Mepivacaine

Mechanism-of-action class: Sodium Channel Interactions.

• Mepivacaine is indicated for production of local anesthesia for dental procedures by infiltration or nerve block in adults and pediatric patients.

• Mepivacaine is contraindicated in patients with a known hypersensitivity to amide-type local anesthetics.contraindicated

As with all local anesthetics, the dose varies and depends upon the area to be anesthetized, the vascularity of the tissues, individual tolerance and the technique of anesthesia. The lowest dose needed to provide effective anesthesia should be administered. For specific techniques and procedures refer to standard dental manuals and textbooks. For infiltration and block injections in the upper or lower jaw, the average dose of 1 cartridge will usually suffice. Each cartridge contains 1.7 mL (34 mg of 2% or 51 mg of 3%). 5.3 cartridges (180 mg of the 2% solution or 270 mg of the 3% solution) are usually adequate to effect anesthesia of the entire oral cavity. Whenever a larger dose seems to be necessary for an extensive procedure, the maximum dose should be calculated according to the patient's weight. A dose of up to 3 mg per pound of body weight may be administered. At any single dental sitting the total dose for all injected sites should not exceed 400 mg in adults. The maximum pediatric dose should be carefully calculated. Maximum dose for pediatric population = Child's Weight (lbs.) 150 × Maximum Recommended Dose for Adults (400 mg) The following table, approximating these calculations, may also be used as a guide.

RESUSCITATIVE EQUIPMENT AND DRUGS SHOULD BE IMMEDIATELY AVAILABLE. (See ADVERSE REACTIONS). Reactions resulting in fatality have occurred on rare occasions with the use of local anesthetics, even in the absence of a history of hypersensitivity. Fatalities may occur with use of local anesthetics in the head and neck region as the result of retrograde arterial flow to vital CNS areas even when maximum recommended doses are observed. The practitioner should be alert to early evidence of alteration in sensorium or vital signs. The solution which contains a vasoconstrictor (Mepivacaine HCl 2% (20 mg/mL)) should be used with extreme caution for patients whose medical history and physical evaluation suggest the existence of hypertension, arteriosclerotic heart disease, cerebral vascular insufficiency, heart block, thyrotoxicosis and diabetes, etc. The solution which contains a vasoconstrictor (Mepivacaine HCl 2% (20 mg/mL)) also contains potassium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and lifethreatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people. Mepivacaine HCl 3% (30 mg/mL) is SULFITE FREE. Mepivacaine, along with other local anesthetics, is capable of producing methemoglobinemia. The clinical signs of methemoglobinemia are cyanosis of the nail beds and lips, fatigue and weakness.

Reactions to Mepivacaine are characteristic of those associated with other amide-type local anesthetics. Systemic adverse reactions involving the central nervous system and the cardiovascular system usually result from high plasma levels (which may be due to excessive dosage, rapid absorption, inadvertent intravascular injection, or slow metabolic degradation), injection technique, or volume of injection. A small number of reactions may result from hypersensitivity, idiosyncrasy or diminished tolerance to normal dosage on the part of the patient. Persistent paresthesias of the lips, tongue, and oral tissues have been reported with the use of mepivacaine, with slow, incomplete, or no recovery. These post-marketing events have been reported chiefly following nerve blocks in the mandible and have involved the trigeminal nerve and its branches. Reactions involving the central nervous system are characterized by excitation and/or depression. Nervousness, dizziness, blurred vision, or tremors may occur followed by drowsiness, convulsions, unconsciousness, and possible respiratory arrest. Since excitement may be transient or absent, the first manifestations may be drowsiness merging into unconsciousness and respiratory arrest. Cardiovascular reactions are depressant. They may be the result of direct drug effect or more commonly in dental practice, the result of vasovagal reaction, particularly if the patient is in the sitting position.

