Parenteral Local anaesthesia, Regional anaesthesia
Adult: Dosage is individualised based on the inj site, procedure and patient status. Brachial, cervical, intercostal and pudendal nerve block: As 1% solution: 5-40 mL (50-400 mg). As 2% solution: 5-20 mL (100-400 mg). For pudendal nerve block, administer 1/2 of the total dose to each side. Transvaginal block (combined paracervical and pudendal): As 1% solution: Up to 30 mL (300 mg) total for both sides; inj 1/2 of the total dose on each side. Paracervical block: As 1% solution: Up to 20 mL (200 mg) total for both sides, inj 1/2 of the total dose on each side (Max recommended dose per 90-minute procedure) with a 5-minute interval between sides. Infiltration: As 1% solution: Up to 40 mL (400 mg). Therapeutic block (pain management): As 1% solution: 1-5 mL (10-50 mg). As 2% solution: 1-5 mL (20-100 mg). Caudal and epidural block: As 1% solution (preservative-free): 15-30 mL (150-300 mg). As 1.5% solution (preservative-free): 10-25 mL (150-375 mg). As 2% solution (preservative-free): 10-20 mL (200-400 mg). During epidural anaesthesia, administer a test dose before induction of complete block and all reinforcing doses with the continuous catheter technique. If possible, test dose must contain epinephrine to serve as a warning of unintended intravascular inj. Use the lowest effective dose and concentration to produce the desired effect. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Dose reduction may be required. Child: Dosage recommendations may vary according to age, procedure and physical status of the patient (refer to local or specific product guidelines).
Parenteral Local dental anaesthesia
Adult: Dosage is individualised based on the inj site, procedure and patient status. Single site in the upper or lower jaw: As 3% solution: 51 mg (1.7 mL). Infiltration and nerve block of the entire oral cavity: As 3% solution: 270 mg (9 mL). Max total dose (single dental sitting): 400 mg. Use the lowest effective dose and concentration to produce the desired effect. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Dose reduction may be required. Child: Dosage recommendations may vary according to age, procedure and physical status of the patient (refer to local or specific product guidelines).
What are the brands available for Mepivacaine in Malaysia?
Scandonest 3% (Plain) Without Vasoconstrictor
Special Patient Group
Acutely ill and debilitated patients: Dose reduction may be required.
Contraindications
Severe AV conduction disorders not controlled by a pacemaker.
Special Precautions
Patient with neurological disease, epilepsy; impaired cardiac function or CV disorders (e.g. rhythm disturbances, hypotension, shock, heart block), peripheral vascular disease; risk factors for methaemoglobinaemia (e.g. G6PD deficiency, congenital or idiopathic methaemoglobinaemia, cardiac or pulmonary compromise). Acutely ill and debilitated patients. Avoid intravascular inj, subarachnoid inj, rapid administration of large doses or inj into inflamed or infected area. Not approved for intrathecal inj and use as continuous intra-articular infusion after arthroscopic and other surgical procedures. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS toxicity (e.g. restlessness, anxiety, drowsiness, dizziness, tremors, depression, tinnitus, blurred vision); methaemoglobinaemia; chondrolysis (particularly in the shoulder joint following intra-articular infusion); familial malignant hyperthermia; systemic toxicity (e.g. confusion, seizures, respiratory depression, respiratory arrest, CV depression or stimulation). Ear and labyrinth disorders: Ear discomfort, hyperacusis. Eye disorders: Eyelid ptosis, diplopia, blindness, mydriasis, miosis. Gastrointestinal disorders: Nausea, vomiting, stomatitis, glossitis, gingivitis, salivary hypersecretion. General disorders and administration site conditions: Fatigue, asthenia, feeling hot, inj site pain. Nervous system disorders: Paraesthesia, headache, nystagmus. Psychiatric disorders: Anxiety, nervousness, euphoric mood. Respiratory, thoracic and mediastinal disorders: Hypoxia, hypercapnia, dysphonia. Vascular disorders: Hypertension, hypotension, local or regional hyperaemia.
This drug may cause dizziness, vertigo, fatigue or blurred vision; if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor vital signs (e.g. heart rate, blood pressure, oxygen saturation), CV and respiratory status and changes in mental status. Assess for signs and symptoms of CNS toxicity.
