Ultracain D-Suprarenin

When are you taking this medicine?
advertisement

Ultracain D-Suprarenin uses


1 INDICATIONS AND USAGE

Ultracain D-Suprarenin HCl and Epinephrine is an amide local anesthetic containing a vasoconstrictor indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures.

Ultracain D-Suprarenin HCl and Epinephrine is an amide local anesthetic containing a vasoconstrictor indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures (1).

2 DOSAGE AND ADMINISTRATION

For dental injection by submucosal infiltration and/or nerve block. :


Maximum recommended dosages (2.2):

Adults: 7 mg/kg (0.175 mL/kg)

Children 4-16 years and adults: 7 mg/kg (0.175 mL/kg), depending on the age, weight and magnitude of the operation.

2.1 General Dosing Information

Table 1 (below) summarizes the recommended volumes and concentrations of Ultracain D-Suprarenin HCl and Epinephrine for various types of anesthetic procedures. The dosages suggested in this table are for normal healthy adults, administered by submucosal infiltration or nerve block.

Ultracain D-Suprarenin HCl and Epinephrine Injection
Procedure Volume (mL) Total dose of Ultracain D-Suprarenin HCl (mg)
Infiltration 0.5 mL - 2.5 mL 20 mg - 100 mg
Nerve block 0.5 mL - 3.4 mL 20 mg - 136 mg
Oral surgery 1.0 mL - 5.1 mL 40 mg - 204 mg

The recommended doses serve only as a guide to the amount of anesthetic required for most routine procedures. The actual volumes to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia, degree of muscular relaxation, and condition of the patient. In all cases, the smallest dose that will produce the desired result should be given.

The onset of anesthesia and the duration of anesthesia are proportional to the volume and concentration (i.e., total dose) of local anesthetic used. Caution should be exercised when employing large volumes because the incidence of side effects may be dose-related.

For most routine dental procedures, Ultracain D-Suprarenin HCl and Epinephrine containing epinephrine 1:200,000 is preferred. However, when more pronounced hemostasis or improved visualization of the surgical field are required, Ultracain D-Suprarenin HCl and Epinephrine containing epinephrine 1:100,000 may be used.

2.3 Dosing in Special Populations

Dose reduction may be required in debilitated patients, acutely ill patients, elderly patients, and pediatric patients commensurate with their age and physical condition. No studies have been performed in patients with renal or liver dysfunction. Caution should be used in patients with severe liver disease.

advertisement

3 DOSAGE FORMS AND STRENGTHS

Injection(clear colorless solution), containing:


Injection (clear colorless solution), containing:

4 CONTRAINDICATIONS

Ultracain D-Suprarenin HCl and Epinephrine is contraindicated in patients who are hypersensitive to products containing sulfites. Products containing sulfites may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people .

Known hypersensitivity to sulfite (4)

5 WARNINGS AND PRECAUTIONS

5.1 Accidental Intravascular Injection

Accidental intravascular injection of Ultracain D-Suprarenin HCl and Epinephrine may be associated with convulsions, followed by central nervous system or cardiorespiratory depression and coma, progressing ultimately to respiratory arrest. Dental practitioners who employ local anesthetic agents including Ultracain D-Suprarenin HCl and Epinephrine should be well versed in diagnosis and management of emergencies that may arise from their use. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use. To avoid intravascular injection, aspiration should be performed before Ultracain D-Suprarenin HCl and Epinephrine is injected. The needle must be repositioned until no return of blood can be elicited by aspiration. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided.

Small doses of local anesthetics injected in dental blocks may produce adverse reactions similar to systemic toxicity seen with unintentional intravascular injections of larger doses. Confusion, convulsions, respiratory depression and/or respiratory arrest, and cardiovascular stimulation or depression have been reported. These reactions may be due to intra-arterial injection of the local anesthetic with retrograde flow to the cerebral circulation. Patients receiving these blocks should be observed constantly. Resuscitative equipment and personnel for treating adverse reactions should be immediately available. Dosage recommendations should not be exceeded .

