Ultrakain ds solution for injection cartridge 1,7ml №100

Indications

Infiltration and conduction anesthesia for dental operations:

- uncomplicated removal of one or more teeth;

- treatment of carious cavities of the tooth;

- grinding teeth before prosthetics.

Dosing regimen

The drug is intended for use in the oral cavity and can be administered only in tissues where there is no inflammation. Injection into inflamed tissue should not be given.

The drug should not be administered in / in.

For anesthesia with uncomplicated removal of the teeth of the upper jaw in the absence of inflammation usually it is enough to create a depot of drug Ultracain^® D-C (Ultracain^® D-C forte) in the area of ​​the transitional fold by introducing it into the submucosa from the vestibular side - 1.7 ml of the drug per tooth. In rare cases, additional administration from 1 ml to 1.7 ml may be required to achieve full anesthesia. In most cases, this allows not to carry out painful palatal injections. When removing several adjacent teeth, the number of injections is usually limited.

For anesthesia with cuts and suturing in the sky in order to create a palatine depot You need about 0.1 ml of the drug for each injection.

In case of removal of premolars of the lower jaw in the absence of inflammation you can do without mandibular anesthesia, because infiltration anesthesia is usually sufficient, provided by the injection of 1.7 ml of the drug per tooth. If in this way it was not possible to achieve the desired effect, an additional injection of 1-1.7 ml of the drug into the submucosa in the region of the transitional fold of the mandible from the vestibular side should be performed. If in this case it was not possible to achieve complete anesthesia, it is necessary to conduct a conductive blockade of the mandibular nerve.

When processing cavities and grinding teeth under the crowns, except for the lower molars, depending on the volume and duration of treatment, administration of the drug Ultracain is indicated.^® D-C with a lower content of epinephrine in the region of the transitional fold from the vestibular side in a dose of 0.5-1.7 ml per tooth.

When performing one treatment procedure for adults You can enter articaine in a dose of up to 7 mg per 1 kg of body weight. Patients were well tolerated in doses up to 500 mg (corresponding to 12.5 ml of solution for injection).

Have children over 4 years old the dose of the drug is selected depending on the age and body weight of the child; the dose should not exceed 5 mg of articaine per 1 kg of body weight.

Have elderly patients and patients with severe renal and hepatic impairment It is possible to create elevated plasma concentrations of articaine. In these patients, the drug should be used in the minimum dose necessary to achieve a sufficient depth of anesthesia.

In order to avoid accidental intravascular administration of the drug, an aspiration test should always be carried out before its administration.

Injection pressure should be appropriate for tissue sensitivity.

Side effect

From the side of the central nervous system: dose-dependent reactions - stupor, sometimes progressing to loss of consciousness, respiratory disorders, sometimes progressing to stop breathing, muscle tremor, muscle twitching, sometimes progressing to generalized seizures; possible - dizziness, paresthesia, hypesthesia, transient visual disorders (blurred vision, blindness, double vision), occurring during or after a short time after injection of local anesthetic.

Sometimes, in case of violation of the correct injection technique with the introduction of a local anesthetic in dental practice, nerve damage is possible, in particular, in such cases, damage to the facial nerve, which can lead to the development of facial paralysis.

Often - a headache, mainly due to the presence in the composition of the drug epinephrine.

From the digestive system: nausea, vomiting.

Since the cardiovascular system: decrease in blood pressure, bradycardia, heart failure, shock. Very rarely, due to the content of epinephrine in the composition, tachycardia, heart rhythm disturbances, and an increase in blood pressure are possible.

Allergic reactions: possible - hyperemia of the skin, conjunctivitis, rhinitis and angioedema. Angioedema can be manifested by swelling of the upper and / or lower lips, cheeks, swelling of the vocal cords with a feeling of "lump in the throat" and difficulty swallowing, urticaria, difficulty breathing. Any of these manifestations can progress to anaphylactic shock.

Local reactions: swelling or inflammation of the mucous membrane at the injection site. In some cases, with an accidental intravascular injection, ischemia zones may appear at the injection site, up to tissue necrosis.

