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Polocaine
mepivacaine
Adult Dosing .
Dosage forms: INJ (1%): 10 mg per mL; INJ (1.5%): 15 mg per mL; INJ (2%): 20 mg per mL
Dosage Form Details
- [formulation clarification]
- Info: some concentrations methylparaben-free (MPF)
local anesthesia
- [infiltration]
- Dose: up to 400 mg/total dose (0.5% or 1%) via infiltration; Max: 400 mg/total dose; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
regional anesthesia
- [peripheral nerve block, cervical]
- Dose: 50-400 mg/total dose (1%) perineurally; Max: 400 mg/total dose; Alt: 100-400 mg/total dose (2%) perineurally; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [peripheral nerve block, brachial]
- Dose: 50-400 mg/total dose (1%) perineurally; Max: 400 mg/total dose; Alt: 100-400 mg/total dose (2%) perineurally; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [peripheral nerve block, intercostal]
- Dose: 50-400 mg/total dose (1%) perineurally; Max: 400 mg/total dose; Alt: 100-400 mg/total dose (2%) perineurally; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [peripheral nerve block, pudendal]
- Dose: 25-200 mg (1%) perineurally x1 on each of 2 sides; Max: 400 mg/total dose; Alt: 50-200 mg (2%) perineurally x1 on each of 2 sides; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [peripheral nerve block, transvaginal]
- Dose: up to 300 mg/total dose (1%) both sides perineurally; Max: 400 mg/total dose; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [peripheral nerve block, paracervical]
- Dose: up to 200 mg/total dose (1%) both sides perineurally; Max: 400 mg/total dose; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [caudal block]
- Dose: 150-300 mg/total dose (1% MPF) intracaudally; Max: 400 mg/total dose; Alt: 150-375 mg/total dose (1.5% MPF) intracaudally; 200-400 mg/total dose (2% MPF) intracaudally; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [lumbar block]
- Dose: 150-300 mg/total dose (1% MPF) epidurally; Max: 400 mg/total dose; Alt: 150-375 mg/total dose (1.5% MPF) epidurally; 200-400 mg/total dose (2% MPF) epidurally; Info: give epidural test dose before initial full dose and any repeat full doses; onset 3-5min, peak 15-45min, duration 0.75-1.5h
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ (1%): 10 mg per mL; INJ (1.5%): 15 mg per mL; INJ (2%): 20 mg per mL
Dosage Form Details
- [formulation clarification]
- Info: some concentrations preservative-free (MPF)
local anesthesia
- [infiltration]
- Dose: varies by procedure (0.5% or 1%); Max: 5-6 mg/kg/total dose; Info: onset 3-5min, peak 15-45min, duration 0.75-1.5h
regional anesthesia
- [peripheral nerve block]
- Dose: varies by procedure (1% or 2%); Max: 5-6 mg/kg/total dose; Info: avoid concentrations >1.5% if <3 yo or <13.6 kg; onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [caudal block]
- Dose: varies by procedure (1% MPF, 1.5% MPF, or 2% MPF); Max: 5-6 mg/kg/total dose; Info: avoid concentrations >1.5% if <3 yo or <13.6 kg; onset 3-5min, peak 15-45min, duration 0.75-1.5h
- [lumbar block]
- Dose: varies by procedure (1% MPF, 1.5% MPF, or 2% MPF); Max: 5-6 mg/kg/total dose; Info: avoid concentrations >1.5% if <3 yo or <13.6 kg; give epidural test dose before initial full dose and any repeat full doses; onset 3-5min, peak 15-45min, duration 0.75-1.5h
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to amide anesthetics
- intra-articular continuous infusion use
- intrathecal use
- caudal use (methylparaben-containing form)
- epidural use (methylparaben-containing form)
- caution: elderly patients
- caution: debilitated patients
- caution: illness, acute
- caution: renal impairment
- caution: hepatic impairment
- caution: cardiac impairment
- caution: pulmonary impairment
- caution: G6PD deficiency
- caution: head administration
- caution: neck administration
Drug Interactions .
