Comparative Pharmacology
Head-to-head clinical analysis: POLOCAINE W LEVONORDEFRIN versus RAVOCAINE AND NOVOCAIN W LEVOPHED.
Peer-Reviewed Evidence
Head-to-head clinical analysis: POLOCAINE W LEVONORDEFRIN versus RAVOCAINE AND NOVOCAIN W LEVOPHED.
POLOCAINE W/ LEVONORDEFRIN vs RAVOCAINE AND NOVOCAIN W/ LEVOPHED
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Polocaine (mepivacaine) is an amide local anesthetic that blocks sodium ion channels in nerve cell membranes, inhibiting the initiation and conduction of nerve impulses. Levonordefrin is a vasoconstrictor that acts as an alpha-adrenergic agonist, causing local vasoconstriction to reduce systemic absorption of mepivacaine and prolong duration of action.
Stabilizes neuronal membranes by blocking sodium channels, inhibiting initiation and conduction of nerve impulses. Levophed (norepinephrine) is an alpha-adrenergic agonist causing vasoconstriction.
Dental local anesthesia: 1:100,000 epinephrine equivalent. For Polocaine (mepivacaine) 2% with levonordefrin 1:20,000, typical adult dose: 1-3 mL infiltrations or 2-4 mL nerve blocks; maximum 6.8 mg/kg (mepivacaine) or about 5.8 mL of 2% solution for a 70 kg adult. Maximum per session: 20 mL of 2% mepivacaine.
Dental infiltration: 1-2 mL of 2% lidocaine with 1:100,000 epinephrine (max 7 mg/kg or 500 mg total). For NOVOCAIN (procaine) with LEVOPHED (levonordefrin): 1-2 mL of 2% procaine with 1:20,000 levonordefrin, max 600 mg procaine per session.
None Documented
None Documented
Terminal elimination half-life of prilocaine is approximately 1.5 hours (range 1-2 hours); clinically, this correlates with duration of anesthesia for infiltration and nerve block procedures.
Procaine: terminal elimination half-life approximately 40 seconds (rapid plasma hydrolysis); levonordefrin: elimination half-life about 5-10 minutes, clinically brief vasoconstrictor effect.
Renal excretion of unchanged drug and metabolites accounts for >90% of elimination; <2% excreted unchanged in urine; major metabolites are glucuronide and sulfate conjugates excreted renally; biliary excretion is minor.
Renal excretion of unchanged drug and metabolites: procaine <2% unchanged, >80% as para-aminobenzoic acid (PABA) and diethylaminoethanol (DEAE); levonordefrin (Levophed) undergoes hepatic metabolism and renal excretion of metabolites, <5% unchanged.
Category C
Category C
Local Anesthetic Combination
Local Anesthetic Combination