metabolite of articaine - articaic acid - does not have local anesthetic activity and systemic toxicity, which allows for repeated injections of the drug. The binding of articaine to plasma proteins is approximately 95%.

Articaine is excreted through the kidneys, mainly in the form of articaic acid. After submucosal administration, the elimination half-life is approximately 25 minutes.

Articaine crosses the placental barrier and is practically not excreted in breast milk.

 Indications: Local anesthetic for infiltration and conduction anesthesia in dentistry. Articaine without epinephrine is used primarily for short procedures in patients in whom the use of epinephrine is unacceptable (eg, cardiovascular diseases), or if necessary, the introduction of small volumes of the drug (in the area of ​​the front teeth, palate). Contraindications:

Hypersensitivity to articaine or other amide-type local anesthetics, unless hypersensitivity to amide-type local anesthetics has been excluded by appropriate investigations carried out in compliance with all necessary rules and requirements.

Severe dysfunction sinus node or severe conduction disturbances (such as severe bradycardia, atrioventricular block II - III degree).

Acute decompensated heart failure.

Severe arterial hypotension.

Children's age up to 4 years (lack of sufficient clinical experience).

 Carefully:- Cholinesterase deficiency (use is possible only in case of emergency, since prolongation and a pronounced increase in the effect of the drug are possible);

- Epilepsy in history (see section "Side effects").

Pregnancy and lactation:

Pregnancy

Articaine crosses the placental barrier. The concentration of articaine in the blood serum of newborns (after administration of the drug to the mother) is approximately 30% of the concentration of articaine in the mother's blood serum.

Due to the lack of clinical data, a decision on the use of the drug by a dentist can only be made if the potential benefit from its use for the mother justifies the potential risk to the fetus.

breastfeeding period

With short-term use of the drug during breastfeeding, as a rule, it is not necessary to interrupt breastfeeding, since in breast milk no clinically significant concentrations of articaine are detected.

Fertility

In rat fertility studies, toxic doses of articaine showed no effect on fertility in males and females.female. No effect on human fertility is expected at therapeutic doses of articaine.

 Dosage and administration:The drug is intended for use in the oral cavity and can only be administered to tissues where there is no inflammation.

Do not inject into inflamed tissues.

The drug should not be administered intravenously.

For infiltration anesthesia, in the absence of inflammation, 1.7 ml of Articaine solution is usually injected per tooth or two adjacent teeth. With conduction anesthesia of the lower alveolar nerve, approximately 1-1.7 ml of the drug solution is required. For additional injections, half the dose or the full dose should be used.

The maximum dose for adults is 4 mg of articaine hydrochloride per kg of body weight.

In order to avoid accidental entry of the drug into the blood vessels. before its introduction, an aspiration test should always be carried out (in two stages). Injection pressure during drug administration should be adjusted depending on tissue sensitivity.

Side effects:

The incidence of side effects is presented in accordance with the classification recommended by the World Health Organization: very often (≥ 1/10); often (≥ 1/100,< 1/10); нечасто (≥ 1/1000, < 1/100); редко (≥ 1/10000, < 1/1000); очень редко (< 1/10000), включая отдельные сообще­ния; частота неизвестна (по имеющимся данным определить частоту встре­чаемости не представляется возможным).

Nervous System Disorders

Often

Paresthesia, hypoesthesia.

Infrequently

Dizziness.

Frequency unknown

Dose-dependent reactions from the central nervous system: agitation, nervousness, stupor, sometimes progressing to loss of consciousness, coma, respiratory disorders, sometimes progressing to respiratory arrest, muscle tremor, muscle twitching, sometimes progressing to generalized convulsions.

Sometimes, if the correct injection technique is violated when a local anesthetic is administered in dental practice, damage may occur. facial nerve, which can lead to the development of facial paralysis.

Violations of the organ of vision

Frequency unknown

Visual disturbances (blurred vision, double vision, mydriasis, blindness) are usually reversible and occur during or shortly after injection of a local anesthetic into the head.

Gastrointestinal disorders

Often

Nausea, vomiting.

Cardiac and vascular disorders

Frequency unknown

Decreased blood pressure, bradycardia, heart failure, shock.

Violations by immune system

Frequency unknown

Allergic and allergic-like reactions may develop. At the injection site, they may appear as swelling or inflammation of the mucous membrane. Manifestations not associated with the injection site may be flushing of the skin, itching, conjunctivitis, rhinitis and angioedema.

