Polocaine Mpf 1.5% Inj, 30ml
It is used to numb an area before a procedure.
Drug Class
Local Anesthetic
Pharmacologic Class
Amide-type Local Anesthetic
Pregnancy Category
Category C
FDA Approved
Jun 1960
DEA Schedule
Not Controlled
Overview
What is this medicine?
Mepivacaine is a medication used to numb a specific area of your body, like a tooth or a part of your skin, to prevent pain during medical or dental procedures. It works by temporarily blocking nerve signals in that area.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered as an injection.
Storing and Disposing of Your Medication
Since this injection is given in a healthcare setting, you will not need to store it at home. The healthcare provider will be responsible for handling and disposing of the medication.
Missing a Dose
This medication is typically given as needed in a healthcare setting, so you will not need to worry about missing a dose. The healthcare provider will administer the medication according to your specific needs.
To use this medication correctly, follow your doctor's instructions and read all the information provided to you. It is essential to follow the instructions carefully. This medication is administered as an injection.
Storing and Disposing of Your Medication
Since this injection is given in a healthcare setting, you will not need to store it at home. The healthcare provider will be responsible for handling and disposing of the medication.
Missing a Dose
This medication is typically given as needed in a healthcare setting, so you will not need to worry about missing a dose. The healthcare provider will administer the medication according to your specific needs.
Lifestyle & Tips
- Avoid eating or drinking until sensation returns to the numb area, especially if the mouth or throat is affected, to prevent choking or biting.
- Be careful not to injure the numb area (e.g., biting your lip or cheek) until full sensation returns.
- Follow post-procedure instructions from your healthcare provider regarding activity restrictions or wound care.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Varies significantly by procedure and site of injection. For 1.5% solution, typical doses range from 5 mL (75 mg) for minor infiltration to 30 mL (450 mg) for major nerve blocks or epidural anesthesia. Max single dose: 400 mg (26.7 mL of 1.5% solution) without epinephrine, or 550 mg (36.7 mL of 1.5% solution) with epinephrine. Max total dose per 24 hours: 1000 mg.
Dose Range:
75 - 550 mg
Condition-Specific Dosing:
infiltration:
5-40 mg (0.3-2.7 mL of 1.5%)
peripheralNerveBlock:
50-400 mg (3.3-26.7 mL of 1.5%)
epidural:
75-300 mg (5-20 mL of 1.5%)
caudal:
75-300 mg (5-20 mL of 1.5%)
Pediatric Dosing
Neonatal:
Not established for routine use; extreme caution and reduced doses if used.
Infant:
Not established for routine use; extreme caution and reduced doses if used. Max dose: 5-6 mg/kg.
Child:
Max dose: 5-6 mg/kg (not to exceed 400 mg). Dosing should be based on patient's weight and age, using the lowest effective concentration and volume.
Adolescent:
Max dose: 5-6 mg/kg (not to exceed 400 mg). Dosing should be based on patient's weight and age, using the lowest effective concentration and volume.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required for single doses.
Moderate:
No specific adjustment required for single doses; monitor for signs of toxicity with repeated doses.
Severe:
Use with caution; monitor for signs of toxicity due to potential accumulation of metabolites. Consider reduced doses for repeated administration.
Dialysis:
Not significantly removed by dialysis. Use with caution; monitor for toxicity.
Hepatic Impairment:
Mild:
No specific adjustment required for single doses.
Moderate:
Use with caution; consider reduced doses, especially with repeated administration, due to impaired metabolism.
Severe:
Use with extreme caution; significant dose reduction may be necessary due to impaired metabolism and increased risk of systemic toxicity.
Pharmacology
Mechanism of Action
Mepivacaine, an amide-type local anesthetic, reversibly blocks the initiation and conduction of nerve impulses by decreasing the permeability of the nerve cell membrane to sodium ions. This action stabilizes the neuronal membrane, preventing the generation and propagation of action potentials, thereby producing local anesthesia.
Pharmacokinetics
Absorption:
Bioavailability:
Not applicable for injection; systemic absorption depends on site of injection, vascularity, and presence of vasoconstrictor. Rapid absorption from highly vascular areas.
Tmax:
Varies by site of injection: 5-15 minutes (epidural), 30-60 minutes (peripheral nerve block).
FoodEffect:
Not applicable (parenteral administration).
Distribution:
Vd:
1.1 L/kg (adults)
ProteinBinding:
70-80%
CnssPenetration:
Yes (readily crosses blood-brain barrier and placenta)
Elimination:
HalfLife:
1.9 hours (adults); prolonged in neonates and patients with hepatic impairment.
