Formulary
Prilocaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Prilocaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Prilocaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Prilocaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Infiltration anaesthesia, Nerve block for Citanest 1%**
- **Child 6 months-11 years** (By regional administration): Up to 5 mg/kg, dose adjusted according to site of administration and response; maximum 400 mg per course.
- **Child 12-17 years** (By regional administration): 100-200 mg/minute, alternatively, may be given in incremental doses; dose adjusted according to site of administration and response; maximum 400 mg per course.
Cautions
Cardiovascular disease; debilitated patients (consider dose reduction); elderly (consider dose reduction); epilepsy; hypovolaemia; impaired cardiac conduction; impaired respiratory function; myasthenia gravis; severe or untreated hypertension; shock
Contraindications
General contra-indications: Acquired methaemoglobinaemia; anaemia; avoid injection into infected tissues; avoid injection into inflamed tissues; congenital methaemoglobinaemia; preparations containing preservatives should not be used for caudal, epidural, or spinal block Specific contra-indications: With intrathecal use Serious cardiac conduction disorders Contra-indications, further information Injection site Manufacturer advises local anaesthetics should not be injected into inflamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.
Side effects
Common or very common Arrhythmias; dizziness; hypertension; hypotension; nausea; paraesthesia; vomiting Uncommon Neurotoxicity Rare or very rare Cardiac arrest; methaemoglobinaemia; nerve disorders Frequency not known Diplopia; respiratory depression Side-effects, further information Toxic effects Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration. Methaemoglobinaemia Methaemoglobinaemia can be treated with an intravenous injection of methylthioninium chloride.
Interactions
**Other interactions (3):**
- Drugs which may predispose to methaemoglobin formation, e.g.
- Prilocaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type anaesthetics, since the toxic effects are additive.
- Specific interaction studies with prilocaine and anti-arrhythmic drugs class III (e.g.
Pregnancy
Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Avoid paracervical or pudendal block in obstetrics (neonatal methaemoglobinaemia reported). Use lower doses for intrathecal use during late pregnancy.
Breast feeding
Present in milk but not known to be harmful.
Hepatic impairment
Manufacturer advises caution. Dose adjustments With intrathecal use: Manufacturer advises consider dose reduction.
Renal impairment
Use with caution. Dose adjustments Lower doses may be required for intrathecal anaesthesia.
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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