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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SCANDONEST L (SCANDONEST L).
| Breastfeeding | Lidocaine enters breast milk in low amounts (M/P ratio ~0.4). Oral bioavailability in infant is poor due to first-pass metabolism. Considered compatible with breastfeeding; monitor for infant sedation if high doses used. |
| 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 |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to mepivacaine or other amide anesthetics","Severe hypotension","Complete heart block","Severe hepatic disease"]
| 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"] |
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| 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. |