Amide local anaesthetic
Prilocaine hydrochloride
Brand names: Citanest
Adult dose
Dose: Max 6 mg/kg (plain), 8 mg/kg with felypressin; total max 400mg
Route: Infiltration/IV regional
Frequency: single
Clinical pearls
- Drug of choice for IVRA (Bier's block)
- Low cardiotoxicity vs lidocaine; risk of methaemoglobinaemia
Contraindications
- Hypersensitivity to amide anaesthetics
- Methaemoglobinaemia (congenital)
- Severe heart block
Side effects
- Methaemoglobinaemia (dose-related)
- CNS toxicity (high doses)
- Cardiovascular collapse
Interactions
- Other local anaesthetics (cumulative)
- Sulfonamides
Monitoring
- SpO2
- Methaemoglobin if symptomatic
Reference: BNF; AAGBI safe practice; https://bnf.nice.org.uk/drugs/prilocaine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines