Medical Editor: John P. Cunha, DO, FACOEP
What Is Citanest Forte Dental?
4% Citanest Forte Dental with Epinephrine 1:200,000 (prilocaine HCl and epinephrine injection) contains a local anesthetic agent and the hormone epinephrine and is indicated for the production of local anesthesia in dentistry by nerve block or infiltration techniques. Citanest Forte Dental is available in generic form.
What Are Side Effects of Citanest Forte Dental?
Citanest Forte Dental may cause serious side effects including:
- difficulty breathing,
- swelling of your face, lips, tongue, or throat,
- red, swollen, blistered, or peeling skin with or without fever,
- tightness in the chest or throat,
- trouble swallowing or talking,
- unusual hoarseness,
- blue or gray color of the lips, nails, or skin,
- fluttering in your chest,
- severe dizziness,
- severe headache,
- shortness of breath,
- fast breathing,
- fast or slow heart rate,
- stomach pain,
- upset stomach,
- burning, numbness or tingling around the mouth,
- blurry vision,
- ringing in the ears,
- poor coordination,
- excitement, and
- feeling hot or cold
Get medical help right away, if you have any of the symptoms listed above.
Common side effects of Citanest Forte Dental include:
- swelling and persistent numbness and tingling of the lips and mouth,
- blurred or double vision,
- sensations of heat or cold,
- breathing problems,
- slow heart rate,
- low blood pressure (hypotension), and
- allergic reactions (rash, hives, swelling, or anaphylaxis)
Seek medical care or call 911 at once if you have the following serious side effects:
- Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
- Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in your chest; shortness of breath; and sudden dizziness, lightheadedness, or passing out;
- 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.
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
Dosage for Citanest Forte Dental
The dosage of Citanest Forte Dental Injection varies and depends on the physical status of the patient, the area of the oral cavity to be anesthetized, the vascularity of the oral tissues, and the technique of anesthesia. The least volume of injection that results in effective local anesthesia should be administered.
What Drugs, Substances, or Supplements Interact with Citanest Forte Dental?
Citanest Forte Dental may interact with nitrates/nitrites, other local anesthetics, anti-cancer drugs, antibiotics, antimalarials, anticonvulsants, acetaminophen, metoclopramide, quinine, sulfasalazine, monoamine oxidase inhibitors, tricyclic antidepressants, phenothiazines, vasopressor drugs, and ergot-type oxytocic drugs. Tell your doctor all medications and supplements you use.
Citanest Forte Dental During Pregnancy or Breastfeeding
Tell your doctor if you are pregnant or plan to become pregnant before using Citanest Forte Dental; it is not expected to be harmful to a fetus. It is unknown if Citanest Forte Dental passes into breast milk. Consult your doctor before breastfeeding.
Our 4% Citanest Forte Dental with Epinephrine 1:200,000 (prilocaine HCl and epinephrine injection) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Swelling and persistent paresthesia of the lips and oral tissues may occur. Persistent paresthesia lasting weeks to months, and in rare instances paresthesia lasting greater than one year have been reported.
Adverse experiences following the administration of prilocaine are similar in nature to those observed with other amide local anesthetic agents. These adverse experiences are, in general, dose-related and may result from high plasma levels caused by excessive dosage, rapid absorption or unintentional intravascular injection, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient. Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported:
Central Nervous System
CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression, and arrest. The excitatory manifestations may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest.
Drowsiness following the administration of prilocaine is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption.
Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest.
Signs and symptoms of depressed cardiovascular function may commonly result from a vasovagal reaction, particularly if the patient is in an upright position. Less commonly, they may result from a direct effect of the drug. Failure to recognize the premonitory signs such as sweating, a feeling of faintness, and changes in pulse or sensorium may result in progressive cerebral hypoxia and seizure or serious cardiovascular catastrophe. Management consists of placing the patient in the recumbent position and ventilation with oxygen. Supportive treatment of circulatory depression may require the administration of intravenous fluids, and, when appropriate, a vasopressor (e.g., ephedrine) as directed by the clinical situation.
Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions. Allergic reactions as a result of sensitivity to prilocaine are extremely rare and, if they occur, should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value.
The incidences of adverse reactions (e.g., persistent neurologic deficit) associated with the use of local anesthetics may be related to the technique employed, the total dose of local anesthetic administered, the particular drug used, the route of administration, and the physical condition of the patient.
Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics:
EXAMPLES OF DRUGS ASSOCIATED WITH METHEMOGLOBINEMIA:
|Nitrates/Nitrites||nitric oxide, nitroglycerin, nitroprusside, nitrous oxide|
|Local anesthetics||articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine|
|Antineoplastic Agents||cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase|
|Antibiotics||dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides|
|Anticonvulsants||phenobarbital, phenytoin, sodium valproate|
|Other drugs||acetaminophen, metoclopramide, quinine, sulfasalazine|
The administration of local anesthetic injections containing epinephrine or norepinephrine to patients receiving monoamine oxidase inhibitors, tricyclic antidepressants or phenothiazines may produce severe, prolonged hypotension or hypertension. Concurrent use of these agents should generally be avoided. In situations when concurrent therapy is necessary, careful patient monitoring is essential.
Concurrent administration of vasopressor drugs and ergot-type oxytocic drugs may cause severe, persistent hypertension or cerebrovascular accidents.
Read the entire FDA prescribing information for Citanest Forte Dental (Prilocaine HCl and Epinephrine Injection)
© Citanest Forte Dental Patient Information is supplied by Cerner Multum, Inc. and Citanest Forte Dental Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.
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