Брилокаин®-адреналин

General characteristics. Structure:

Active ingredient: 40 mg of an artikain of a hydrochloride, 0,005 mg of adrenaline in the form of hydrotartrate (1:200000).

Excipients: sodium chloride, sodium pyrosulphite, Trilonum of B, sodium hydroxide, water for injections.

Pharmacological properties:

Pharmacodynamics. Брилокаин®-адреналин solution for injections 1/200000-combined drug for local anesthesia in stomatology. Being its part артикаин - local anesthetic of amide type of thiafoehn group. Effect of drug begins quickly - in 1-3 minutes. Duration of anesthesia makes not less than 45 minutes. Drug provides the reliable anesthetizing effect. The wound repair proceeds without complications that is caused by good fabric tolerance and the minimum vasoconstrictive action.

Owing to the low content of adrenaline in drug its action on cardiovascular system is expressed a little: almost increase in the ABP and increase in ChSS is not noted.

Pharmacokinetics. Artikain at submucosal introduction to oral cavities has high diffusion ability. Linkng with proteins makes 95%. Active agents in the minimum degree get through a placental barrier, are practically not emitted with breast milk, the elimination half-life makes 25 minutes. It is metabolized in a liver. Excretion kidneys - 54-63% (for 6 h).

Indications to use:

Infiltration and conduction anesthesia in stomatology (especially at patients with the accompanying heavy somatopathies), including when carrying out the following manipulations:

- uncomplicated removal of one or several teeth;

- preparation of carious cavities and teeth before prosthetics.

Route of administration and doses:

At an uncomplicated exodontia of an upper jaw in the absence of an inflammation usually enter submucosal in the field of a transitional fold from the vestibular party of 1,8 ml of drug (on each tooth). In some cases additional introduction from 1 to 1,8 ml of drug for achievement of full anesthesia can be required. In most cases there is no need to carry out painful injections from the palatal party.

Anesthesia at palatal cuts and suture for the purpose of creation of palatal depot requires about 0,1 ml of drug on a prick. During removal several the quantity of injections usually manages to be limited to a number of the located teeth. In case of removal of premolar tooths of a mandible in the absence of an inflammation it is possible to do without mandibular anesthesia as the infiltration anesthesia provided injections of 1,8 ml on tooth, as a rule, is sufficient. If this way it was not succeeded to reach desirable effect, it is necessary to execute an additional injection of 1-1,8 ml of drug in submucosal in the field of a transitional fold of a mandible from the vestibular party. If in this case it was not succeeded to reach full anesthesia, it is necessary to carry out blockade of a mandibular nerve.

For preparation of a cavity or preparation under a crown of any tooth, except for the lower painters, administration of drug in a dose from 0,5 to 1,8 ml on each tooth as an infiltration anesthesia from the vestibular party is shown. The exact quantity depends on the desirable depth of duration of the procedure. At implementation of one medical procedure by the adult it is possible to enter to 7 mg of an artikain on 1 kg of body weight.

Duration of anesthesia during which it is possible to carry out intervention makes 30 ~ 45 minutes.

Features of use:

Pregnancy and lactation. Use of drug during pregnancy is possible. In need of use of drug for the nursing mother there is no need to interrupt feeding as active agents are not emitted with breast milk in clinically significant quantities.

Drug contains sulfites which can strengthen anaphylactic reaction.

The drug cannot be administered intravenously. It is impossible to carry out an injection to the area of an inflammation. Hypersensitivity to sulfites is more often observed at patients with bronchial asthma.

At patients with deficit of a holinosteraza drug can be used only according to urgent indications as these patients have a probability of prolongation and sometimes to strengthening of effect of drug.

Influence on ability to manage vehicles and mechanisms. In special tests clear influence of drug on operator activity was not revealed. However because the preoperative concern of the patient and the stress caused by an operative measure can exert impact on efficiency of activity, the dentist has to individually, resolve in each case issues of the admission of the patient to management of transport or work with mechanisms.

Side effects:

Drug is usually well transferred by patients, however, perhaps development of the following by-effects:

From TsNS: depending on the applied dose chances of disturbance of consciousness up to its loss; disturbances of breath up to its stop; muscular tremor; involuntary twitchings of muscles; sometimes progressing up to generalized spasms; nausea, vomiting.

From an organ of sight: occasionally - opacification in eyes, a passing blindness, a diplopia.