Angioedema may present with swelling of the upper and/or lower lips, cheeks, swelling of the vocal cords with a sensation of "lump in the throat" and difficulty swallowing, hives and difficulty breathing. Any of these manifestations can progress to anaphylactic shock. Overdose: At the first manifestations of toxic action, such as dizziness, motor agitation or stupor during the administration of the drug, its administration should be stopped and the patient should be transferred to a horizontal position with elevated lower limbs. It is necessary to ensure the patency of the respiratory tract and monitor hemodynamic parameters (heart rate and blood pressure). It is always recommended, even if the symptoms of intoxication seem mild, to put an intravenous catheter in order to be able to immediately carry out if necessary. intravenous administration necessary medicines. In case of respiratory disorders, depending on their severity, oxygen supply is recommended, and if there are indications for artificial respiration, endotracheal intubation and mechanical ventilation are recommended.

The administration of centrally acting analeptics is contraindicated.

Muscle twitches and generalized convulsions can be stopped by intravenous administration of short-acting or ultra-short-acting barbiturates. It is recommended to administer these drugs slowly, under constant medical supervision (risk of hemodynamic disorders and respiratory depression) and with simultaneous oxygen supply and monitoring of hemodynamic parameters.

Often, bradycardia or a sudden drop in blood pressure can be corrected by simply placing the patient in a supine position with the lower extremities elevated.

In severe circulatory disorders and shock, regardless of their cause, the drug should be discontinued and the patient shouldbe transferred to a horizontal position with raised lower limbs. Oxygen supply, intravenous administration of electrolyte solutions, glucocorticosteroids (250-1000 mg of methylprednisolone), if necessary, plasma substitutes, including albumin, should be carried out. With the development of collapse and increased bradycardia, slow intravenous administration of a solution of epinephrine (0.0025-0.1 mg) under the control of heart rate and blood pressure is indicated. If necessary, the introduction of doses exceeding 0.1 mg should be administered by infusion, adjusting the rate of administration under the control of the number of heartbeats and blood pressure.

 Interaction:

With drugs that depress the central nervous system (CNS)

Local anesthetics enhance the effect of drugs that depress the central nervous system. Narcotic analgesics enhance the effect of local anesthetics and increase the risk of respiratory depression.

With heparin, acetylsalicylic acid

When injecting the drug to patients receiving heparin or acetylsalicylic acid, bleeding may develop at the injection site.

With cholinesterase inhibitors

Slowing down the metabolism of local anesthetic drugs, as a result of which prolongation and a pronounced increase in the action of articaine are possible.

With vasoconstrictors

The local anesthetic effect of articaine is enhanced and lengthened by vasoconstrictor drugs.

With disinfectant solutions containing heavy metals

When treating the injection site of a local anesthetic with disinfectant solutions containing heavy metals, the risk of developing a local reaction in the form of painful sensitivity and swelling increases.

 Special instructions:

The drug is not intended for long-term administration (more than 20 minutes).

To prevent infection (including with the hepatitis virus), it is necessary to ensure that new sterile syringes and needles are always used when taking the solution from the ampoules.

Patients require monitoring of the state of the cardiovascular system, respiratory system, CNS. Caution should be exercised when using the drug in patients with angina pectoris, atherosclerosis, blood clotting disorders, severe impairment of liver or kidney function.

In order to avoid the risk of developing adverse reactions, it is necessary to use the minimum effective doses of the drug and conduct a two-stage aspiration test before its administration.

Regional and local anesthesia should be carried out by experienced professionals in an appropriately equipped room with the availability of equipment and preparations ready for immediate use, necessary for monitoring cardiac activity and resuscitation. Anesthesia personnel should be qualified and trained in anesthesia technique and should be familiar with the diagnosis and treatment of systemic toxic reactions, adverse events and reactions, and other complications.

You can eat only after the termination of the action of local anesthesia (restoration of sensitivity). Children and their parents should be warned about the risk of accidental damage to soft tissues by teeth (biting) due to reduced tissue sensitivity due to the action of the drug.

It should be borne in mind that 1 ml of the drug solution contains less than 1 mmol (23 mg) of sodium.

 Influence on the ability to drive transport. cf. and fur.:

The decision on when the patient after dental intervention can return to driving vehicles or engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions should be made by the doctor.

 Release form / dosage:

Solution for injections 40 mg/ml.

 Package: 2 ml in ampoules of neutral glass brand NS-3 or glass of the first hydrolytic class.

5 ampoules are placed in a blister pack made of PVC film.

1 or 2 blisters are placed in a cardboard box.

10 ampoules are placed in a cardboard box.

Each pack or box contains instructions for use and an ampoule scarifier.

When using ampoules with a notch, a break ring or a break point, the ampoule scarifier is not inserted.

Storage conditions:

In a place protected from light at a temperature not exceeding 25 ° C.

Keep out of the reach of children.

 Best before date: 5 years. Do not use after the expiry date stated on the packaging. Conditions for dispensing from pharmacies: On prescription Registration number:LP-001151 Instructions

During a number of dental operations and procedures, local anesthesia (infiltration and conduction) is used.

