Articaine
Septocaine · Ultacan
Amide local anesthetic (with an ester side-group)
Amide LA that uniquely also has a thiophene ester group → partial plasma-esterase metabolism → shorter systemic half-life. Excellent bone/tissue penetration in dentistry.
Indications
- •Dental / oral surgery infiltration + blocks
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Dental | 4% with epinephrine; max 7 mg/kg | — |
Maximum dose
7 mg/kg plain (absolute max 500 mg)
Max-dose calculator
single-injection infiltration / blockPlain
490 mg
| Concentration | Max volume (plain) |
|---|---|
| 4% (40 mg/mL) | 12.3 mL |
Dental use; hybrid amide with an ester side-chain (partial plasma hydrolysis). Education only — confirm against the package insert. Max doses are not additive across agents; account for total LA when mixing.
Pharmacokinetics
Onset fast. Half-life ~20 min (ester side-chain hydrolysis) — shorter systemic exposure than pure amides.
Side effects
- !Methemoglobinemia (high dose)
- !Paresthesia after dental blocks (reported)
- !LAST
Contraindications
- ×Sulfite sensitivity (epi formulations)
Clinical pearls
- ★The dental LA — strong tissue penetration; the ester side-chain shortens systemic half-life despite being an amide.
- ★Almost always used as 4% with epinephrine.
Other drugs in Local Anesthetics
- Lidocaine
Blocks voltage-gated Na⁺ channels in nerves (LA) and cardiac myocytes (antiarrhythmic).
- Bupivacaine
Voltage-gated Na⁺ channel blocker. Higher protein binding and lipid solubility than lidocaine → longer duration but greater cardiotoxicity.
- Ropivacaine
S-enantiomer of propivacaine. Less lipid-soluble than bupivacaine → less cardiotoxicity but slightly less potency.
- Tetracaine
Blocks voltage-gated Na⁺ channels. Long-acting ester, metabolized by plasma cholinesterase. High potency + toxicity.
- Chloroprocaine
Na⁺-channel blocker. Extremely rapid plasma-cholinesterase metabolism (half-life seconds) → lowest systemic toxicity of the LAs, ideal for OB epidural top-up.
- Procaine
Na⁺-channel blocker; prototype ester LA. Plasma-cholinesterase metabolized to PABA.
- Prilocaine
Na⁺-channel blocker. Metabolized to o-toluidine → oxidizes hemoglobin → methemoglobinemia at high doses.
- Levobupivacaine
The S(−)-enantiomer of bupivacaine → similar block with LESS cardiotoxicity + CNS toxicity than racemic bupivacaine.
Browse all classes: /reference/drugs
Suggested reading
- •Stoelting & Hines, Pharmacology & Physiology in Anesthetic Practice, 6e
- •FDA package insert
- •ASRA LAST checklist, 2020