5.2 Systemic Toxicity

This includes toxicity arising from accidental intravascular injection of Ultracain D-Suprarenin HCl and Epinephrine discussed in Section 5.1, as well as that related to higher systemic concentrations of local anesthetics or epinephrine . Systemic absorption of local anesthetics including Ultracain D-Suprarenin HCl and Epinephrine can produce effects on the central nervous and cardiovascular systems.

At blood concentrations achieved with therapeutic doses of Ultracain D-Suprarenin HCl and Epinephrine, changes in cardiac conduction, excitability, refractoriness, contractility, and peripheral vascular resistance are minimal. However, toxic blood concentrations of Ultracain D-Suprarenin HCl and Epinephrine can depress cardiac conduction and excitability, which may lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest, possibly resulting in fatalities. In addition, myocardial contractility is depressed and peripheral vasodilatation occurs, leading to decreased cardiac output and arterial blood pressure. Ultracain D-Suprarenin HCl and Epinephrine should also be used with caution in patients with heart block as well as those with impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs.

Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of central nervous system toxicity.

Careful and constant monitoring of cardiovascular and respiratory (adequacy of ventilation) vital signs and the patient’s state of consciousness should be performed after each local anesthetic injection of Ultracain D-Suprarenin HCl and Epinephrine. Repeated doses of Ultracain D-Suprarenin HCl and Epinephrine may cause significant increases in blood levels because of possible accumulation of the drug or its metabolites. The lowest dosage that results in effective anesthesia should be used to decrease the risk of high plasma levels and serious adverse effects. Tolerance to elevated blood levels varies with the status of the patient. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use. Precautions for epinephrine administration, discussed in Section 5.3 should be observed.

Debilitated patients, elderly patients, acutely ill patients, and pediatric patients should be given reduced doses commensurate with their age and physical condition . No studies have been performed in patients with liver dysfunction, and caution should be used in patients with severe hepatic disease.

5.3 Vasoconstrictor Toxicity

Ultracain D-Suprarenin HCl and Epinephrine contains epinephrine, a vasoconstrictor that can cause local or systemic toxicity and should be used cautiously. Local toxicity may include ischemic injury or necrosis, which may be related to vascular spasm. Ultracain D-Suprarenin HCl and Epinephrine should be used with caution in patients during or following the administration of potent general anesthetic agents, since cardiac arrhythmias may occur under such conditions. Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response.

The American Heart Association has made the following recommendation regarding the use of local anesthetics with vasoconstrictors in patients with ischemic heart disease: "Vasoconstrictor agents should be used in local anesthesia solutions during dental practice only when it is clear that the procedure will be shortened or the analgesia rendered more profound. When a vasoconstrictor is indicated, extreme care should be taken to avoid intravascular injection. The minimum possible amount of vasoconstrictor should be used." (Kaplan, 1986).

It is essential to aspirate before any injection to avoid administration of the drug into the blood stream.

5.4 Methemoglobinemia

Ultracain D-Suprarenin HCl and Epinephrine, like other local anesthetic solutions containing a vasoconstrictor, can cause methemoglobinemia, particularly in conjunction with methemoglobin-inducing agents. Ultracain D-Suprarenin HCl and Epinephrine should not be used in patients with congenital or idiopathic methemoglobinemia, and in patients who are receiving treatment with methemoglobin-inducing agents since they are more susceptible to drug-induced methemoglobinemia.