From cardiovascular system: moderately expressed disturbances of a hemodynamics which are shown in decrease in the ABP, tachycardia or bradycardia, oppression of cardiovascular activity that in extreme manifestation can lead to a collapse and a cardiac standstill.

Allergic reactions: hypostasis or an inflammation in the place of an injection; in other areas - erubescence, an itch, conjunctivitis, rhinitis, a Quincke's disease of various degree of manifestation (including hypostasis of an upper and/or lower gula and/or cheeks, a glottis with swallowing difficulty, a small tortoiseshell, breath difficulty). All these phenomena can progress before development of an acute anaphylaxis.

Local reactions: hypostasis or an inflammation in the place of an injection.

Others: the headaches connected probably with existence in composition of drug of adrenaline are often observed.

Other by-effects caused by effect of adrenaline (tachycardia, arrhythmia, increase in the ABP) are shown extremely seldom. Extremely seldom accidental intravascular injection can lead to development of ischemic zones in an injection site, sometimes progressing to a fabric necrosis.

Interaction with other medicines:

The hypertensive effect of sympathomimetic amines like adrenaline can be strengthened by tricyclic antidepressants and inhibitors of a monoaminooxidase.

It is not necessary to appoint drug against the background of treatment non-selective beta adrenoblockers as in this case the risk of development of hypertensive crisis and the expressed bradycardia is high.

Contraindications:

- hypersensitivity to an artikain, adrenaline, sulfites, and also to any of auxiliary components of drug;

- Bouveret's disease and other tachyarrhythmias;

- bronchial asthma at hypersensitivity to sulfites;

- closed-angle glaucoma, concomitant use of non-selective beta adrenoblockers;

- severe form of a liver failure (porphyria);

- intravascular injections;

- hyperthyroidism;

- the patients undergoing treatment using MAO inhibitors or tricyclic antidepressants;

- TsNS diseases;

- malignant anemia.

Overdose:

At emergence of the first signs of development of side or toxic effect (dizziness, motive concern, consciousness disturbance) it is necessary to stop urgently an injection and to give to the patient horizontal position. Careful control of indicators of a hemodynamics (pulse, the ABP) and passability of respiratory tracts is necessary. Even if symptoms do not seem heavy, it is necessary to prepare all necessary for intravenous infusion and, at least, to carry out a venipuncture. Depending on extent of disturbance of breath it is necessary to give oxygen, to carry out an artificial respiration and, if necessary, an endotracheal intubation with controlled ventilation of the lungs.

Use of analeptical drugs of the central action is contraindicated. At involuntary muscular twitchings or generalized spasms intravenous administration of barbiturates of short or ultrashort action is shown. Introduction should be carried out slowly, under constant control of indicators of a hemodynamics and breath. At the same time it is necessary to carry out intravenous infusion of liquid through a predefined cannula. Also it is necessary to give to the patient oxygen.

At tachycardia, bradycardia or the expressed decrease in the ABP the patient should give horizontal position with the raised legs. At heavy disturbances of blood circulation and shock the injection of drug should be stopped. To provide to the patient horizontal position with the raised legs, to carry out inhalation of oxygen and intravenous infusion of the balanced electrolytic and plasma substituting solutions, to intravenously enter glucocorticoids (250-1000 mg of Methylprednisolonum).

In case of menacing vascular to a collapse and the accruing bradycardia to enter intravenously 25-100 mkg of adrenaline (0,25-1,0 ml of solution with concentration of 100 mkg/ml). Introduction is carried out slowly, under control of pulse and arterial pressure. It is not necessary to enter more than 100 mkg of adrenaline (1 ml of solution for 1 time). At introduction of additional amounts of adrenaline it should be added to infusion solution. Speed of infusion has to correlate with pulse rate and the ABP level.

 

Severe forms of tachycardia and tachyarrhythmia can be eliminated with use of antiarrhytmic drugs, however, it is not necessary to use non-selective beta adrenoblockers. In these cases use of oxygen and control of indicators of a hemodynamics is necessary.

At increase in arterial pressure at patients with an arterial hypertension it is necessary to apply peripheral vasodilators, in case of need.

Storage conditions:

List B. To store in protected from light, the place, unavailable to children, at a temperature not above 25 °C, without allowing freezing. A period of validity - 2 years. Not to use upon termination of the period of validity specified on packaging.

Issue conditions:

According to the recipe

Packaging:

Solution for injections on 1,7 ml or on 1,8 ml in inserts glass (cartridges).