Ultracaine D-C, 40 mg+0.005 mg/mL cartridges 1.7 ml 100 pcs

Pharmacodynamics

Ultracaine D-C is a local anesthetic for infiltration and conduction anesthesia in dental practice. It has a fast action (latency period of 1 to 3 minutes).

The duration of anesthesia is at least 75 minutes.

Owing to the low content of epinephrine in the drug, its effect on the cardiovascular system is expressed insignificantly: there is almost no increase in blood pressure and increase in heart rate.

Pharmacokinetics

Binding to plasma proteins of articaine is 95%. After injection into the oral submucosa, the half-life is on average 25 minutes.

The drug penetrates the placental barrier to a minimal extent and is practically not excreted with the breast milk. Articaine is excreted from the body mainly through the kidneys.

Indications

Infiltration and conduction anesthesia in dentistry (including in patients with concomitant severe medical conditions):

Active ingredient

Composition

1 ml of solution for injection contains:

the active ingredients:

articaine hydrochloride – 40 mg and epinephrine hydrochloride – 0.006 mg;

excipients:

Sodium metabisulfite – 0.5 mg,

sodium chloride – 1 mg,

water for injection.

How to take, the dosage

In uncomplicated upper jaw dental extractions in the absence of inflammation, 1.7 ml of Ultracaine D-C (per tooth) is usually injected into the submucosa in the area of the vestibular transition fold.

In rare cases, an additional 1 ml to 1.7 ml is required to achieve complete anesthesia. The painful palatal injection can be dispensed with in most cases.

Anesthesia for palatal incisions and sutures to create a palatal depot requires approximately 0.1 ml of anesthetic per injection. When several adjacent teeth are extracted, the number of injections can usually be limited.

In the case of mandibular premolars without inflammation, mandibular anesthesia can be dispensed with, since the infiltration anesthesia provided by an injection of 1.7 ml per tooth is usually sufficient. If the desired effect is not achieved in this way, an additional injection of 1-1.7 ml of anesthetic into the submucosa in the area of the transition fold of the lower jaw on the vestibular side should be made. If even in this case it was not possible to achieve complete anesthesia, it is necessary to perform a blockade of the mandibular nerve.

In surgical interventions Ultracaine D-S is dosed individually depending on the severity and duration of the intervention. When performing a single therapeutic procedure in adults, up to 7 mg of Ultracaine (articaine) per 1 kg of body weight may be administered. It has been noted that patients tolerated doses up to 500 mg (corresponding to 7 cylindrical ampoules) well.

Intravenous use is contraindicated!

Do not inject into an inflamed area!

Interaction

The effects of blood pressure-increasing vasoconstrictors such as adrenomimetics, such as epinephrine, can be enhanced by tricyclic antidepressants or MAO inhibitors.

Similar observations have been described for concentrations of norepinephrine 1:25000 and epinephrine 1:80000 as vasoconstrictors.

The concentration of epinephrine in Ultracaine D-C is much lower at 1:200000. However, it is necessary to consider the possibility of such enhancement of action.

Special Instructions

In order to avoid intravascular injection, it is fundamentally necessary to perform an aspiration test, for which the Uniject K/Uniject K vario injection syringes are particularly suitable when using cartridges.

The injection pressure must match the sensitivity of the tissue.

In order to prevent infections (including hepatitis), care must be taken to always use new sterile syringes and needles each time a solution is drawn from vials or ampoules. Opened cartridges must not be used again for other patients!

Damaged cartridges must not be used for injections. Maximum safety from glass damage and perfect functioning is ensured by the use of accessories such as syringe holders (infiltration anesthesia: Uniject K or Uniject K vario; intraligamentary anesthesia: Ultraject).

It is not possible to eat until sensitivity returns.

Contraindications

Hypersensitivity to articaine, epinephrine or any other component of the drug.
Since the drug contains epinephrine, it is contraindicated in the following cases:

Do not use in patients with bronchial asthma with hypersensitivity to sulfites.

Side effects

Depending on the dosage, central nervous system disorders may occur:

Overdose

The treatment is symptomatic.

In case of the first signs of adverse effects or intoxication, such as nausea, motor restlessness, confusion during injection, it should be interrupted, the patient should be transferred to a horizontal position, the airway should be cleared, and the pulse and blood pressure should be monitored. It is recommended, even if symptoms do not seem to be too pronounced, to provide intravenous access.

In case of respiratory disorders, depending on the degree of severity, give oxygen, in some cases perform artificial respiration. Central analeptics are contraindicated. Muscle twitches or generalized convulsions are relieved by intravenous injection of barbiturates of short or ultra-short duration.

Decline in blood pressure and tachycardia or bradycardia are often relieved by placing the patient in a horizontal position. In severe circulatory disorders and shock of any genesis after discontinuation of the injection, emergency measures are indicated: ensuring airway patency (oxygen insufflation), intravenous infusion of fluids (electrolyte solution), glucocorticosteroids. Additionally, plasma substitutes, albumin may be administered.

In case of threatening circulatory failure and increasing bradycardia, 0.25 ml to 1 ml of epinephrine is administered. Intravenous injection of epinephrine should be done slowly under control of pulse rate and blood pressure.

The single dose of intravenous injection of epinephrine should not exceed 0.1 mg, subsequently, if necessary, epinephrine can be administered by drip (the rate of infusion through the dropper is adjusted depending on the pulse rate and blood pressure).

Severe forms of tachycardia and tachyarrhythmia can be managed with antiarrhythmic drugs, but non-selective beta-adrenoblockers should not be used. Oxygen supply and circulatory control are necessary in all cases.

In patients with arterial hypertension, peripheral vasodilators should be used if necessary.

Pregnancy use

For surgical interventions during pregnancy, local anesthesia is considered a gentle method of anesthesia. Articaine passes through the placental barrier in smaller amounts than other local anesthetics.

Because of the very rapid drop in and rapid elimination of articaine from the body, it enters the mother’s milk in clinically insignificant amounts. Therefore, interruption of breastfeeding is not necessary.

The efficacy and safety of the drug in children under 4 years of age has not been studied.

Similarities