One of the commonly used drugs with analgesic effect is Articaine. The properties of the drug and the rules for its use will be discussed in the article.

Articaine - what kind of drug?

The Latin name of the drug is Articainum, the purpose is pain relief of soft tissues.

In addition to articaine hydrochloride ( active ingredient) includes sodium chloride. Water for injection is used as a solvent.

The drug is a derivative of thiophene, has a local anesthetic effect.

The active substance affects the receptors, prevents the delivery of sodium ions to the cells and prevents impulses from propagating along the nerve fibers.

After the introduction of the drug, an instant effect (about 2 minutes) is noted, which continues:

  • on pulp tissues about 60 minutes;
  • on soft tissues - about 3 hours.

The action is reduced in an acidic environment. It is excreted from the body with the help of the liver and kidneys (more than half of the dose used is released in 6 hours).

The drug Articaine is used mainly in dentistry for infiltration and conduction anesthesia.

An anesthetic is produced in the form of a solution intended for injection. The liquid is transparent with a slight yellowish tint, free from mechanical impurities.

What is it used for in dentistry?

Unlike other painkillers, it can be injected into areas with purulent formations

Articaine is used in dentistry as a local anesthetic during infiltration or conduction anesthesia.

The popularity of the drug is due to the rapid action active substances, lasting effect, the possibility of using for different types anesthesia.

Unlike other painkillers, it can be injected into areas with purulent formations, while its properties are not lost.

Articaine in dentistry is used mainly during the following manipulations:

  • operations to remove teeth (simple);
  • preparation of carious cavities;
  • in the process of prosthetics.

The injection solution is used only on soft tissues. It is forbidden to inject Articaine into a vein.

Instructions for use in dentistry

Articaine is used in an individual dosing regimen, taking into account the severity of the disease.

An anesthetic is injected after a preliminary aspiration test, which avoids the needle entering the vessels.

The puncture is done on the mucosal area where there is no inflammation.

When releasing the drug from the syringe, the pressure on the plunger should be controlled to prevent damage to sensitive tissues.

Articaine is used in an individual dosing regimen, taking into account the severity of the disease, the characteristics of the body and the time of the operation.

The maximum dose taken once should not exceed 6 mg / kg of body weight of an adult, daily - 7 mg / kg.

  • to remove a tooth in the upper row in the absence of an inflammatory process - 1.7 ml per unit (the puncture is carried out vestibularly), if the analgesic effect is mild, an additional 1-1.7 ml is administered;
  • when performing palatine incisions, suturing to form a palatine depot - 0.1 ml;
  • preparation of a cavity, tooth enamel for prosthetic structures (with the exception of the molars of the lower row) - 0.5-1.7 ml per unit.

Eating is allowed after complete restoration of the sensitivity of oral tissues.

Side effects

During clinical research the following side effects after applying Articaine:

Contraindications

Before using Artikain, you need to familiarize yourself with the contraindications highlighted by the manufacturer.

They concern such disorders with health:

Taking Articaine only as a last resort, when the risk is justified, is allowed for the following health problems:

  • hypoxia;
  • pathology of the central nervous system;
  • anemia (malignant nature);
  • pseudocholinesterase deficiency.

The drug crosses the placenta, but the degree of danger of the active substance has not been studied during clinical trials. A dentist may prescribe Articaine in some cases, but an assessment is made of the ratio of the potential risk to the fetus and the expected benefit.

When breastfeeding, the drug can be used, since no concentrated active ingredient was found in milk during the analysis.

Articaine should not be used in patients under 4 years of age. Older children are prescribed a certain dosage, depending on body weight and age group.

Overdose

When the dose of the drug is exceeded, the patient has the following symptoms:

In case of dizziness or loss of consciousness, the patient is asked to take a horizontal position to facilitate breathing.

Air access is also provided (ventilation of the room), blood pressure and pulse are monitored.

If breathing is difficult, endotracheal intubation and mechanical ventilation will be required. If convulsions appear, then short-acting barbiturates (intravenously) are administered in parallel with oxygen inhalation.

If serious circulatory problems are identified or the patient enters a state of shock, it is recommended to inject plasma substitutes and electrolytes, glucocorticoids and Albumin into the vein.

If the manifested bradycardia increases, vascular collapse is observed, then Epinephrine (0.1 mg) is slowly injected into the vein, while the heart rate and blood pressure are regularly monitored.

drug interaction

With the simultaneous administration of a local anesthetic with other drugs, the following effect may be noted:

Terms and conditions of storage

The place where pharmacological agents are kept should be hidden from children and animals. Sun protection is also required. Temperature regime - from 0 ° to 25 °.