Signs and symptoms of methemoglobinemia may be delayed some hours after exposure. Initial signs and symptoms of methemoglobinemia include slate grey cyanosis seen in buccal mucous membranes, lips and nail beds. In severe cases, symptoms may include central cyanosis, headache, lethargy, dizziness, fatigue, syncope, dyspnea, CNS depression, seizures, dysrythmia and shock. Methemoglobinemia should be considered if central cyanosis unresponsive to oxygen therapy occurs, especially if methemoglobin-inducing agents have been used. Calculated oxygen saturation and pulse oximetry are inaccurate in the setting of methemoglobinemia. The diagnosis can be confirmed by an elevated methemoglobin level of at least 10% is present. The development of methemoglobinemia is dose-related.

Management of methemoglobinemia : If methemoglobinemia does not respond to administration of oxygen, clinically significant symptoms of methemoglobinemia should be treated with administration of a slow intravenous injection of methylene blue at a dosage of 1-2 mg/kg body weight.

5.5 Anaphylaxis and Allergic-Type Reactions

Ultracain D-Suprarenin HCl and Epinephrine contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people.

advertisement

6 ADVERSE REACTIONS

Reactions to Ultracain D-Suprarenin are characteristic of those associated with other amide local anesthetics. Adverse reactions to this group of drugs may also result from excessive plasma levels, injection technique, volume of injection, or hypersensitivity or they may be idiosyncratic.

The most common adverse reactions (incidence >2%) are headache and pain (6.1).

To report SUSPECTED ADVERSE REACTIONS, contact Pierrel S.p. A. at 610-989-4213 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

6.1 Clinical Studies Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed cannot be directly compared to rates in other clinical trials and may not reflect the rates observed in practice.

The reported adverse events are derived from clinical trials in the United States and the United Kingdom with a similar product containing Ultracain D-Suprarenin and epinephrine. Table 2 displays the adverse events reported in clinical trials where 882 individuals were exposed to Ultracain D-Suprarenin containing epinephrine 1:100,000. Table 3 displays the adverse events reported in clinical trials where 182 individuals were exposed to Ultracain D-Suprarenin containing epinephrine 1:100,000 and 179 individuals were exposed to Ultracain D-Suprarenin containing epinephrine 1:200,000.

Adverse reactions observed in at least 1% of patients:

Body System/Reaction Ultracain D-Suprarenin containing epinephrine 1:100,000 (N=882) Incidence
Body as a whole
Face edema 13 (1%)
Headache 31 (4%)
Infection 10 (1%)
Pain 114 (13%)
Digestive system
Gingivitis 13 (1%)
Nervous system
Paresthesia 11 (1%)
Reaction Ultracain D-Suprarenin with epinephrine 1:200,000 (N=179) Incidence Ultracain D-Suprarenin with epinephrine 1:100,000 (N=182) Incidence
Any adverse event 33 (18%) 35 (19%)
Pain 11 (6.1%) 14 (7.6%)
Headache 9 (5%) 6 (3.2%)
Positive blood aspiration into syringe 3 (1.6%) 6 (3.2%)
Swelling 3 (1.6%) 5 (2.7%)
Trismus 1 (0.3%) 3 (1.6%)
Nausea and emesis 3 (1.6%) 0 (0%)
Sleepiness 2 (1.1%) 1 (0.5%)
Numbness and tingling 1 (0.5%) 2 (1.%)
Palpitation 0 (0%) 2 (1.%)
Ear symptoms (earache, otitis media) 1 (0.5%) 2 (1.%)
Cough, persistent cough 0 (0%) 2 (1.%)

Adverse reactions observed in less than 1% of patients:

Body System Events
Body as a Whole Asthenia; back pain; injection site pain; burning sensation above injection site; malaise; neck pain
Cardiovascular System Hemorrhage; migraine; syncope; tachycardia; elevated blood pressure
Digestive System Dyspepsia; glossitis; gum hemorrhage; mouth ulceration; nausea; stomatitis; tongue edemas; tooth disorder; vomiting
Hemic and Lymphatic System Ecchymosis; lymphadenopathy
Metabolic and Nutritional System Edema; thirst
Musculoskeletal System Arthralgia; myalgia; osteomyelitis
Nervous System Dizziness; dry mouth; facial paralysis; hyperesthesia; increased salivation; nervousness; neuropathy; paresthesia; somnolence; exacerbation of Kearns-Sayre Syndrome
Respiratory System Pharyngitis; rhinitis; sinus pain; sinus congestion
Skin and Appendages Pruritus; skin disorder
Special Senses Ear pain; taste perversion

6.2 Postmarketing Experience

The following adverse reactions have been identified during postapproval use of Ultracain D-Suprarenin hydrochloride with epinephrine. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a casual relationship to drug exposure.

