SCANDONEST PLAIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SCANDONEST PLAIN (SCANDONEST PLAIN).
Scandonest Plain (mepivacaine) is an amide-type local anesthetic that stabilizes neuronal membranes by binding to voltage-gated sodium channels, inhibiting sodium influx and blocking nerve impulse conduction.
| Metabolism | Hepatic metabolism primarily via CYP1A2 and to a lesser extent CYP3A4; undergoes N-demethylation to inactive metabolites. |
| Excretion | Renal excretion of unchanged drug and metabolites accounts for >95% of elimination; approximately 80% as unchanged mepivacaine and 15% as N-demethylated metabolites; biliary/fecal excretion minimal (<5%). |
| Half-life | Terminal elimination half-life: 1.9–3.2 hours in healthy adults; prolonged to 6–8 hours in hepatic impairment or severe renal disease; clinically meaningful for redosing intervals. |
| Protein binding | Approximately 75–80% bound to plasma proteins, primarily alpha-1-acid glycoprotein and albumin. |
| Volume of Distribution | Volume of distribution: 1–2 L/kg at steady state (Vdss); high Vd indicates extensive tissue distribution, binding to skeletal muscle and adipose tissue. |
| Bioavailability | Bioavailability: 100% following intravenous administration; oral bioavailability not applicable due to extensive first-pass hepatic metabolism (and not used orally). |
| Onset of Action | Onset of clinical effect: infiltration 1–2 minutes; peripheral nerve block 5–15 minutes; epidural 10–20 minutes. |
| Duration of Action | Duration of clinical effect: infiltration 1.5–3 hours; peripheral nerve block 2–4 hours; epidural 1.5–3 hours (dose-dependent and without epinephrine). |
| Molecular Weight | 282.38 |
Dental infiltration: 1-2 mL (20-40 mg mepivacaine). Nerve block: 2-4 mL (40-80 mg). Max dose: 400 mg (approx 7 mg/kg). Do not repeat within 2 hours.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment recommended; use with caution in severe renal impairment (CrCl <30 mL/min) due to potential accumulation of metabolites. |
| Liver impairment | Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50%. Child-Pugh C: Avoid use or use with extreme caution, monitoring for toxicity. |
| Pediatric use | Infiltration or block: Up to 4.4-5.0 mg/kg (max 300 mg). Adjust based on age/weight; reduce doses in younger children. |
| Geriatric use | Reduce initial dose by 20-30% due to decreased clearance and increased sensitivity; monitor for prolonged effect or toxicity. |
| 1st trimester | Use only if clearly needed. No well-controlled studies in pregnant women, but animal studies have not shown fetal harm at clinical doses. |
| 2nd trimester | Use only if clearly needed. Similar to t1, but risk of teratogenicity is lower. |
| 3rd trimester | Use only if clearly needed. May accumulate in fetal tissues; neonatal depression rare with appropriate dosing. |
Clinical note
Comprehensive clinical and safety monograph for SCANDONEST PLAIN (SCANDONEST PLAIN).
| Placental transfer | Mepivacaine readily crosses the placenta. The fetal:maternal ratio is approximately 0.7. Higher umbilical vein concentrations compared to other amide anesthetics may occur; accumulation possible with repeated doses. |
| Breastfeeding | Mepivacaine (present in Scandonest Plain) is excreted into breast milk in small amounts. Although the risk to the nursing infant is considered low, caution should be exercised, especially with repeated doses or high maternal doses. Monitor infant for signs of local anesthetic toxicity. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Known hypersensitivity to mepivacaine or amide-type local anestheticsSevere hypotension or cardiogenic shockMyasthenia gravis (relative, but consider risk of increased weakness)Severe hepatic disease (risk of accumulation)Methemoglobinemia (may exacerbate condition)Intravenous regional anesthesia (Bier block) due to risk of systemic toxicity
| Precautions | Risk of methemoglobinemia, especially in patients with glucose-6-phosphate dehydrogenase deficiency or concurrent use of oxidizing agents, Systemic toxicity can occur if high doses are inadvertently administered intravascularly, Use with caution in patients with hepatic impairment, as metabolism may be reduced, May cause allergic reactions in patients with amide-type local anesthetic hypersensitivity, Avoid use in patients with severe shock or heart block |
| Food/Dietary | No clinically significant food interactions. Avoid eating or drinking until numbness resolves to prevent injury. Caffeine may lower seizure threshold; use with caution in patients consuming high amounts. |
Loading safety data…
| Lactation Rating | L2 - Safer |
| Teratogenic Risk | FDA Pregnancy Category C. No adequate and well-controlled studies in pregnant women. Animal studies have shown fetal harm. Risk cannot be ruled out. First trimester: Limited data, but potential for teratogenicity based on animal studies. Second and third trimesters: May cause fetal bradycardia and acidosis. Use only if benefit outweighs risk. |
| Fetal Monitoring | Monitor maternal vital signs (heart rate, blood pressure), fetal heart rate (continuous electronic monitoring for signs of bradycardia), and maternal ECG for arrhythmias. Assess for signs of systemic toxicity (e.g., neurological symptoms, seizures). |
| Fertility Effects | No specific data on human fertility. Animal studies did not show impaired fertility at clinically relevant doses. Theoretical risk based on anesthetic effects on sperm or oocyte function is low. |
| Clinical Pearls | SCANDONEST PLAIN (mepivacaine HCl) is an amide-type local anesthetic without epinephrine. Its onset is rapid (2-4 min) and duration of moderate action (30-60 min for infiltration, 60-90 min for nerve block). It is contraindicated in patients with hypersensitivity to amide anesthetics, severe hepatic disease, or myasthenia gravis. Use with caution in patients with cardiac disease, as it may cause myocardial depression. For dental procedures, max dose is 300 mg (5.4 mg/kg) for adults; for pediatric, 5-6 mg/kg. Avoid intravascular injection; aspirate before administration. Can cause CNS stimulation followed by depression; treat seizures with benzodiazepines. May cause methemoglobinemia in susceptible patients; use with caution in patients with G6PD deficiency. |
| Patient Advice | You may experience numbness in the injected area, which will resolve as the medication wears off. · Avoid eating or drinking until sensation returns to prevent accidental biting injury. · If you develop a rash, swelling, difficulty breathing, or rapid heart rate after injection, seek emergency medical attention. · Report any persistent pain, infection, or swelling at the injection site to your healthcare provider. · Inform your dentist or doctor of all medications you take, including blood thinners, MAO inhibitors, or other anesthetics. |