Overview
mepivacaine
local anesthetic
- bradycardia
- displaces liposomal agent
- hypotensive effects
- methemoglobinemia
- potentiates neuromuscular blockade
Contraindicated
- lidocaine topical
- prilocaine topical
Avoid/Use Alternative
- aldesleukin
- brigatinib
- bupivacaine
- bupivacaine liposomal
- ceritinib
- crizotinib
- etrasimod
- fexinidazole
- fingolimod
- landiolol
- lofexidine
- ozanimod
- ponesimod
- primaquine
- siponimod
Monitor/Modify Tx
- acebutolol
- adenosine
- alectinib
- alfentanil
- alfuzosin
- aliskiren
- alprostadil intracavernous
- amantadine
- amifostine
- amiloride
- amiodarone
- amitriptyline
- amlodipine
- amoxapine
- apomorphine
- apraclonidine ophthalmic
- aprocitentan
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- articaine
- asenapine
- atazanavir
- atenolol
- atracurium
- avanafil
- azilsartan medoxomil
- benazepril
- berberine
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bexagliflozin
- bisoprolol
- bortezomib
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- bumetanide
- buprenorphine
- butorphanol
- cabergoline
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carbamazepine
- cariprazine
- carteolol ophthalmic
- carvedilol
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- cisatracurium
- clevidipine
- clofarabine
- clomipramine
- clonidine
- clozapine
- codeine
- coenzyme Q-10
- dapagliflozin
- denileukin diftitox
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- digoxin
- dihydrocodeine
- diltiazem
- dinutuximab
- dipyridamole
- disopyramide
- donepezil
- doxazosin
- doxepin
- dronabinol
- dronedarone
- dulaglutide
- duloxetine
- eliglustat
- empagliflozin
- enalapril
- enalaprilat
- ensartinib
- entacapone
- entrectinib
- eplerenone
- epoprostenol
- ertugliflozin
- esmolol
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethanol injection
- etripamil nasal
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- flaxseed
- flecainide
- flibanserin
- fluphenazine
- flutamide
- fosinopril
- foslevodopa
- fosphenytoin
- furosemide
- gadobenate dimeglumine
- galantamine
- garlic
- gilteritinib
- guanfacine
- haloperidol
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydromorphone
- iloperidone
- iloprost
- imipramine
- indapamide
- irbesartan
- iron sucrose
- isocarboxazid
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ivabradine
- labetalol
- lacosamide
- lamotrigine
- lanreotide
- levobunolol ophthalmic
- levodopa
- levorphanol
- lidocaine
- lisinopril
- lopinavir/ritonavir
- lorlatinib
- losartan
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- magnesium sulfate
- maraviroc
- mefloquine
- meperidine
- methadone
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- midazolam
- midodrine
- milrinone
- milsaperidone
- minoxidil
- mirtazapine
- moexipril
- molindone
- morphine
- nadolol
- nalbuphine
- nattokinase
- naxitamab
- nebivolol
- neostigmine
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obinutuzumab
- octreotide
- olanzapine
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- palopegteriparatide
- paltusotine
- pasireotide
- pentamidine
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenelzine
- phenobarbital
- phenoxybenzamine
- phentolamine
- phenytoin
- pindolol
- pramipexole
- praziquantel
- prazosin
- procainamide
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- propranolol
- protriptyline
- pyridostigmine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- quinine
- ramipril
- rasagiline
- regadenoson
- remifentanil
- remimazolam
- riociguat
- risperidone
- ritonavir
- rivastigmine
- rocuronium
- ropinirole
- ropivacaine
- rotigotine transdermal
- sacubitril
- safinamide
- selegiline
- selegiline transdermal
- sevoflurane
- sildenafil
- silodosin
- sodium ferric gluconate complex
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- succinylcholine
- sufentanil
- sugammadex
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- terazosin
- thalidomide
- thioridazine
- thiothixene
- ticagrelor
- timolol
- timolol ophthalmic
- tizanidine
- tolcapone
- torsemide
- tramadol
- trandolapril
- tranylcypromine
- trazodone
- treprostinil
- triamterene
- trifluoperazine
- trimipramine
- valsartan
- vardenafil
- vecuronium
- verapamil
- vosoritide
- yohimbe
- ziprasidone
Caution Advised
- acetaminophen
- benzocaine topical
- butamben
- chloroquine
- cyclophosphamide
- dapsone
- dapsone topical
- hydroxyurea
- ifosfamide
- metoclopramide
- nitrofurantoin
- phenazopyridine
- procaine
- rasburicase
- resorcinol topical
- sulfadiazine
- sulfamethoxazole
- sulfasalazine
- tafenoquine
- tetracaine
Adverse Reactions .
Serious Reactions
- CNS toxicity
- seizures
- respiratory arrest
- cardiac arrest
- heart block
- bradycardia
- ventricular arrhythmia
- hypotension, severe
- local anesthetic systemic toxicity (LAST), rapid or delayed onset
- anaphylactoid reaction
- methemoglobinemia
Common Reactions
- hypotension
- nausea
- vomiting
- paresthesia
- pain
- bradycardia
- headache
- fever
- rigors
- dizziness
- injection site burning
- pruritus
- drowsiness
- restlessness
- anxiety
- blurred vision
- tinnitus
- tremor
Safety/Monitoring .
Monitoring Parameters
ECG; pulse oximetry; vital signs; neurological status
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 1st and 3rd trimesters; risk of teratogenicity and possible risk of neonatal behavioral abnormalities based on limited human data
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm low based on drug properties; inadequate human data available to assess effects on milk production
Pharmacology .
Metabolism: for mepivacaine: liver; CYP450: unknown
Excretion: for mepivacaine: urine primarily (5-10% unchanged); Half-life: 1.9-3.2h
Subclass: Anesthetics, Local
Mechanism of Action
for mepivacaine: inhibits Na ion channels, stabilizing neuronal cell membranes and inhibiting nerve impulse initiation and conduction (amide local anesthetic)
Formulary .
No Formulary Selected
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