Clearance:
Approximately 0.8 L/min (adults)
ExcretionRoute:
Renal (primarily as metabolites, small amount as unchanged drug)
Unchanged:
5-10% (renal)
Pharmacodynamics
OnsetOfAction:
3-5 minutes (infiltration), 5-15 minutes (nerve block, epidural)
PeakEffect:
15-30 minutes
DurationOfAction:
2-3 hours (infiltration), 2-6 hours (nerve block, epidural), depending on dose and site.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of acidosis (too much acid in the blood):
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ Irregular heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Signs of methemoglobinemia (a rare but potentially life-threatening condition):
+ Blue or gray discoloration of the lips, nails, or skin
+ Irregular heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling extremely tired or weak
+ Shortness of breath
Other severe side effects:
+ Abnormal heartbeat (fast, slow, or irregular)
+ Restlessness
+ Anxiety
+ Changes in speech
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Numbness or tingling in the mouth
+ Metallic taste
+ Dizziness or fainting
+ Ringing in the ears
+ Shakiness
+ Twitching
+ Seizures
+ Depression
+ Breathing difficulties (trouble breathing, slow breathing, or shallow breathing)
+ Feeling nervous and excitable
+ Severe nausea or vomiting
+ Feeling hot or cold
+ Sneezing
+ Excessive sweating
Additional Side Effects (Epidural Use)
If you are using this medication via epidural administration, you may also experience:
Erectile dysfunction
Long-lasting burning, numbness, tingling, or paralysis in the lower half of the body
Loss of bladder or bowel control
Urination difficulties
Headache
Backache
Fever or chills
Stiff neck
Sensitivity to light
Other Side Effects
As with any medication, you may experience side effects that are not severe but still bothersome. If you have any side effects that concern you or do not go away, contact your doctor for advice. Not all side effects are listed here. If you have questions or concerns about side effects, you can:
Call your doctor for medical advice
Report side effects to the FDA at 1-800-332-1088
Report side effects online at https://www.fda.gov/medwatch
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of acidosis (too much acid in the blood):
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ Irregular heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Signs of methemoglobinemia (a rare but potentially life-threatening condition):
+ Blue or gray discoloration of the lips, nails, or skin
+ Irregular heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling extremely tired or weak
+ Shortness of breath
Other severe side effects:
+ Abnormal heartbeat (fast, slow, or irregular)
+ Restlessness
+ Anxiety
+ Changes in speech
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Numbness or tingling in the mouth
+ Metallic taste
+ Dizziness or fainting
+ Ringing in the ears
+ Shakiness
+ Twitching
+ Seizures
+ Depression
+ Breathing difficulties (trouble breathing, slow breathing, or shallow breathing)
+ Feeling nervous and excitable
+ Severe nausea or vomiting
+ Feeling hot or cold
+ Sneezing
+ Excessive sweating
Additional Side Effects (Epidural Use)
If you are using this medication via epidural administration, you may also experience:
Erectile dysfunction
Long-lasting burning, numbness, tingling, or paralysis in the lower half of the body
Loss of bladder or bowel control
Urination difficulties
Headache
Backache
Fever or chills
Stiff neck
Sensitivity to light
Other Side Effects
As with any medication, you may experience side effects that are not severe but still bothersome. If you have any side effects that concern you or do not go away, contact your doctor for advice. Not all side effects are listed here. If you have questions or concerns about side effects, you can:
Call your doctor for medical advice
Report side effects to the FDA at 1-800-332-1088
Report side effects online at https://www.fda.gov/medwatch
Seek Immediate Medical Attention If You Experience:
- Feeling lightheaded or dizzy
- Ringing in your ears (tinnitus)
- Blurred vision
- Numbness or tingling around your mouth
- Unusual drowsiness or confusion
- Tremors or muscle twitching
- Feeling unusually anxious or restless
- Slow or irregular heartbeat
- Difficulty breathing
- Any signs of an allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
Before Using This Medicine
Before taking this medication, it is essential to inform your doctor about the following:
Any allergies you have, including allergies to this drug, any of its components, or other substances, such as foods or medications. Be sure to describe the symptoms you experienced as a result of the allergy.
Potential interactions with other medications or health conditions, as this drug may affect or be affected by other drugs or health problems.
All medications you are currently taking, including prescription and over-the-counter (OTC) medications, natural products, and vitamins. This information will help your doctor and pharmacist assess potential interactions and ensure safe use.
All your health problems, as certain conditions may affect the safety or efficacy of this medication.
* Do not start, stop, or change the dose of any medication without first consulting your doctor to confirm it is safe to do so.