Persistent paresthesias of the lips, tongue, and oral tissues have been reported with use of Ultracain D-Suprarenin hydrochloride, with slow, incomplete, or no recovery. These postmarketing events have been reported chiefly following nerve blocks in the mandible and have involved the trigeminal nerve and its branches.

Hypoesthesia has been reported with use of Ultracain D-Suprarenin, especially in pediatric age groups, which is usually reversible. Prolonged numbness can result in soft tissue injuries such as that of the lips and tongue in these age groups.

Ischemic injury and necrosis has been described following use of Ultracain D-Suprarenin with epinephrine and has been postulated to be due to vascular spasm of terminal arterial branches.

Paralysis of ocular muscles has been reported, especially after posterior, superior alveolar injections of Ultracain D-Suprarenin during dental anesthesia. Symptoms include diplopia, mydriasis, ptosis and difficulty in abduction of the affected eye. These symptoms have been described as developing immediately after injection of the anesthetic solution and persisting one minute to several hours, with generally complete recovery.

advertisement

7 DRUG INTERACTIONS

The administration of local anesthetic solutions containing epinephrine to patients receiving monoamine oxidase inhibitors, nonselective beta-adrenergic antagonists or tricyclic antidepressants may produce severe, prolonged hypertension. Phenothiazines and butyrophenones may reduce or reverse the pressor effect of epinephrine. Concurrent use of these agents should generally be avoided. In situations when concurrent therapy is necessary, careful patient monitoring is essential [see Warnings and Precautions (5.1)].

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Teratogenic Effects-Pregnancy Category C.

There are no adequate and well-controlled studies in pregnant women with Ultracain D-Suprarenin with epinephrine. Ultracain D-Suprarenin hydrochloride and epinephrine (1:100,000) has been shown to increase fetal deaths and skeletal variations in rabbits when given in doses approximately 4 times the maximum recommended human dose (MRHD). Ultracain D-Suprarenin HCl and Epinephrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

In embryo-fetal toxicity studies in rabbits, 80 mg/kg, subcutaneously (approximately 4 times the MRHD based on body surface area) caused fetal death and increased fetal skeletal variations, but these effects may be attributable to severe maternal toxicity, including seizures, observed at this dose. In contrast, no embryo-fetal toxicities were observed when Ultracain D-Suprarenin and epinephrine (1:100,000) was administered subcutaneously throughout organogenesis at doses up to 40 mg/kg in rabbits and 80 mg/kg in rats (approximately 2 times the MRHD based on body surface area).

In pre- and postnatal developmental studies subcutaneous administration of Ultracain D-Suprarenin hydrochloride to pregnant rats throughout gestation and lactation, at a dose of 80 mg/kg (approximately 2 times the MRHD based on body surface area) increased the number of stillbirths and adversely affected passive avoidance, a measure of learning, in pups. This dose also produced severe maternal toxicity in some animals. A dose of 40 mg/kg (approximately equal to the MRHD on a mg/m2 basis) did not produce these effects. A similar study using Ultracain D-Suprarenin and epinephrine (1:100,000) rather than Ultracain D-Suprarenin hydrochloride alone produced maternal toxicity, but no effects on offspring.

