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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Brand Name
Citanest Forte Dental
Generic Name
Prilocaine Hcl And Epinephrine
Active Ingredient
Epinephrine BitartrateCategory
Other
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| .005 mg/mL | INJECTION, SOLUTION | SUBMUCOSAL | 66312-580 |
Detailed information about Citanest Forte Dental
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Citanest Forte Dental, you must consult a qualified healthcare professional.
Epinephrine Bitartrate is a sympathomimetic agent used in the emergency treatment of severe allergic reactions (anaphylaxis) and for the temporary relief of asthma symptoms. It acts as a potent agonist at both alpha and beta-adrenergic receptors to restore respiratory and cardiovascular function.
Dosage for Epinephrine Bitartrate varies significantly based on the route of administration and the condition being treated.
Pediatric dosing is strictly weight-based to avoid toxicity.
No specific dosage adjustments are required for patients with renal impairment due to the rapid non-renal metabolism of epinephrine by COMT and MAO. However, close monitoring of blood pressure is advised.
While the liver is a primary site for COMT and MAO activity, the widespread distribution of these enzymes in other tissues means that hepatic impairment does not significantly alter the clearance of epinephrine. No formal dose adjustments are established.
Geriatric patients (aged 65 and older) are at a higher risk of adverse cardiovascular effects. Healthcare providers typically recommend the lowest effective dose and cautious monitoring for arrhythmias or severe hypertension.
Since Epinephrine Bitartrate is used on an 'as-needed' basis for emergencies or acute symptoms, there is no set schedule for doses. Do not 'double up' on doses to make up for a perceived delay. For asthma, do not use more frequently than every 4 hours.
Signs of an epinephrine overdose include a sudden and dangerous rise in blood pressure, which can lead to cerebral hemorrhage (stroke), pulmonary edema (fluid in the lungs), and cardiac arrhythmias. Other symptoms include severe headache, pallor, and metabolic acidosis. Emergency medical treatment is required immediately, often involving the administration of rapid-acting alpha-blockers or vasodilators.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance. In an emergency, use the medication first and call 911 immediately.
Because Epinephrine Bitartrate stimulates the 'fight or flight' response, side effects are common and often expected as part of the drug's pharmacological action. Common effects include:
These effects are usually transient and subside as the medication is metabolized (within 10 to 30 minutes).
> Warning: Stop taking Epinephrine Bitartrate and call your doctor immediately if you experience any of these serious reactions.
Epinephrine Bitartrate is generally not used for long-term, daily maintenance. However, repeated use of inhaled epinephrine can lead to 'tachyphylaxis' (a rapid decrease in response to the drug) or rebound bronchoconstriction. In ophthalmic use, long-term application may lead to 'adrenochrome' deposits (pigmented spots) on the conjunctiva or cornea.
There are currently no FDA Black Box Warnings for Epinephrine Bitartrate. However, the FDA emphasizes that the risks of using epinephrine in a life-threatening emergency (anaphylaxis) are almost always outweighed by the benefits, even in patients with heart disease.
Report any unusual symptoms to your healthcare provider. If you have used an epinephrine injection, you MUST go to the emergency room immediately for further monitoring, as the initial dose may wear off before the allergic reaction has fully resolved.
Epinephrine Bitartrate is a high-potency medication that must be used with extreme caution. While it is life-saving in emergencies, its systemic effects on the cardiovascular system can be profound. Patients with a history of cardiovascular disease, including high blood pressure, coronary artery disease, or heart rhythm disorders, must discuss these conditions with their doctor before being prescribed an epinephrine autoinjector or using OTC inhalation products.
No FDA black box warnings for Epinephrine Bitartrate. However, the drug carries significant 'Warnings and Precautions' regarding its use in patients with certain pre-existing conditions.
For patients using Epinephrine Bitartrate for asthma or carrying it for anaphylaxis, regular monitoring is essential:
Following the administration of Epinephrine Bitartrate, patients may experience tremors, dizziness, or intense anxiety. You should not drive or operate heavy machinery until these effects have completely dissipated and you have been cleared by a medical professional.
Alcohol should be avoided when using Epinephrine Bitartrate. Alcohol can potentiate the cardiovascular effects of epinephrine, increasing the risk of tachycardia and arrhythmias. Furthermore, alcohol can impair the judgment needed to recognize an emergency or use an autoinjector correctly.
There is no withdrawal syndrome associated with the emergency use of Epinephrine Bitartrate. However, for those using it for asthma, stopping the medication suddenly after frequent use may result in a return of asthma symptoms. It is vital to have a long-term asthma management plan (e.g., inhaled corticosteroids) as discussed with a pulmonologist.
> Important: Discuss all your medical conditions with your healthcare provider before starting Epinephrine Bitartrate. In a life-threatening emergency, do not hesitate to use the medication even if you have these conditions, but seek immediate follow-up care.
There are no absolute contraindications to the use of epinephrine in a life-threatening situation. However, in non-emergency settings (like asthma or surgery), certain combinations are strictly avoided:
Epinephrine Bitartrate can interfere with certain laboratory results:
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. Carry a list of your medications with your epinephrine autoinjector at all times.
