Adrenaline with articaine hydrochloride

How it works

Articaine reversibly blocks voltage-gated sodium channels in nerve fibres to prevent impulse conduction, while the added adrenaline causes local vasoconstriction that prolongs anaesthesia and reduces systemic absorption of the local anaesthetic.

Prescribing in practice

• Avoid inadvertent intravascular injection, which can cause systemic local-anaesthetic and adrenaline toxicity; aspirate before injecting and use the lowest effective volume.
• The adrenaline component warrants caution in cardiovascular disease, hyperthyroidism and in patients taking tricyclic antidepressants or non-selective beta-blockers, where pressor effects may be exaggerated.
• Articaine is metabolised largely by plasma esterases; use cautiously where there is methaemoglobinaemia risk and follow the SPC for population-specific limits.

Monitoring

Observe the patient during and after injection for signs of systemic toxicity, vasovagal reactions or excessive cardiovascular stimulation.

Counselling the patient

• Numbness of the lips, tongue and cheek will persist for some time after the procedure, so avoid biting the area or taking hot drinks until sensation returns.
• Report palpitations, dizziness or feeling faint promptly.

Evidence & guidelines

Use is supported by established dental anaesthesia practice and the product SPC; articaine with adrenaline is a widely used dental local anaesthetic.