8.3 Nursing Mothers

It is not known whether Ultracain D-Suprarenin HCl and Epinephrine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Ultracain D-Suprarenin HCl and Epinephrine is administered to a nursing woman. When using Ultracain D-Suprarenin HCl and Epinephrine, nursing mothers may choose to pump and discard breast milk for approximately 4 hours following an injection of Ultracain D-Suprarenin HCl and Epinephrine (to minimize infant ingestion) and then resume breastfeeding.

8.4 Pediatric Use

Safety and effectiveness of Ultracain D-Suprarenin HCl 4% with epinephrine 1:200,000 and 1:100,000 in pediatric patients below the age of 4 years have not been established.

Safety and effectiveness was established in clinical trials with 61 pediatric patients between the ages of 4 and 16 years administered another product containing Ultracain D-Suprarenin hydrochloride 4% and epinephrine 1:100,000 injections. Fifty-one of these patients received doses from 0.76 mg/kg to 5.65 mg/kg (0.9 mL to 5.1 mL) of Ultracain D-Suprarenin HCl for simple dental procedures and 10 patients received doses between 0.37 mg/kg and 7.48 mg/kg (0.7 mL to 3.9 mL) of Ultracain D-Suprarenin HCl for complex dental procedures. Approximately 13% of these pediatric patients required additional injections of anesthetic for complete anesthesia. Safety of doses greater than 7 mg/kg (0.175 mL/kg) of Ultracain D-Suprarenin HCl in pediatric patients has not been established. Dosages in pediatric patients should be reduced, commensurate with age, body weight, and physical condition [see Dosage and Administration (2.2)].

8.5 Geriatric Use

In clinical trials, 54 patients between the ages of 65 and 75 years, and 11 patients 75 years and over received another product containing Ultracain D-Suprarenin and epinephrine 1:100,000. Among all patients between 65 and 75 years, doses from 0.43 mg/kg to 4.76 mg/kg of Ultracain D-Suprarenin HCl were administered safely to 35 patients for simple procedures and doses from 1.05 mg/kg to 4.27 mg/kg (1.3 mL to 6.8 mL) of Ultracain D-Suprarenin HCl were administered safely to 19 patients for complex procedures. Among the 11 patients ≥ 75 years old, doses from 0.78 mg/kg to 4.76 mg/kg (1.3 mL to 11.9 mL) of Ultracain D-Suprarenin HCl were administered safely to 7 patients for simple procedures and doses of 1.12 mg/kg to 2.17 mg/kg (1.3 mL to 5.1 mL) of Ultracain D-Suprarenin HCl were safely administered to 4 patients for complex procedures.

Approximately 6% of patients between the ages of 65 and 75 years and none of the 11 patients 75 years of age or older required additional injections of anesthetic for complete anesthesia compared with 11% of patients between 17 and 65 years old who required additional injections.

No overall differences in safety or effectiveness were observed between elderly subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

8.6 Renal/Hepatic Insufficiency

No studies have been performed with Ultracain D-Suprarenin hydrochloride 4% and epinephrine 1:200,000 injection or Ultracain D-Suprarenin hydrochloride 4% and epinephrine 1:100,000 injection in patients with renal or hepatic dysfunction [see Warnings and Precautions (5.2)].

advertisement

10 OVERDOSAGE

Acute emergencies from local anesthetics are generally related to high plasma levels encountered during therapeutic use of local anesthetics or to unintended subarachnoid injection of local anesthetic solution .

The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered.

The first step in the management of convulsions, as well as hypo-ventilation, consists of immediate attention to the maintenance of a patient airway and assisted or controlled ventilation as needed. The adequacy of the circulation should be assessed. Should convulsions persist despite adequate respiratory support, treatment with appropriate anticonvulsant therapy is indicated. The practitioner should be familiar with the use of anticonvulsant drugs, prior to the use of local anesthetics. Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor.

If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and/or cardiac arrest. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted.

For additional information about overdose treatment, call a poison control center (1-800-222-1222).