Any allergies you have, including allergies to this drug, any of its components, or other substances, such as foods or medications. Be sure to describe the symptoms you experienced as a result of the allergy.
Potential interactions with other medications or health conditions, as this drug may affect or be affected by other drugs or health problems.
All medications you are currently taking, including prescription and over-the-counter (OTC) medications, natural products, and vitamins. This information will help your doctor and pharmacist assess potential interactions and ensure safe use.
All your health problems, as certain conditions may affect the safety or efficacy of this medication.
* Do not start, stop, or change the dose of any medication without first consulting your doctor to confirm it is safe to do so.
Precautions & Cautions
Important Warnings and Cautions
When taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are using this drug.
Risk of Methemoglobinemia
A severe blood disorder called methemoglobinemia has been associated with medications like this one. Your risk may be increased if you have:
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- Heart problems
- Lung problems
- Are taking certain other medications
- Are an infant younger than 6 months of age
If you have a history of methemoglobinemia, notify your doctor.
Special Considerations
- Children: This medication should be used with caution in children, as the risk of side effects may be higher in some pediatric patients.
- Older Adults (65 and older): Use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks to you and your baby.
Mouth and Numbing Effects
- Eating: Avoid eating until the numbness in your mouth has worn off to prevent accidentally biting your tongue.
- Numbness: Until the numbing effects of this medication have resolved and you feel fully alert, refrain from driving or engaging in activities that require your full attention.
- If you are discharged before the numbness has worn off, take precautions to protect the treated area from injury until sensation returns.
Epidural Administration
After receiving this medication via epidural, you may experience temporary loss of feeling and motor function in the lower half of your body. Do not attempt to get out of bed or perform any tasks until your sensation and motor abilities have returned to normal.
When taking this medication, it is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are using this drug.
Risk of Methemoglobinemia
A severe blood disorder called methemoglobinemia has been associated with medications like this one. Your risk may be increased if you have:
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- Heart problems
- Lung problems
- Are taking certain other medications
- Are an infant younger than 6 months of age
If you have a history of methemoglobinemia, notify your doctor.
Special Considerations
- Children: This medication should be used with caution in children, as the risk of side effects may be higher in some pediatric patients.
- Older Adults (65 and older): Use this medication with caution, as you may be more susceptible to side effects.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks to you and your baby.
Mouth and Numbing Effects
- Eating: Avoid eating until the numbness in your mouth has worn off to prevent accidentally biting your tongue.
- Numbness: Until the numbing effects of this medication have resolved and you feel fully alert, refrain from driving or engaging in activities that require your full attention.
- If you are discharged before the numbness has worn off, take precautions to protect the treated area from injury until sensation returns.
Epidural Administration
After receiving this medication via epidural, you may experience temporary loss of feeling and motor function in the lower half of your body. Do not attempt to get out of bed or perform any tasks until your sensation and motor abilities have returned to normal.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Numbness and tingling, especially around the mouth
- Tinnitus (ringing in ears)
- Blurred vision
- Slurred speech
- Drowsiness, confusion, disorientation
- Tremors, muscle twitching, convulsions (seizures)
- Difficulty breathing, respiratory arrest
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Cardiac arrest
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. In the US, you can also call Poison Control at 1-800-222-1222. Management involves supporting vital functions (airway, breathing, circulation), administering oxygen, managing seizures (e.g., with benzodiazepines), and treating cardiovascular collapse (e.g., with vasopressors, lipid emulsion therapy for severe toxicity).
Drug Interactions
Major Interactions
- Other local anesthetics (additive systemic toxicity)
- Antiarrhythmics (e.g., Class I antiarrhythmics like lidocaine, mexiletine, tocainide - additive cardiac effects)
- Sedatives/Hypnotics/Opioids (additive CNS depression, increased risk of respiratory depression)
Moderate Interactions
- Vasoconstrictors (e.g., epinephrine, norepinephrine - prolongs duration of action, but also increases systemic absorption of mepivacaine if not intended)
- Cholinesterase inhibitors (e.g., neostigmine, pyridostigmine - theoretical increased risk of toxicity due to reduced metabolism, though less significant for amide-type anesthetics)
- Sulfonamides (may inhibit metabolism of mepivacaine, increasing toxicity risk)
Monitoring
Baseline Monitoring
Allergy history
Rationale: To identify hypersensitivity reactions to amide-type local anesthetics.
Timing: Prior to administration
Vital signs (heart rate, blood pressure, respiratory rate)
Rationale: To establish baseline and detect early signs of systemic toxicity.
Timing: Prior to administration
Patient's general condition and comorbidities
Rationale: To assess risk factors for toxicity (e.g., hepatic/renal impairment, cardiovascular disease).
