[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Local anesthetics](https://durgical.com/en/pharmacology/classes/local-anesthetics/) › Mepivacaine # 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](https://durgical.com/en/pharmacology/classes/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. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## 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](https://www.rcsb.org/structure/8I5B) · Drag to rotate · pinch to zoom 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 ### Serious (rare, important) - Systemic toxicity: seizures, respiratory depression, bradycardia and cardiac arrest - Methaemoglobinaemia - Allergic-type reactions to the sulfite in vasoconstrictor-containing solutions - Neonatal toxicity, so it is not used for obstetric anaesthesia ## 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. ## Memory aid MEPIvacaine = «Middle-length, Easy dental, Poor in Infants (newborns)»: lidocaine-like, trapped in acidic neonatal blood. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/mepivacaine/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **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. ## Connections ## Related drugs 3 - [Lidocaine](https://durgical.com/en/pharmacology/lidocaine/) - [Articaine](https://durgical.com/en/pharmacology/articaine/) - [Prilocaine](https://durgical.com/en/pharmacology/prilocaine/) [← Back to the class: Local anesthetics](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a3c2cddc-827b-4644-9060-e2fd2188b459) (DailyMed (U.S. National Library of Medicine), 2024); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01BB03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/mepivacaine/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/mepivacaine/