SCANDONEST L
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SCANDONEST L (SCANDONEST L).
Scandonest L (mepivacaine hydrochloride) is an amide-type local anesthetic that stabilizes neuronal membranes by inhibiting sodium ion influx across the membrane, thereby blocking nerve impulse initiation and conduction.
| Metabolism | Primarily hepatic via N-demethylation by CYP1A2 and CYP2D6; less than 10% excreted unchanged in urine. |
| Excretion | Primarily hepatic metabolism (approx. 90%) via amidase hydrolysis and aromatic hydroxylation; renal excretion of unchanged drug accounts for <5% of the dose; less than 1% excreted in feces. |
| Half-life | Terminal elimination half-life is 1.5–2.0 hours in healthy adults; prolonged to 3–5 hours in patients with hepatic impairment or severe renal disease. |
| Protein binding | Approximately 55% bound to plasma proteins, primarily alpha-1-acid glycoprotein. |
| Volume of Distribution | 1.0–1.5 L/kg; distribution is rapid and extensive reflecting high tissue uptake, particularly in well-perfused organs. |
| Bioavailability | Not applicable for intravenously administered local anesthetics; after oral administration, extensive first-pass metabolism reduces systemic bioavailability to <30% (not clinically used orally). |
| Onset of Action | Infiltration: 2–4 minutes; peripheral nerve block: 5–15 minutes; epidural: 10–20 minutes. |
| Duration of Action | Infiltration: 30–90 minutes (without epinephrine); peripheral nerve block: 60–120 minutes; epidural: 60–90 minutes; duration is extended 50–100% with epinephrine. |
| Molecular Weight | 220.31 |
Dental infiltration or nerve block: 1.3 mL of 3% solution (isocaine) per site; maximum 9 mg/kg (0.3 mL/kg) per session. Infiltration: 0.5-1.0 mL; nerve block: 1.0-1.3 mL.
| Dosage form | INJECTABLE |
| Renal impairment | GFR < 60 mL/min: caution, reduce dose by 50% due to potential accumulation of metabolites; GFR < 15 mL/min: avoid or use with extreme caution. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated. |
| Pediatric use | Weight-based: mepivacaine HCl 3% (scandonesT L) for dental use: maximum 4.5 mg/kg (0.15 mL/kg) per session; maximum absolute dose 300 mg. |
| Geriatric use | Reduce dose by 20-30% due to decreased hepatic metabolism and increased sensitivity; maximum dose 6 mg/kg; monitor for CNS and cardiovascular effects. |
| 1st trimester | Limited data; avoid unless clearly needed. Animal studies show risk, human data inadequate. |
| 2nd trimester | Use only if clearly indicated; no known specific risk but caution advised. |
| 3rd trimester | Avoid near term due to potential neonatal CNS depression and bradycardia. |
Clinical note
Comprehensive clinical and safety monograph for SCANDONEST L (SCANDONEST L).
| Placental transfer | Crosses placenta; rapid transfer observed. Fetal levels may be similar to maternal. |
| Breastfeeding | Excreted into breast milk in small amounts; unlikely to cause adverse effects in infants. Consider timing feeds to minimize exposure. |
| Lactation Rating |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to amide-type local anestheticsSevere hypotensionThird-degree heart blockCNS depression
| Precautions | Risk of cardiac arrest and respiratory failure with high doses or rapid injection, Monitor cardiovascular and respiratory status during use, Use with caution in patients with impaired cardiovascular function, May cause methemoglobinemia |
| Food/Dietary | No specific food interactions reported with mepivacaine or levonordefrin. However, avoid consuming alcohol or grapefruit juice 24 hours before and after administration due to potential increased side effects such as dizziness or nausea. |
Loading safety data…
| L2 (Safer) |
| Teratogenic Risk | FDA Pregnancy Category B. Animal studies reveal no fetal harm; no adequate human studies in first trimester. Lidocaine crosses placenta; fetal bradycardia risk with paracervical block. No teratogenicity reported at standard doses. |
| Fetal Monitoring | Monitor maternal vital signs, ECG, and level of consciousness during administration. For paracervical block, continuous fetal heart rate monitoring to detect bradycardia. |
| Fertility Effects | No known adverse effects on human fertility from lidocaine use. Animal studies show no impairment of fertility. |
| Clinical Pearls |
| Scandonest L (mepivacaine with levonordefrin) is a local anesthetic with vasoconstrictor. Levonordefrin is a sympathomimetic amine; avoid in patients with severe hypertension, hyperthyroidism, or MAOI use. Onset is 1-2 minutes; duration 1-3 hours. Maximum dose: mepivacaine 6.6 mg/kg (max 400 mg) with levonordefrin 0.25 mg (per standard dilution). Do not exceed 0.5 mg of levonordefrin per appointment. Avoid intravascular injection: aspirate before injection. Use with caution in patients with cardiovascular disease, as levonordefrin may increase heart rate and blood pressure. Scandonest L is contraindicated in patients with hypersensitivity to amide anesthetics or sulfites (contains sodium metabisulfite). |
| Patient Advice | The medication will numb the area for 1-3 hours; avoid eating or drinking until sensation returns to prevent biting your cheek or tongue. · Do not drive or operate machinery if you feel dizzy or drowsy after the procedure. · Report any signs of allergic reaction: rash, itching, swelling, or difficulty breathing. · Inform your dentist or doctor if you have heart disease, high blood pressure, thyroid problems, or are taking MAO inhibitors or tricyclic antidepressants. · Avoid alcohol consumption for at least 24 hours after the procedure as it may increase side effects. |