mepivacaine

Mepivacaine is a prescription medication used for infiltration anesthesia and nerve blocks such as an epidural or spinal block.

Contraindications

• Hypersensitivity to mepivacaine or amide anesthetics, sensitivity to parabens

Effects of drug abuse

• None

Cautions

• Some formulations may contain sulfites
• History of malignant hyperthermia
• Monitor the patient's state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity
• DO NOT use solutions with epinephrine in distal areas of the body (.g, digit, nose, ear)
• Respiratory arrest reported with the use
• An unintentional intravascular injection may result in seizures
• The addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase the duration of action
• Risk of chondrolysis if receiving continuous intra-articular infusion following arthroscopic or other surgical procedures

Methemoglobinemia

• Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
• Advise patients or caregivers to seek immediate medical attention if the patient experiences the following signs or symptoms: pale, gray, or blue-colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue the drug and any other oxidizing agents; depending on the severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen

Common side effects of mepivacaine include:

• Anxiety,
• Restlessness,
• Excitement,
• Depression,
• Dizziness,
• Tremors,
• Blurred vision, and
• Ringing in your ears

Serious side effects of mepivacaine include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Skin redness,
• Nausea,
• Vomiting,
• Sweating,
• Feeling hot,
• Fast heartbeats,
• Sneezing,
• Dizziness,
• Fainting,
• Numbness and tingling in the mouth or lips,
• Metallic taste in the mouth,
• Ringing in the ears,
• Blurred vision,
• Slurred speech,
• Headache,
• Confusion,
• Depression,
• Severe drowsiness,
• Lightheadedness,
• Slow heart rate,
• Weak pulse,
• Shallow breathing,
• Fever,
• Neck stiffness,
• Increased sensitivity to light,
• Tremors or muscle twitching,
• Anxiety,
• Restlessness,
• Ongoing numbness,
• Weakness,
• Loss of movement in the legs or feet,
• Loss of bladder or bowel control,
• Loss of feeling in the lower stomach, groin, or genitals,
• Painful or difficult urination,
• Fast heart rate,
• Rapid breathing, and
• Feeling hot

Rare side effects of mepivacaine include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Injectable solution

• 1%
• 1.5%
• 2%
• 3%

Infiltration Anesthesia

Adult dosage

• Up to 400 mg (80 mL of 0.5% or 40 mL of 1% solution)

Cervical/Brachial/Intercostal or Pudendal Block

Adult dosage

• 50-400 mg (5-40 mL) of 1% or 100-400 mg (5-20 mL) 2% solution; for pudendal block inject one-half total dose on each side; not to exceed 400 mg

Transvaginal Block

Adult dosage

• Up to 300 mg (30 mL of 1% solution); inject one-half total dose on each side; not to exceed 300 mg

Paracervical Block

Adult dosage

• Up to 200 mg (20 mL of 1% solution); inject one-half total dose on each side; not to exceed 200 mg

Pediatric dosage

Administration

• Below 3 years or below 13.6 kg: Not to exceed 5-6 mg/kg/dose; administer below 2% concentration solution only

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Mepivacaine has severe interactions with the following drug:
  • bupivacaine liposome
• Mepivacaine has serious interactions with the following drug:
  • bupivacaine implant
• Mepivacaine has moderate interactions with the following drugs
  • nadolol
  • pindolol
  • propranolol
  • timolol
• Mepivacaine has minor interactions with the following drug:
  • hyaluronidase

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. 

Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Pregnancy and Lactation

• Use with caution if the benefits outweigh the risks during pregnancy.

Lactation

• Not known if excreted in breast milk