11 DESCRIPTION

Ultracain D-Suprarenin HCl and Epinephrine injection is a sterile, aqueous solution that contains Ultracain D-Suprarenin HCl 4% (40mg/mL) and epinephrine bitartrate in an epinephrine 1:200,000 or epinephrine 1:100,000 strength. Ultracain D-Suprarenin HCl is an amino amide local anesthetic, chemically designated as 4-methyl-3-[2-(propylamino)-propionamido]-2-thiophene-carboxylic acid, methyl ester hydrochloride and is a racemic mixture. Ultracain D-Suprarenin HCl has a molecular weight of 320.84 and the following structural formula:

Ultracain D-Suprarenin HCl has a partition coefficient in n-octanol/Soerensen buffer (pH 7.35) of 17 and a pKa of 7.8.

Epinephrine bitartrate, (-)-1-(3,4-dihydroxyphenyl)-2-methylamino-ethanol (+) tartrate (1:1) salt, is a vasoconstrictor that is added to Ultracain D-Suprarenin HCl in a concentration of 1:200,000 or 1:100,000 (expressed as free base). It has a molecular weight of 333.3 and the following structural formula:

Ultracain D-Suprarenin HCl and Epinephrine contains Ultracain D-Suprarenin HCl (40 mg/mL), epinephrine (1:200,000 or 1:100,000) (as epinephrine bitartrate) sodium chloride (1.0 mg/mL), sodium metabisulfite (0.5 mg/mL), and water for injection. The product is formulated with a 10% overage of epinephrine. The pH is adjusted to 3.6 with hydrochloric acid.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Ultracain D-Suprarenin HCl is an amide local anesthetic. Local anesthetics block the generation and conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse and by reducing the rate of rise of the action potential. In general, the progression of anesthesia is related to the diameter, myelination, and conduction velocity of the affected nerve fibers. Epinephrine is a vasoconstrictor added to Ultracain D-Suprarenin HCl to slow absorption into the general circulation and thus prolong maintenance of an active tissue concentration.

12.2 Pharmacodynamics

Clinically, the order of loss of nerve function is as follows: pain; (2) temperature; (3) touch; (4) proprioception; and (5) skeletal muscle tone. The onset of anesthesia has been shown to be within 1 to 9 minutes of injection of Ultracain D-Suprarenin HCl and Epinephrine. Complete anesthesia lasts approximately 1 hour for infiltrations and up to approximately 2 hours for nerve block.

Administration of Ultracain D-Suprarenin HCl and Epinephrine results in a 3- to 5-fold increase in plasma epinephrine concentrations compared to baseline; however, in healthy adults it does not appear to be associated with marked increases in blood pressure or heart rate, except in the case of accidental intravascular injection .

12.3 Pharmacokinetics

Absorption: Following dental injection by the submucosal route of an Ultracain D-Suprarenin solution containing epinephrine 1:200,000, Ultracain D-Suprarenin reaches peak blood concentration about 25 minutes after a single dose injection and 48 minutes after three doses. Peak plasma levels of Ultracain D-Suprarenin achieved after 68 mg and 204 mg doses are 385 ng/mL and 900 ng/mL, respectively. Following intraoral administration of a near maximum dose of 476 mg, Ultracain D-Suprarenin reaches peak blood concentrations of 2037 ng/mL and 2145 ng/mL for Ultracain D-Suprarenin solution containing epinephrine 1:100,000 and 1:200,000, respectively, approximately 22 minutes post-dose.

Distribution: Approximately 60% to 80% of Ultracain D-Suprarenin HCl is bound to human serum albumin and γ-globulins at 37°C in vitro.

Metabolism: Ultracain D-Suprarenin HCl is metabolized by plasma carboxyesterase to its primary metabolite, articainic acid, which is inactive. In vitro studies show that the human liver microsome P450 isoenzyme system metabolizes approximately 5% to 10% of available Ultracain D-Suprarenin with nearly quantitative conversion to articainic acid.