Gross formula

C 13 H 20 N 2 O 3 S

Pharmacological group of the substance Articaine

Nosological classification (ICD-10)

CAS code

23964-58-1

Characteristics of the substance Articaine

Local anesthetic from the group of amides.

White or off-white crystalline powder. Soluble in water and alcohol.

Pharmacology

pharmachologic effect- local anesthetic.

In tissues (in a slightly alkaline environment) it undergoes hydrolysis and releases a base that has lipophilic properties and easily penetrates through the membrane into the nerve fiber. Ionizes (due to lower pH) and transforms into a cation. Interacts with receptors, inhibits the entry of sodium ions into the cell in the depolarization phase and blocks the conduction of an impulse along the nerve fiber.

With the / m administration Cmax is achieved in 20-40 minutes. T 1/2 - about 40 min. With infiltration anesthesia in the oral cavity, it has a high diffusion capacity. Biotransformed in the liver. Penetrates through the placental barrier, in a small amount penetrates through the BBB, practically not excreted in breast milk. Excreted by the kidneys (54-63% in 6 hours). The duration of anesthesia is 60 and 180 minutes with the addition of vasoconstrictors. In an acidic environment, the effect is reduced.

Application of the substance Articaine

Infiltration and conduction anesthesia, incl. in dental operations: uncomplicated extraction of one or more teeth, treatment of carious tooth cavities and grinding of teeth before prosthetics.

Contraindications

Hypersensitivity to articaine, other local anesthetic drugs of the amide group, as well as to sulfites (especially in patients bronchial asthma), anemia (including B 12 -deficiency anemia), paroxysmal tachycardia, atrial fibrillation, severe dysfunction of the sinus node or conduction (such as severe bradycardia, AV block II-III degree), acute decompensated heart failure, severe arterial hypotension, angle-closure glaucoma, methemoglobinemia, hypoxia, children under 4 years of age (safety and efficacy have not been determined).

Use during pregnancy and lactation

It has no effect on the fetus (with the exception of possible bradycardia) with any application technique and dosage.

Updating information

Articaine crosses the placental barrier. Due to insufficient clinical data, a decision to prescribe articaine by a dentist should only be made if the potential benefit from its use justifies the potential risk to the fetus.
During lactation, there is no need to interrupt breast-feeding, because no clinically significant concentrations of articaine are found in breast milk, however, as a precaution, breastfeeding should be interrupted for 4 hours after the last dose of articaine.

[Updated 14.03.2013 ]

Side effects of the substance Articaine

From the nervous system and sensory organs: headache, dizziness, impaired consciousness (up to its loss), muscle tremor and muscle twitching (up to generalized convulsions), blurred vision, diplopia.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): decrease in blood pressure, cardiac arrest.

From the digestive tract: nausea, vomiting.

From the respiratory system: respiratory failure (up to a life-threatening stop).

Allergic reactions: itching, urticaria, skin hyperemia, conjunctivitis, rhinitis, angioedema, anaphylactic shock.

Others: local reactions (swelling and inflammation at the injection site).

Interaction

The effect of articaine is enhanced and lengthened by vasoconstrictors.

Updating information

Local anesthetics enhance the effect of drugs that depress the central nervous system. Narcotic analgesics enhance the effect of local anesthetics and increase the risk of respiratory depression.
When injecting articaine in patients receiving heparin or acetylsalicylic acid, bleeding may develop at the injection site.
With the simultaneous use of articaine and muscle relaxants, it is possible to enhance and prolong the action of muscle relaxants.
Articaine exhibits antagonism in relation to the effect on skeletal muscles with antimyasthenic drugs, especially when used in high doses, which requires additional correction in the treatment of myasthenia gravis.
The combined use of articaine with cholinesterase inhibitors may slow down the metabolism of articaine.

The source of information

grls.rosminzdrav.ru

[Updated 06.05.2013 ]

Overdose

Symptoms: dizziness, motor agitation, loss of consciousness, decrease in blood pressure, tachycardia / bradycardia.

Treatment: when the first signs of an overdose appear during the injection, it is necessary to stop the administration of the drug, give the patient a horizontal position, ensure free airway patency, control heart rate and blood pressure. With shortness of breath, apnea - oxygen, endotracheal intubation, mechanical ventilation (central analeptics are contraindicated); with convulsions - in / in the slow introduction of short-acting barbiturates with simultaneous inhalation of oxygen and control of hemodynamics; in severe circulatory disorders and shock - intravenous infusion of electrolytes and plasma substitutes, HA, albumin; with vascular collapse and increasing bradycardia - in / in the slow introduction of epinephrine 0.1 mg (hereinafter - in / in drip under the control of heart rate and blood pressure). Oxygen therapy and circulatory control are necessary in all cases.