RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN (RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN).
Ravocaine (propoxycaine) and Novocain (procaine) are ester-type local anesthetics that block voltage-gated sodium channels, inhibiting nerve impulse conduction. Neo-Cobefrin (levonordefrin) is a vasoconstrictor that acts on alpha-adrenergic receptors, causing local vasoconstriction to prolong anesthesia.
| Metabolism | Primarily hydrolyzed by plasma pseudocholinesterase (butyrylcholinesterase) to para-aminobenzoic acid (PABA) and diethylaminoethanol. |
| Excretion | Renal excretion of metabolites (>90% as para-aminobenzoic acid and other conjugates); <10% unchanged |
| Half-life | Procaine: 40–84 seconds (plasma ester hydrolysis); 2-(diethylamino)ethanol metabolite: 2–4 hours; Levonordefrin: ~2 hours |
| Protein binding | Procaine: ~5.8% (primarily albumin); Levonordefrin: minimal binding |
| Volume of Distribution | Procaine: 0.7–1.0 L/kg (rapid distribution); Levonordefrin: ~0.5 L/kg |
| Bioavailability | Oral: negligible (first-pass hydrolysis); Intravenous: 100% (not used); Infiltration/nerve block: essentially 100% at site |
| Onset of Action | Infiltration: 2–5 minutes; Nerve block: 5–15 minutes; Epidural: 10–15 minutes |
| Duration of Action | Infiltration: 30–60 minutes (with levonordefrin: 60–90 minutes); Nerve block: 30–90 minutes; Dental use: 60–120 minutes (due to vasoconstrictor) |
| Molecular Weight | 272.4 Da (for RAVOCAINE active component), 236.3 Da (NOVOCAIN), and 271.5 Da (NEO-COBEFRIN) per component. |
Local infiltration or nerve block: 1-7 mL of 2% solution (20 mg/mL lidocaine equivalent) with epinephrine 1:100,000, maximum dose 7 mg/kg (actual lidocaine) or 500 mg per procedure, not to exceed 3.5 mg/kg plain or 7 mg/kg with epinephrine in adults.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment is needed for impaired renal function as local anesthetics are hepatically metabolized. However, monitor for accumulation of metabolites in severe renal impairment (GFR <30 mL/min). |
| Liver impairment | Severe hepatic impairment (Child-Pugh Class C): Reduce dose by 50% and monitor for toxicity. Moderate impairment (Child-Pugh B): Use with caution, consider reducing dose. Mild impairment (Child-Pugh A): No adjustment required. |
| Pediatric use | Weight-based: 1-2 mg/kg actual lidocaine per injection site, maximum 4.5 mg/kg (with epinephrine) total dose, not to exceed 4 mg/kg plain. Individual doses should be adjusted based on age, weight, and procedure. |
| Geriatric use | Elderly patients may require lower doses due to decreased clearance, reduced hepatic blood flow, and increased sensitivity. Start at the low end of the dosing range and titrate carefully to effect. Maximum dose 5-7 mg/kg with epinephrine, not to exceed 400 mg per procedure. |
| 1st trimester | Avoid use in first trimester due to potential teratogenicity (animal studies show fetal toxicity). |
| 2nd trimester | Use only if clearly needed; may cause uterine artery constriction and fetal bradycardia. |
| 3rd trimester | Use with caution; may induce preterm labor or fetal bradycardia. Avoid in preeclampsia. |
Clinical note
Comprehensive clinical and safety monograph for RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN (RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN).
| Placental transfer | Rapidly crosses placenta; extent depends on protein binding and ionization. |
| Breastfeeding | Excreted into breast milk in low amounts; unlikely to harm infant. Monitor for irritability or feeding difficulties. |
| Lactation Rating |
■ FDA Black Box Warning
Not available
| Serious Effects |
Hypersensitivity to any componentSevere hypotension or hypertensionCardiac decompensationConcurrent use of MAO inhibitors or tricyclic antidepressantsCocaine abuse (additive cardiotoxicity)
| Precautions | Risk of methemoglobinemia, especially with high doses or in patients with glucose-6-phosphate dehydrogenase deficiency., Avoid intravascular injection to prevent systemic toxicity., Use caution in patients with cardiovascular disease, as vasoconstrictors may increase heart rate and blood pressure. |
| Food/Dietary | No specific food interactions are reported for this combination. However, patients should avoid consuming food or beverages until numbness resolves to prevent injury. |
Loading safety data…
| L3 (Moderately Safe) |
| Teratogenic Risk | Lidocaine (Ravocaine) and procaine (Novocain) are classified as FDA Pregnancy Category B. Animal studies have not shown fetal harm; however, no adequate human studies exist. Epinephrine (Neo-Cobefrin) may reduce uterine blood flow; use caution in 2nd and 3rd trimesters. Avoid in 1st trimester unless necessary. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, and ECG for arrhythmias. Fetal heart rate monitoring recommended if high doses used or if signs of toxicity. Assess for maternal seizures or CNS depression. |
| Fertility Effects | No known adverse effects on fertility in humans. Animal studies show no impairment. |
| Clinical Pearls | RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN is a combination of procaine (Novocain) and levonordefrin (Neo-Cobefrin) used for local anesthesia. Levonordefrin is a vasoconstrictor that prolongs the effect of procaine. Avoid use in patients with severe hypertension, hyperthyroidism, or on MAOIs due to risk of hypertensive crisis. Procaine has a shorter duration than lidocaine, and levonordefrin is less potent than epinephrine. For dental procedures, use with caution in patients with sulfite allergy (levonordefrin may contain sulfites). |
| Patient Advice | This medication is a local anesthetic used to numb a specific area for procedures. · You may feel a burning sensation during injection that quickly subsides. · Avoid eating or drinking until numbness has fully worn off to prevent accidental biting. · If you experience chest pain, severe headache, or rapid heartbeat, seek immediate medical attention. · Tell your dentist or doctor if you have high blood pressure, thyroid problems, or are taking antidepressants. |