Mepivacaine

Local anesthetics
Local anesthetics
Pregnancy: avoid
It is not used for obstetric anaesthesia because of toxicity in the newborn; other dental use in pregnancy is weighed case by case.

Intermediate-acting amide local anaesthetic, similar to lidocaine, widely used in dentistry. Avoided in obstetrics because of neonatal toxicity.

Updated Nov 1, 2026

Also called: Mepivacaine hydrochloride

Quick facts

Group: Local anesthetics
Target: Voltage-gated sodium channels (Nav)
Used for: Dental anaesthesia by infiltration
Key effects: Numbness lasting beyond the procedure
Monitor: Heart rate · Early signs of toxicity
ATC: N01BB03

No doses: the clinician sets them by the current guideline.

Mechanism of action

Voltage-gated sodium channels (Nav)Mepivacaine

There is no structure with mepivacaine. The figure shows levobupivacaine, a closely related pipecoloxylidide amide, in the inner pore of the human Nav1.7 sodium channel.

Target in 3D: Voltage-gated sodium channels (Nav). PDB structure 8I5B (RCSB PDB, public domain). View the structure at RCSB PDB

Mepivacaine is an amide local anaesthetic that blocks voltage-gated sodium channels from the inside of the axon, so no action potential and no pain signal pass the block. Its properties resemble those of lidocaine, with a slightly longer action, and it is not destroyed by plasma esterases. It does not work topically. In the newborn, whose blood is more acidic, it becomes trapped in its ionised form, which explains its neonatal toxicity.

Injected next to the nerve, with or without vasoconstrictor
Blocks the sodium channel from inside
No action potential: no pain signal
Cleared by the liver, not by plasma esterases

Indications

Dental anaesthesia by infiltration or nerve block in adults and children
Infiltration and peripheral nerve blocks

Adverse effects

Common

Numbness lasting beyond the procedure, with risk of biting the lips or tongue
Early CNS signs: restlessness, dizziness, tinnitus, drowsiness
Fainting from vasovagal reactions in the dental chair

Contraindications

Hypersensitivity to amide-type local anaesthetics
Sulfite hypersensitivity, for solutions that contain a vasoconstrictor and sulfite

Key interactions

Drugs that cause methaemoglobinaemia (nitrates, dapsone, sulfonamides and others): Higher risk of methaemoglobinaemia.
Other local anaesthetics: Additive systemic toxicity.

What is monitored

Heart rate, blood pressure, breathing and consciousness after the injection
Early signs of toxicity
Lip and nail-bed colour (methaemoglobinaemia)

Administration and safety

Dental cartridges are for dental use only and are not autoclaved.
Aspirate and inject slowly; repeated doses can accumulate.
Resuscitation equipment and oxygen are kept available.
A plain solution without vasoconstrictor and one with vasoconstrictor exist: check the label.

Pregnancy and breastfeeding

It is not used for obstetric anaesthesia because of toxicity in the newborn; other dental use in pregnancy is weighed case by case.

Nursing care

Ask about local anaesthetic or sulfite allergy and about drugs that cause methaemoglobinaemia.
Warn the patient not to eat or chew until sensation returns.
Watch for fainting, especially with the patient seated.
Teach the signs of methaemoglobinaemia: blue lips or nails, fatigue, weakness.

Pharmacokinetics

Metabolism: Rapid hepatic metabolism; not hydrolysed by plasma esterases.
Elimination: Kidney, mostly as metabolites; a small fraction unchanged.
Onset and duration: Rapid in dental blocks, slightly faster in the upper jaw than in the lower.

Test yourself

Think of the answer, then tap the question to see it.

Why is mepivacaine avoided in obstetric anaesthesia?

It is more toxic to the neonate: the lower pH of neonatal blood traps it in its ionised form.

How does mepivacaine compare with lidocaine?

Similar properties and onset, with a slightly longer duration; unlike lidocaine it is not effective topically.

Is mepivacaine broken down by plasma esterases?

No; as an amide it is metabolised in the liver.

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Connections

← Back to the class: Local anesthetics

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - MEPIVACAINE HYDROCHLORIDE injection, solution (DailyMed (U.S. National Library of Medicine), 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.