Pregnancy Teratogenic Effects: Pregnancy Category C: Animal reproduction studies have not been conducted with this solution. It is also not known whether this solution can cause fetal harm when administered to a pregnant woman or can effect reproductive capacity. This solution should be given to a pregnant woman only if clearly needed.

Treatment of a patient with toxic manifestations consists of assuring and maintaining a patent airway and supporting ventilation (respiration) as required. This usually will be sufficient in the management of most reactions. Should a convulsion persist despite ventilatory therapy, small increments of anticonvulsive agents may be given intravenously, such as benzodiazephine (e.g., diazepam) or ultrashort-acting barbiturates (e.g., thiopental or thiamylal) or short-acting barbiturates (e.g., pentobarbital or secobarbital). Cardiovascular depression may require circulatory assistance with intravenous fluids and/or vasopressor (e.g., Ephedrine) as dictated by the clinical situation. Allergic reactions should be managed by conventional means. IV and SC LD 50 's in mice for Mepivacaine Hydrochloride 3% are 33 and 258 mg/kg, respectively. The acute IV and SC LD 50 's in mice for Mepivacaine Hydrochloride 2% with Levonordefrin 1:20,000 are 30 and 184 mg/kg, respectively.

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• Dec 1, 1986ANDAANDA089407Fresenius Kabi Usa
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1. 1Drug Ineffective14313%
2. 2Dyspnoea625.6%
3. 3Off Label Use615.5%
4. 4Dizziness585.2%
5. 5Nausea565.0%
6. 6Hypotension554.9%
7. 7Pruritus373.3%
8. 8Anaphylactic Shock363.2%
9. 9Hypertension363.2%
10. 10Tachycardia343.0%
11. 11Vomiting343.0%
12. 12Bradycardia322.9%
13. 13Seizure312.8%
14. 14Confusional State302.7%
15. 15Erythema302.7%

Recent PubMed references pinned to Mepivacaine as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• Mepivacaine vs. bupivacaine in spinal anesthesia for total joint arthroplasty: a systematic review and meta-analysis.
  Minerva anestesiologica · 2025 · Tapioca V, Maia Martins Pereira E, Tatsch Terres M, et al.
  PMID 41542730DOI 10.23736/S0375-9393.25.19317-6
• CACNB1 alleviates mepivacaine‑induced myocardial ischemia/reperfusion injury by promoting Nrf2 nuclear translocation.
  Molecular medicine reports · 2026 · Shao Q, Zhang J, Wang H, et al.
  PMID 41416438DOI 10.3892/mmr.2025.13781
• Knockdown of FXYD2 inhibits mepivacaine-induced cardiomyocyte injury by activating the PI3K/AKT signaling pathway.
  European journal of medical research · 2025 · Cheng L, Wang B, Chen J, et al.
  PMID 41413828DOI 10.1186/s40001-025-03509-z
• Comparative evaluation of 2% mepivacaine and 2% lidocaine for inferior alveolar nerve block: a double-blind randomized clinical trial.
  BMC oral health · 2025 · Panya S, Chongarnon S, Chintaroj S, et al.
  PMID 41188798DOI 10.1186/s12903-025-07123-7
• Articaine provides a faster onset and longer duration of analgesia at lower supplemental injections compared to mepivacaine in third molar extractions.
  Oral and maxillofacial surgery · 2025 · Santos SS, Bonatto MDS, Mendes PGJ, et al.
  PMID 41068533DOI 10.1007/s10006-025-01476-7
• Comparative evaluation of 3% plain mepivacaine and 2% lignocaine with 1:100,000 adrenaline in the pediatric population: A double-blind, randomized controlled trial.
  Journal of the Indian Society of Pedodontics and Preventive Dentistry · 2025 · Arora R, Chattopadhyay S, Agarwal S, et al.
  PMID 41026565DOI 10.4103/jisppd.jisppd_238_25
• Outcomes of Low-Dose 2% Mepivacaine Spinal for Total Hip and Knee Arthroplasty in an Ambulatory Surgery Center Setting.
  The Journal of arthroplasty · 2026 · Bradbury TL, Gresham NL, Bradham AA, et al.
  PMID 40716582DOI 10.1016/j.arth.2025.07.046
• The efficacy of pre-operative oral aceclofenac and intra-ligamentary mepivacaine on the success of failed inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomised, double-blinded clinical trial.
  PeerJ · 2025 · Ghosh S, Gehlot PM, Jadhav G, et al.
  PMID 40321815DOI 10.7717/peerj.19293

