Drug reference

Prilocaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1448, 1449

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

CITANEST 1% ® Infiltration anaesthesia | Nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: 100–200 mg/minute, alternatively may be given in incremental doses; dose adjusted according to site of administration and response, and in elderly and debilitated patients (smaller doses may be required); maximum 400 mg per course PRILOTEKAL ® Spinal anaesthesia ▶BY INTRATHECAL INJECTION ▶Adult: Usual dose 40–60 mg (max. per dose 80 mg), dose may need to be reduced in elderly or debilitated patients, or in late pregnancy DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.

PDF pages 1448, 1449

Contra Indications

GENERAL CONTRA-INDICATIONS Acquired methaemoglobinaemia. anaemia. avoid injection into infected tissues. avoid injection into inﬂamed tissues. congenital methaemoglobinaemia. preparations containing preservatives should not be used for caudal, epidural, or spinal block SPECIFIC CONTRA-INDICATIONS ▶With intrathecal use Serious cardiac conduction disorders CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises local anaesthetics should not be injected into inﬂamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

PDF page 1449

Cautions

Cardiovascular disease. debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy. hypovolaemia. impaired cardiac conduction. impaired respiratory function. myasthenia gravis. severe or untreated hypertension. shock

PDF page 1449

Allergy And Cross Sensitivity

▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

PDF page 1449

National Funding Access Decisions

PRILOTEKAL ® Scottish Medicines Consortium (SMC) decisions ▶With intrathecal use The Scottish Medicines Consortium has advised (January 2011) that prilocaine 2% hyperbaric solution for injection (Prilotekal ®) is accepted for restricted use within NHS Scotland for use in spinal anaesthesia in ambulatory surgery settings.

PDF page 1449

Safety

Important Safety Information

Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

PDF page 1449

Interactions

→Appendix 1: anaesthetics, local

PDF page 1449

Side Effects

▶Common or very common Arrhythmias. dizziness. hypertension. hypotension. nausea. paraesthesia. vomiting ▶Uncommon Neurotoxicity ▶Rare or very rare Cardiac arrest. methaemoglobinaemia. nerve disorders ▶Frequency not known Diplopia. respiratory depression SIDE-EFFECTS, FURTHER INFORMATION Toxic effects Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration. Methaemoglobinaemia Methaemoglobinaemia can be treated with an intravenous injection of methylthioninium chloride.

PDF page 1449

Pregnancy

Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Avoid paracervical or pudendal block in obstetrics (neonatal methaemoglobinaemia reported). Dose adjustments Use lower doses for intrathecal use during late pregnancy.

PDF page 1449

Breast Feeding

Present in milk but not known to be harmful.

PDF page 1449

Hepatic Impairment

Manufacturer advises caution. Dose adjustments ▶With intrathecal use Manufacturer advises consider dose reduction.

PDF page 1449

Renal Impairment

Use with caution. Dose adjustments Lower doses may be required for intrathecal anaesthesia.

PDF page 1449

Dose and formulations

Medicinal Forms

There can be variation in the licensing of Anaesthesia different medicines containing the same drug. Solution for injection ▶Citanest (Aspen Pharma Trading Ltd) Prilocaine hydrochloride 10 mg per 1 ml Citanest 1% solution for injection 50ml vials | 1 vial P £5.06 ▶Prilotekal (Sintetica Ltd) Prilocaine hydrochloride 20 mg per 1 ml Prilotekal 100mg/5ml solution for injection ampoules | 10 ampoule P £78.80 (Hospital only)

PDF page 1449

Dose text by age group

Adult

100–200 mg/minute, alternatively may be given

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1448

Adult

Usual dose 40–60 mg (max. per dose 80 mg),

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1449

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Prilocaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1448, 1449

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 1448, 1449

Contra Indications

PDF page 1449

Cautions

PDF page 1449

Allergy And Cross Sensitivity

PDF page 1449

National Funding Access Decisions

PDF page 1449

Safety

Important Safety Information

PDF page 1449

Interactions

→Appendix 1: anaesthetics, local

PDF page 1449

Side Effects

PDF page 1449

Pregnancy

PDF page 1449

Breast Feeding

Present in milk but not known to be harmful.

PDF page 1449

Hepatic Impairment

Manufacturer advises caution. Dose adjustments ▶With intrathecal use Manufacturer advises consider dose reduction.

PDF page 1449

Renal Impairment

Use with caution. Dose adjustments Lower doses may be required for intrathecal anaesthesia.

PDF page 1449

Dose and formulations

Medicinal Forms

PDF page 1449

Dose text by age group

Adult

100–200 mg/minute, alternatively may be given

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1448

Adult

Usual dose 40–60 mg (max. per dose 80 mg),

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1449

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.