Excretion: At the dose of 476 mg of Ultracain D-Suprarenin, the elimination half-life was 43.8 minutes and 44.4 minutes for Ultracain D-Suprarenin solution containing epinephrine 1:100,000 and 1:200,000, respectively. Ultracain D-Suprarenin is excreted primarily through urine with 53% to 57% of the administered dose eliminated in the first 24 hours following submucosal administration. Articainic acid is the primary metabolite in urine. A minor metabolite, articainic acid glucuronide, is also excreted in urine. Ultracain D-Suprarenin constitutes only 2% of the total dose excreted in urine.

Special Populations: No studies have been performed to evaluate the pharmacokinetics of Ultracain D-Suprarenin HCl and Epinephrine injection in pediatric subjects. There is insufficient information to determine whether the pharmacokinetics of Ultracain D-Suprarenin HCl and Epinephrine injection differs by race.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Studies to evaluate the carcinogenic potential of Ultracain D-Suprarenin HCI in animals have not been conducted. Five standard mutagenicity tests, including three in vitro tests (the nonmammalian Ames test, the mammalian Chinese hamster ovary chromosomal aberration test, and a mammalian gene mutation test with Ultracain D-Suprarenin HCl) and two in vivo mouse micronucleus tests (one with Ultracain D-Suprarenin and epinephrine 1:100,000 and one with Ultracain D-Suprarenin HCl alone) showed no mutagenic effects.

No effects on male or female fertility were observed in rats for Ultracain D-Suprarenin and epinephrine 1:100,000 administered subcutaneously in doses up to 80 mg/kg/day (approximately 2 times the MRHD based on body surface area).

14 CLINICAL STUDIES

Another product containing Ultracain D-Suprarenin with epinephrine 1:100,000 was studied in three randomized, double-blind, active-controlled trials to evaluate the effectiveness of Ultracain D-Suprarenin containing epinephrine 1:100,000 as a dental anesthetic. Patients ranging in age from 4 years to over 65 years old underwent simple dental procedures such as single uncomplicated extractions, routine operative procedures, single apical resections, and single crown procedures, or complex dental procedures such as multiple extractions, multiple crowns and/or bridge procedures, multiple apical resections, alveolectomies, muco-gingival operations, and other surgical procedures on the bone. Ultracain D-Suprarenin containing epinephrine 1:100,000 was administered as submucosal infiltration and/or nerve block. Efficacy was measured immediately following the procedure by having the patient and investigator rate the patient’s procedural pain using a 10 cm visual analog scale (VAS), in which a score of zero represented no pain and a score of 10 represented the worst pain imaginable. Mean patient and investigator VAS pain scores were 0.3 cm-0.4 cm for simple procedures and 0.5 cm-0.6 cm for complex procedures.

Ultracain D-Suprarenin with epinephrine 1:100,000 was also studied compared to Ultracain D-Suprarenin with epinephrine 1:200,000 in four randomized, double-blind, activecontrolled trials. The first two studies used electric pulp testers (EPT) to evaluate the success rate (maximum EPT value within 10 minutes), onset, and duration of Ultracain D-Suprarenin containing epinephrine 1:100,000 versus Ultracain D-Suprarenin containing epinephrine 1:200,000 and Ultracain D-Suprarenin solution without epinephrine in healthy adults between 18 and 65 years old. Results indicated that the anesthetic characteristics of the 1:100,000 and 1:200,000 formulations were not significantly different.

A third study compared the difference in visualization of the surgical field after administration of Ultracain D-Suprarenin containing 1:100,000 epinephrine versus Ultracain D-Suprarenin containing 1:200,000 epinephrine during bilateral maxillary periodontal surgeries in patients ranging from 21 to 65 years old. Ultracain D-Suprarenin containing 1:100,000 epinephrine provided better visualization of the surgical field and less blood loss during the procedures. In a fourth study, designed to assess and compare cardiovascular safety, when the maximum dose of each formulation was administered, no clinically relevant differences in blood pressure or heart rate between formulations were observed.