The 10 most recently updated of 158 ClinicalTrials.gov registrations naming Mepivacaine as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• PENG Block + LIA For Endoprosthesis Surgery
  Recruiting · Interventional · 100 enrolled · ASST Gaetano Pini-CTO
  NCT07239817updated 2026-06-12
• Plantar Compartment Block Versus Sciatic Block in Hallux Valgus Ambulatory Surgery
  Completed · Interventional · 60 enrolled · University Hospital, Montpellier
  NCT03922412updated 2026-06-02
• Local Anesthetic Clinical Trial
  Enrolling by invitation · Phase 4 · Interventional · 400 enrolled · Baylor Research Institute
  NCT07601750updated 2026-05-22
• Therapeutic Effect of Shoulder Anterior Capsular Block Versus Suprascapular Nerve Block in Patients With Frozen Shoulder
  Recruiting · Interventional · 50 enrolled · Sohag University
  NCT06725823updated 2026-05-06
• GA + ESP vs. SA + ESP in Lumbar Decompression Surgeries
  Enrolling by invitation · Phase 3 · Interventional · 142 enrolled · Hospital for Special Surgery, New York
  NCT05444751updated 2026-04-28
• Femoral Peri-arterial Local Anesthetic Injection Via Peri-arterial Perineural Catheter Reverses Tourniquet Associated Ischemic Hypertension
  Recruiting · Phase 4 · Interventional · 40 enrolled · Duke University
  NCT04454203updated 2026-03-23
• Discomfort Following Oral Biopsy Comparing Laser and Punch Biopsy
  Completed · Interventional · 112 enrolled · Catholic University of the Sacred Heart
  NCT07414797updated 2026-02-18
• Stellate Ganglion Block for COVID-19-Induced Olfactory Dysfunction
  Completed · Phase 1 · Phase 2 · Interventional · 20 enrolled · Washington University School of Medicine
  NCT05445921updated 2026-02-12
• Comparing Spinal Anesthesia With 1% Chloroprocaine Versus 1% Mepivacaine in Patients Undergoing Outpatient Primary Total Knee Arthroplasty
  Not yet recruiting · Phase 4 · Interventional · 170 enrolled · Nova Scotia Health Authority
  NCT07239999updated 2026-02-06
• Oct Angiography Changes After Local Anesthesia in Cataract Surgery
  Not yet recruiting · Interventional · 100 enrolled · Sohag University
  NCT07298746updated 2025-12-23

Frequently asked questions

How does Mepivacaine work?

Mechanism-of-action class: Sodium Channel Interactions.

What is Mepivacaine used for?

According to FDA labeling, Mepivacaine carries indications including: Mepivacaine is indicated for production of local anesthesia for dental procedures by infiltration or nerve block in adults and pediatric patients.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Mepivacaine?

Mepivacaine is classified as Amides, Amide Local Anesthetic, Sodium Channel Interactions, Decreased Organized Electrical Activity, Local Anesthesia.

What are the brand names for Mepivacaine?

Mepivacaine is marketed under brand names including Carbocaine, Carbocaine with NeoCobefrin, Polocaine, Scandonest.

What are the contraindications for Mepivacaine?

Mepivacaine labeling lists contraindications including: Mepivacaine is contraindicated in patients with a known hypersensitivity to amide-type local anesthetics.. Always consult the full prescribing information and a clinician.