Overdosage
Symptoms: Agitation, dizziness, paraesthesia around the mouth, sensation of numbness in the lips and tongue, visual and hearing disturbances, buzzing in the ears; loss of consciousness, onset of generalised seizures that may be preceded by joint and muscle stiffness or twitching; hypoxia, hypercapnia; myocardial failure, potentially followed by cardiac arrest; respiratory arrest (severe cases).
Management: Symptomatic and supportive treatment. Ensure appropriate airway or respiratory support, oxygenation, ventilation and circulatory support. Acidifying the urine may accelerate drug elimination. Administer anticonvulsants for convulsions. May give IV fluids, vasopressor and/or inotropic agents for CV depression. Employ immediate CV resuscitation in case of cardiac arrest.
Drug Interactions
Additive toxic effects with other local anaesthetics. Increased plasma concentration with cimetidine or β-blockers (e.g. propranolol, nadolol). Increased risk of methaemoglobinaemia with other agents associated with methaemoglobinaemia such as other local anaesthetics (e.g. bupivacaine, lidocaine), nitrates (e.g. glyceryl trinitrate, nitroprusside), antibiotics (e.g. dapsone, nitrofurantoin), antimalarials (e.g. chloroquine, primaquine), antineoplastic agents (e.g. cyclophosphamide, flutamide), anticonvulsants (e.g. phenobarbital, phenytoin), paracetamol and metoclopramide.
Action
Description: Overview: Mepivacaine is an intermediate-acting amide-type local anaesthetic. Mechanism of Action: Mepivacaine reversibly and selectively binds to the intracellular surface of the sodium channels, therefore blocking the influx of sodium ions into the axon. This results in the prevention of depolarisation needed for action potential propagation and subsequent nerve function. Pharmacodynamics: The systemic absorption of mepivacaine may cause depression/and or stimulation on both the cardiovascular and central nervous systems. If blood concentrations are within the normal therapeutic range, changes in cardiac conduction, contractility, excitability, refractoriness and peripheral vascular resistance are minimal. However, at toxic blood concentrations, cardiac excitability and conduction are depressed which may lead to AV block, ventricular arrhythmia and cardiac arrest. Furthermore, myocardial contractility is depressed and peripheral vasodilation occurs, resulting in a reduced cardiac output and arterial blood pressure. Onset: Epidural block: 7-15 minutes (2% solution). Dental anaesthesia: 0.5-2 minutes (upper jaw); 1-4 minutes (lower jaw). Duration: Epidural block: 115-150 minutes (2% solution). Caudal block: 105-170 minutes (1-2% solution). Dental anaesthesia: 20 minutes (upper jaw); 40 minutes (lower jaw). Soft tissue anaesthesia: 60-100 minutes. Pharmacokinetics: Distribution: Plasma protein binding: Approx 75%. Metabolism: Primarily metabolised in the liver via N-demethylation, hydroxylation and glucuronidation. Excretion: Via urine (90-95% as metabolites). Elimination half-life: 1.9-3.2 hours.
Chemical Structure
Mepivacaine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4062, Mepivacaine. https://pubchem.ncbi.nlm.nih.gov/compound/Mepivacaine. Accessed Oct. 29, 2025.
Storage
1%, 1.5% and 2% inj solution: Store between 20-25°C. 3% inj solution: Store below 25°C. Protect from light. Do not freeze. Storage recommendations may vary among countries and between individual products. Refer to specific product guidelines.
N01BB03 - mepivacaine ; Belongs to the class of amides. Used as local anesthetics.
References
Brayfield A, Cadart C (eds). Mepivacaine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/10/2025.Ivoclar Vivadent Ltd. Scandonest 2% Special and Scandonest 3% data sheet 26 October 2017. Medsafe. http://www.medsafe.govt.nz. Accessed 06/10/2025.Joint Formulary Committee. Mepivacaine Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/10/2025.Mepivacaine Hydrochloride. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/10/2025.Mepivacaine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 06/10/2025.Mepivacaine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/10/2025.Polocaine 1% 500 mg/50 mL (HF Acquisition Co LLC, DBA HealthFirst). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/10/2025.Polocaine 2% 1,000 mg/50 mL (HF Acquisition Co LLC, DBA HealthFirst). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/10/2025.Scandonest 3% Plain, Solution for Injection (Septodont Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/10/2025.Scandonest 3% Plain, Solution for Injection (Septodont Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/10/2025.
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