Timing: Prior to administration
Routine Monitoring
Vital signs (heart rate, blood pressure, respiratory rate)
Frequency: Every 5-10 minutes during and immediately after injection, then as clinically indicated.
Target: Within patient's normal range, or as per clinical protocol.
Action Threshold: Significant deviations (e.g., bradycardia, hypotension, tachypnea) warrant immediate intervention.
Level of consciousness/CNS status
Frequency: Continuously during and immediately after injection, then periodically.
Target: Alert and oriented, no signs of CNS excitation or depression.
Action Threshold: Drowsiness, dizziness, tinnitus, circumoral numbness, muscle twitching, seizures, or loss of consciousness require immediate assessment and intervention.
Pain relief/Sensory block
Frequency: As needed to assess efficacy.
Target: Adequate anesthesia for the procedure.
Action Threshold: Inadequate anesthesia may require additional dosing or alternative methods.
Symptom Monitoring
- Lightheadedness
- Dizziness
- Tinnitus
- Blurred vision
- Numbness of lips/tongue (circumoral numbness)
- Metallic taste
- Drowsiness
- Confusion
- Tremors
- Muscle twitching
- Seizures
- Bradycardia
- Hypotension
- Cardiac arrest
- Respiratory depression/arrest
Special Patient Groups
Pregnancy
Mepivacaine is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It crosses the placenta.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless clearly necessary due to potential for organogenesis disruption, though not specifically linked to mepivacaine.
Second Trimester:
Generally considered safer than first trimester if needed, but still Category C. Monitor maternal and fetal vital signs.
Third Trimester:
Can be used for obstetric anesthesia, but careful monitoring of maternal and fetal status is crucial. Fetal bradycardia and other adverse effects have been reported with paracervical block.
Lactation
Mepivacaine is considered L3 (moderately safe) for lactation. It is excreted into breast milk in small amounts. The amount ingested by the infant is generally low and unlikely to cause adverse effects.
Infant Risk:
Low risk. Monitor infant for drowsiness or feeding difficulties, though these are rare.
Pediatric Use
Use with caution. Dosing must be carefully calculated based on weight (mg/kg) to avoid systemic toxicity. Neonates and young infants have immature hepatic metabolism, leading to prolonged half-life and increased risk of accumulation and toxicity. Monitor closely for signs of CNS and cardiovascular toxicity.
Geriatric Use
Use with caution. Elderly patients may be more susceptible to systemic toxicity due to decreased hepatic function, reduced renal clearance, and altered body composition. Consider lower doses and slower administration rates. Monitor vital signs and CNS status closely.
Clinical Information
Clinical Pearls
- Always aspirate prior to injection to avoid inadvertent intravascular administration, which can lead to rapid systemic toxicity.
- The 1.5% solution is typically used for procedures requiring moderate duration of action without the need for a vasoconstrictor.
- Systemic toxicity primarily affects the CNS and cardiovascular system. Early signs are often CNS-related (e.g., circumoral numbness, tinnitus, lightheadedness).
- Lipid emulsion therapy is a critical antidote for severe local anesthetic systemic toxicity (LAST).
- Mepivacaine is not recommended for intravenous regional anesthesia (Bier block) due to high risk of systemic toxicity if tourniquet fails.
- Avoid rapid injection to minimize peak plasma concentrations and reduce the risk of toxicity.
Alternative Therapies
- Lidocaine (another amide-type local anesthetic, often with epinephrine)
- Bupivacaine (longer-acting amide-type local anesthetic)
- Ropivacaine (amide-type local anesthetic, similar to bupivacaine but with less motor block)
- Articaine (amide-type local anesthetic, often used in dentistry)
- Procaine (ester-type local anesthetic, less common due to higher allergy risk)
Cost & Coverage
Average Cost:
Not available per 30ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often covered under medical benefit for procedures)
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not dispose of them by flushing down the toilet or pouring down the drain unless specifically instructed to do so. If you are unsure about the correct disposal method, consult your pharmacist for advice. Many communities have drug take-back programs that provide a safe and environmentally friendly way to dispose of unwanted medications.
Some medications may come with an additional patient information leaflet. Check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred, as this will aid in providing appropriate treatment.
Proper disposal of unused or expired medications is crucial. Do not dispose of them by flushing down the toilet or pouring down the drain unless specifically instructed to do so. If you are unsure about the correct disposal method, consult your pharmacist for advice. Many communities have drug take-back programs that provide a safe and environmentally friendly way to dispose of unwanted medications.
Some medications may come with an additional patient information leaflet. Check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it occurred, as this will aid in providing appropriate treatment.