combinations

N01BB20

Forms & Strengths

Injectable solution: Lidocaine HCl + Epinephrine (various concentrations, e.g., 1% + 1:100,000)
Topical preparations: Lidocaine + Prilocaine cream (2.5% / 2.5%)
Dental cartridges: Articaine HCl 4% + Epinephrine 1:100,000 or 1:200,000
Topical sprays/gels: Benzocaine + Tetracaine combinations

Adult Dosing

Infiltration/Local Anesthesia (Lidocaine/Epinephrine): Max 7 mg/kg with epinephrine, not to exceed 500 mg total dose
Topical Anesthesia (Lidocaine/Prilocaine): Apply 1 to 2 g of cream per 10 cm2 of skin for at least 60 minutes
Dental Anesthesia (Articaine/Epinephrine): 1.7 to 3.4 mL (68 to 136 mg articaine) for routine procedures; max 7 mg/kg

Pediatric Dosing

Local Infiltration (Lidocaine/Epinephrine): Do not exceed 4.5 to 7 mg/kg based on formulation and patient weight
Topical Anesthesia (Lidocaine/Prilocaine): Dosing varies by age and weight; neonates 0-3 months max 1 g / 10 cm2 applied for 1 hour
Dental Anesthesia (Articaine/Epinephrine): Children >4 years, 1.7 mg/kg to max 5 mg/kg depending on age and weight

Indications

Local, regional, or spinal anesthesia for surgical procedures
Dental anesthesia for routine and complex procedures
Surface anesthesia of intact skin or mucous membranes prior to minor dermal procedures
Symptomatic relief of local pruritus or pain

Mechanism of Action

Local anesthetics block fast voltage-gated sodium channels in the neuronal cell membrane, inhibiting depolarization and nerve impulse propagation
Vasoconstrictors (e.g., epinephrine) constrict local blood vessels, reducing systemic absorption, prolonging local anesthetic duration, and minimizing bleeding

Contraindications

Hypersensitivity to amide- or ester-type local anesthetics or any component of the formulation
Presence of severe inflammation or sepsis at the injection site
Idiopathic or congenital methemoglobinemia (for prilocaine-containing combinations)
Severe conduction disturbances or cardiogenic shock (when systemic absorption is significant)

Adverse Reactions

Central nervous system effects: Tinnitus, dizziness, apprehension, lightheadedness, tremors, seizures
Cardiovascular effects: Hypotension, bradycardia, myocardial depression, arrhythmias
Local reactions: Edema, burning sensation, tenderness, prolonged numbness
Hematological: Methemoglobinemia associated with high doses of prilocaine or benzocaine

Drug Interactions

Class I antiarrhythmic drugs (e.g., mexiletine): Additive toxic effects on cardiac conduction
Non-selective beta-blockers: Risk of severe hypertension and bradycardia due to unopposed alpha-adrenergic vasoconstriction from epinephrine
Monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants: Enhanced pressor response to vasopressors, precipitating severe hypertension
Drugs associated with methemoglobinemia (e.g., sulfonamides, acetaminophen): Increased risk of methemoglobin formation when combined with prilocaine or benzocaine

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