Contraindications

- hypersensitivity to articaine or to other local anesthetic agents of the amide type, except for cases when, in case of hypersensitivity to these agents, artikuin allergy was excluded with the help of relevant studies conducted in compliance with all necessary rules and requirements;

- Hypersensitivity to epinephrine;

- Hypersensitivity to auxiliary components of the drug, including to sulfites (including manifested in the form of bronchial asthma).

Contraindications related to articaine

- severe sinus dysfunction or severe conduction disorders (such as severe bradycardia, AV block II and III degree);

- acute decompensated heart failure;

- pronounced arterial hypotension;

- anemia (including in₁₂- deficiency anemia));

- methemoglobinemia;

- hypoxia;

- children's age up to 4 years (lack of clinical experience);

Contraindications related to epinephrine

- paroxysmal tachycardia, tachyarrhythmia;

- angle-closure glaucoma;

- taking non-cardio selective beta-blockers, for example, propranolol (risk of developing hypertensive crisis and severe bradycardia);

- hyperthyroidism;

- pheochromocytoma;

- severe arterial hypertension.

WITH caution the drug should be used in patients with angina pectoris, atherosclerosis, post-infarction cardiosclerosis, cerebral circulation disorders, history of stroke, chronic bronchitis, emphysema, diabetes mellitus, cholinesterase deficiency (use only possible in case of emergency, because prolonged and excessively severe action of the drug), blood clotting disorders, severe liver and kidney dysfunction, marked excitement.

Use during pregnancy and lactation

Artikain penetrates the placental barrier.

Due to the lack of clinical data, a decision on the appointment of a drug by a dentist can be made only if the potential benefit from its use justifies the potential risk to the fetus. If it is necessary to use articaine during pregnancy, it is preferable to use Ultracain.^® D-C with a lower concentration of epinephrine compared with Ultracain preparpate^® D-S Forte or a drug that does not contain it (Ultracain^® D).

During lactation there is no need to interrupt breastfeeding, because no clinically significant concentrations of articain are detected in breast milk.

Application for violations of the liver

Have patients with severe hepatic impairment It is possible to create elevated plasma concentrations of articaine. In these patients, the drug should be used in the minimum dose necessary to achieve a sufficient depth of anesthesia.

WITH caution It should be used in patients with severely impaired liver function.

Application for violations of kidney function

Have patients with severe renal failure It is possible to create elevated plasma concentrations of articaine. In these patients, the drug should be used in the minimum dose necessary to achieve a sufficient depth of anesthesia.

WITH caution the drug should be used in patients with severely impaired renal function.

Use in children

Use in children under 4 years of age is contraindicated (lack of clinical experience).

Use in elderly patients

Have elderly patients It is possible to create elevated plasma concentrations of articaine. In these patients, the drug should be used in the minimum dose necessary to achieve a sufficient depth of anesthesia.

special instructions

The drug should not be administered in / in. It is impossible to carry out an injection in the inflamed area.In order to avoid intravascular administration, an aspiration test should always be carried out.

Injection pressure must match the sensitivity of the tissue.

To prevent infections (including viral hepatitis) from entering, it is necessary to ensure that new sterile syringes and needles are always used when taking the solution from the ampoules. Open cartridges cannot be used again for other patients.

Do not use a damaged cartridge for injection.

In patients with diseases of the cardiovascular system (chronic heart failure, coronary vascular disease, angina pectoris, cardiac rhythm disturbances, history of myocardial infarction, arterial hypertension), cerebrovascular disorders, a history of stroke, chronic bronchitis, heart failure. and also in the presence of expressed concern, it is advisable to use the drug Ultracain^® D, not containing epinephrine.

Eating is possible only after the termination of the local anesthesia (restoration of sensitivity).

Influence on ability to drive motor transport and control mechanisms

Local anesthesia with Ultracain^® D-S, as shown by the tests, does not cause any noticeable deviation from the usual ability to drive and participate in traffic. However, the decision about when the patient after dental surgery can return to driving vehicles and engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions,must take a doctor.

Overdose

Symptoms: the first manifestations of toxic action are dizziness, motor agitation or stupor; possible bradycardia, a sharp decrease in blood pressure, respiratory disorders, muscle twitching, generalized convulsions, severe circulatory disorders, shock.