15 REFERENCES

Kaplan, EL, editor. Cardiovascular disease in dental practice. Dallas; American Heart Association; 1986.

16 HOW SUPPLIED/STORAGE AND HANDLING

Ultracain D-Suprarenin HCl and Epinephrine Injection is available in 1.8 mL single use glass cartridges, packaged in boxes of 50 cartridges in the following two strengths:


Storage and Handling

Store at 25°C (77°F) with brief excursions permitted between 15° and 30°C (59°F-86°F). Protect from light. Do Not Freeze.

For chemical disinfection of the carpule, either isopropyl alcohol (91%) or ethyl alcohol (70%) is recommended. Many commercially available brands of isopropyl (rubbing) alcohol, as well as solutions of ethyl alcohol not of U.S.P. grade, contain denaturants that are injurious to rubber and therefore are not to be used.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

17 PATIENT COUNSELING INFORMATION

Loss of Sensation and Muscle Function:


Manufactured in Italy by:

Pierrel S.p. A. - Strada Statale Appia 46/48 - 81043 Capua (CE), Italy

Distributed by:

Safco Dental Supply Co. - Buffalo Grove, IL 60089

800-621-2178

www.safcodental.com

Revisided: 05/2013

00756637-00

Package Label - Principal Display Panel – Ultracain D-Suprarenin HCl and Epinephrine (Articaine Hydrochloride 4% and Epinephrine 1:100,000) Injection Cartridge Label

Package Label - Principal Display Panel – Ultracain D-Suprarenin HCl and Epinephrine (Articaine Hydrochloride 4% and Epinephrine 1:100,000) Injection Carton Label

Package Label - Principal Display Panel – Ultracain D-Suprarenin HCl and Epinephrine (Articaine Hydrochloride 4% and Epinephrine 1:200,000) Injection Cartridge Label

Package Label - Principal Display Panel – Ultracain D-Suprarenin HCl and Epinephrine (Articaine Hydrochloride 4% and Epinephrine 1:200,000) Injection Carton Label

Ultracain D-Suprarenin pharmaceutical active ingredients containing related brand and generic drugs:

Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Ultracain D-Suprarenin available forms, composition, doses:

Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Ultracain D-Suprarenin destination | category:

Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Ultracain D-Suprarenin Anatomical Therapeutic Chemical codes:

A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Ultracain D-Suprarenin pharmaceutical companies:

Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


advertisement

References

  1. "Articaine". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
  2. "Articaine". http://www.drugbank.ca/drugs/DB0900... (accessed August 28, 2018).
  3. "articaine: Link to the compound information in Wikipedia.". https://en.wikipedia.org/wiki/Artic... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Ultracain D-Suprarenin?

Depending on the reaction of the Ultracain D-Suprarenin after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Ultracain D-Suprarenin not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Ultracain D-Suprarenin addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

advertisement

Review

sdrugs.com conducted a study on Ultracain D-Suprarenin, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Ultracain D-Suprarenin consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

Visitor reports

Visitor reported useful

No survey data has been collected yet

Visitor reported side effects

No survey data has been collected yet

Visitor reported price estimates

No survey data has been collected yet

Visitor reported frequency of use

No survey data has been collected yet

Visitor reported doses

No survey data has been collected yet

Visitor reported time for results

No survey data has been collected yet

Visitor reported administration

No survey data has been collected yet

Visitor reported age

No survey data has been collected yet

Visitor reviews


There are no reviews yet. Be the first to write one!


Your name: 
Email: 
Spam protection:  < Type 28 here

The information was verified by Dr. Rachana Salvi, MD Pharmacology

© 2002 - 2024 "sdrugs.com". All Rights Reserved