Citanest and Prilocaine

From Chris Wheeler

Those who prefer to use 2.2ml dental cartridges when administering a local anaesthetic will be well aware that lignocaine is no longer available as a plain solution.  Lignocaine with adrenaline (usually 1 in 80,000) continues to be available from the usual suppliers.  There has long been discussion about the wisdom of using vasoconstrictors with end arteries such as the toes.  An alternative to lignocaine is prilocaine 3.4% plain (Citanest 4% dental).  Unfortunately as you may know the sole supplier of this in Australia, Dentsply has been unable to have a sufficient supply to meet the needs of Australia’s dentists and thus podiatrists Dentsply ph no is: 1300 552 929 re order no 00804 for prilocaine 3.4% plain, When available, prilocaine  is sold in a box of 100 cartridges.  

The reason for this drought as I understand is that the Australian market for lignocaine plain was too small for that manufacturer (Astra Pharmaceuticals) to continue.  Dentsply apparently moved their manufacturing base for prilocaine from Australia to America.  As I found out some months ago, supplies of prilocaine were to return to normal in July of this year after some three months absence.  Unfortunately the back orders exceeded Dentsply’s ability to supply same.  This situation caused me, as I was reluctant to return to drawing up solutions of lignocaine in the more traditional way, to source another supplier.  My investigations have taken me to Henry Schein Regional, (8 Michael St, Brunswick. Ph 1300 360 324).  They sell mepivacaine hydrochloride 66mg in 2.2mls (otherwise known as Scandonest 3%)  (The re order no of Scandonest 3% plain through Henry Schein Regional is ST 4049). Without vasoconstrictors, mepivacaine has a similar action to  prilocaine and lignocaine is the same but interestingly, the Scandonest 3%, which is delivered in boxes of fifty cartridges is cheaper (say $70 for 100 where as Citanest is $110 per 100 as was lignocaine.  It is a requirement of Henry Schein Regional and Dentsply that an aspiring purchaser must register as an account holder.  This they do to (supposedly) ensure that you have the legal authority to use this medication.  

It is noteworthy that I expect that I shall continue using mepivacaine instead of citanest when the citanest drought is resolved because I estimate that one third to one half of all patients for whom I injected citanest reported some ongoing paresthesia around the site of the injection and sometimes distally in the toe.  This has continued for at least one month in one case.  One patient developed localised necrosis at the injection sites.  I raised this matter with a local dentist who said that it is known in dental literature that tissue toxicity can occur with prilocaine. It is assumed this is caused by the relatively high strength of this form of prilocaine that is causing these problems.  It is also worthwhile asking to receive a copy of their most recent catalogue which, whilst currently out of date, for podiatric needs is quite adequate provided allowances are made for changes in price.