Treatment: at the first manifestations of symptoms of toxic action during the administration of the drug, it should stop its introduction and transfer the patient to a horizontal position with raised lower limbs. It is necessary to ensure the permeability of the respiratory tract and monitor hemodynamic parameters (heart rate and blood pressure). It is always recommended, even if the symptoms of intoxication seem mild, to put a catheter in / in order, if necessary, to be able to immediately / in the introduction of the necessary medicines.

If breathing is impaired, depending on their severity, oxygen supply is recommended, and if indications for artificial respiration occur, endotracheal intubation and mechanical ventilation are recommended.

The introduction of centrally acting analeptics is contraindicated.

Muscle twitching and generalized convulsions can be stopped by IV injection of short or ultrashort barbiturates. It is recommended to administer these drugs slowly, under constant medical supervision (risk of hemodynamic disorders and respiratory depression) and with simultaneous supply of oxygen and monitoring of hemodynamic parameters.

Often bradycardia or a sharp decrease in blood pressure can be eliminated by simply moving the patient to a horizontal position with raised lower limbs.

In severe circulatory disorders and shock, regardless of their cause, administration of the drug should be discontinued and the patient should be placed in a horizontal position with raised lower limbs. It is necessary to provide oxygen, in / in the introduction of electrolyte solutions, GCS (250-1000 mg of methylprednisolone), if necessary, plasma substitutes, including albumin.

With the development of collapse and the enhancement of bradycardia, slow i / v administration of an epinephrine solution (0.0025–0.1 mg) is shown under the control of heart rate and blood pressure. If necessary, the introduction of doses greater than 0.1 mg, epinephrine should be administered infusion, adjusting the rate of administration under the control of heart rate and blood pressure.

Severe tachycardias and tachyarrhythmias can be stopped by administering antiarrhythmic drugs, with the exception of cardio-selective beta-blockers.

Increased blood pressure in patients with arterial hypertension, if necessary, should be reduced using vasodilators.

Drug interaction

Contraindications

The combination with cardioselective beta-blockers, such as propranolol, is contraindicated. there is a risk of developing hypertensive crisis and severe bradycardia.

Interactions that should be taken into account

It is possible to enhance the action of vasoconstrictors that increase blood pressure, such as epinephrine, while using tricyclic antidepressants or MAO inhibitors . Similar observations have been described for concentrations of norepinephrine 1:25 000 and epinephrine 1:80 000 when used as vasoconstrictors. The concentration of epinephrine in the drug Ultracain^® D-C below - 1: 200 000. However, consider the possibilities of such an increase in the action is necessary.

Local anesthetics enhance the effect of drugs that depress the central nervous system. Opioid analgesics increase the effect of local anesthetics, but increase the risk of respiratory depression.

When conducting injections of the drug Ultracain^® D-C patients receiving Heparin or Acetylsalicylic acid may develop bleeding at the injection site.

Ultracain^® D-C increases the intensity and duration of action of muscle relaxants.

Ultracain^® D-C shows antagonism with respect to the effects on the skeletal muscle with drugs for the treatment of myasthenia, therefore, its use, especially in high doses, requires additional correction of the treatment of myasthenia.

Ultracain^® D-C causes a slowdown in the metabolism of local anesthetic drugs.

When applied simultaneously with cholinesterase inhibitors, the metabolism of local anesthetic drugs slows down.

Epinephrine is able to inhibit the release of insulin from the beta cells of the pancreas and reduce the effects of hypoglycemic agents for oral administration.

Halothane may increase the sensitivity of the heart to catecholamines and therefore increase the risk of developing heart rhythm disorders after injecting Ultracain.^® Ds

When processing the injection site of a local anesthetic with disinfecting solutions containing heavy metals, the risk of developing local reactions - edema, pain increases.

Terms and conditions of storage

List B.

Ampoules should be stored in a dark place at a temperature no higher than 25 ° C.

Cartridges should be stored in a dark place at a temperature no higher than 30 ° C.

The drug should be kept out of the reach of children.