Prilocaine

Careful and constant monitoring of the patient's state of consciousness should be done following each local anesthetic injection; at such times, restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of CNS toxicity. Treatment is primarily symptomatic and supportive.

Use caution in patients who are very young or have glucose-6-phosphate deficiencies (G6PD). Use caution in patients taking concurrent drugs that can cause methemoglobinemia. Methemoglobinemia has been reported with local anesthetics including prilocaine; clinically significant methemoglobinemia requires immediate treatment. Use is contraindicated in patients with congenital or idiopathic methemoglobinemia.

Local anesthetics have been associated with rare occurrences of sudden respiratory arrest.

Convulsions due to systemic toxicity leading to cardiac arrest have also been reported, presumably following unintentional intravascular injection. Disease-related concerns:

Use with caution in patients with cardiovascular disease, severe shock, or heart block.

Prilocaine may potentially trigger malignant hyperthermia; follow standard protocol for identification and treatment.

Use with caution in patients with hepatic impairment; amide-type anesthetics are metabolized hepatically. Concurrent drug therapy issues:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Use with caution in acutely-ill patients; reduce dose consistent with age and physical status.

Use with caution in debilitated patients; reduce dose consistent with age and physical status.

Use with caution in the elderly; reduce dose consistent with age and physical status.

Use with caution in children; reduce dose consistent with age and physical status. Other warnings/precautions:

Intravascular injections should be avoided; aspiration should be performed prior to administration; the needle must be repositioned until no return of blood can be elicited by aspiration; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided.

To avoid serious adverse effects and high plasma concentrations, the lowest dosage resulting in effective anesthesia should be administered. Repeated doses may significantly increase blood concentrations of both the drug or its metabolites; tolerance to elevated blood concentrations varies with patient status. Reduced dosages, commensurate with age and physical condition, should be given to patients who are debilitated, elderly, acutely-ill, or pediatric.

Dental practitioners using local anesthetic agents should be well trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.