In the context of a life-threatening anaphylactic reaction, there are no absolute contraindications to the use of epinephrine. The risk of death from anaphylaxis outweighs any potential risk from the medication. However, for non-emergency uses (such as asthma relief or elective surgery), the following are absolute contraindications:
Relative contraindications require a careful risk-benefit analysis by a physician:
Patients who are sensitive to other sympathomimetic amines (such as Pseudoephedrine, Phenylephrine, or Albuterol) may exhibit heightened sensitivity to the side effects of Epinephrine Bitartrate. Additionally, those with 'sulfite sensitivity' must be identified, as many injectable forms use sulfites as preservatives. While a sulfite-sensitive patient should still receive epinephrine for anaphylaxis, they must be monitored extremely closely for a secondary asthmatic reaction.
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Epinephrine Bitartrate. Always disclose any heart conditions or previous reactions to adrenaline-like drugs.
Epinephrine Bitartrate is classified under FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Epinephrine has been shown to have teratogenic (birth defect-causing) effects in animal studies when given at doses much higher than the human therapeutic dose. In humans, epinephrine crosses the placenta and can cause fetal tachycardia (fast heart rate) and a decrease in uterine blood flow. However, in the case of maternal anaphylaxis, the resulting hypoxia (lack of oxygen) is a much greater threat to the fetus than the medication. Therefore, epinephrine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
It is not known whether epinephrine is excreted in human milk. However, because epinephrine has extremely poor oral bioavailability, any drug present in breast milk would likely be destroyed in the infant's digestive tract. The very short half-life (2-3 minutes) also means the drug is cleared from the mother's system rapidly. Most experts consider the emergency use of epinephrine compatible with breastfeeding.
Epinephrine Bitartrate is safe and effective for use in children for anaphylaxis, provided the dose is correctly adjusted for weight. The use of 0.15 mg autoinjectors is standard for children 15-30 kg. For children under 15 kg, manual dosing by a healthcare professional is often preferred. For asthma, OTC inhalation products are generally not approved for children under 12 years of age due to the risk of misuse and the need for professional diagnosis of asthma in young children.
Patients aged 65 and older are significantly more sensitive to the effects of Epinephrine Bitartrate. They have a higher prevalence of undiagnosed coronary artery disease and hypertension, making them more susceptible to drug-induced heart attacks or strokes. When prescribing for elderly patients, doctors often emphasize the importance of using the drug only for true emergencies and may recommend lower doses if administered in a clinical setting.
No dosage adjustment is typically necessary for patients with kidney disease. Epinephrine is primarily inactivated by enzymes in the liver and other tissues, not through renal filtration. However, since renal impairment often co-occurs with hypertension, these patients should be monitored for excessive blood pressure spikes after administration.
While the liver is involved in the metabolism of epinephrine via COMT and MAO, hepatic impairment (even Child-Pugh Class C) does not significantly slow the clearance of the drug because these enzymes are ubiquitous throughout the body's tissues. No specific dose adjustments are required.
> Important: Special populations require individualized medical assessment. Pregnant women or elderly patients should have a detailed discussion with their doctor about their 'emergency action plan'.
Epinephrine Bitartrate is a direct-acting sympathomimetic agent. It exerts its effects by binding to and activating alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors.
The physiological response to Epinephrine Bitartrate is near-instantaneous. Following inhalation, bronchodilation occurs within 1 minute. Following IM injection, peak cardiovascular effects occur within 5 to 10 minutes. The duration of effect is short, typically 1 to 4 hours for bronchodilation and less than 30 minutes for pressor (blood pressure) effects. Tolerance (tachyphylaxis) can develop with frequent, repeated use of inhalation forms.
| Parameter | Value |
|---|---|
| Bioavailability | 0% (Oral), High (IM/Inhalation) |
| Protein Binding | ~50% (primarily to albumin) |
| Half-life | 2 - 3 minutes |
| Tmax (IM) | 5 - 10 minutes |
| Metabolism | Hepatic/Tissue (COMT and MAO) |
| Excretion | Renal (95% as metabolites) |
Epinephrine Bitartrate is classified as a Sympathomimetic Adrenergic Agonist. It is related to other catecholamines such as Norepinephrine and Dopamine, but differs in its high affinity for Beta-2 receptors, making it uniquely effective for treating bronchospasm.
Common questions about Citanest Forte Dental
Epinephrine Bitartrate is primarily used as a life-saving emergency treatment for severe allergic reactions, known as anaphylaxis, which can be caused by stings, food, or medication. It is also found in over-the-counter inhalation products used for the temporary relief of mild, intermittent asthma symptoms like wheezing and chest tightness. In surgical settings, it may be used as an eye drop to dilate the pupil during intraocular procedures. Because it works rapidly to open airways and raise blood pressure, it is the first-line treatment for medical emergencies involving systemic shock. It is not intended for the long-term maintenance of asthma or chronic allergies.
The most common side effects are a direct result of the body's 'fight or flight' response being activated. Patients frequently experience a rapid or pounding heartbeat (palpitations), shakiness or tremors in the hands, and feelings of intense anxiety or nervousness. Sweating, dizziness, and a pale appearance are also very common shortly after the medication is administered. These effects are usually temporary and begin to fade within 10 to 20 minutes as the drug is metabolized. If these symptoms persist or are accompanied by chest pain, you should seek medical help immediately.
It is strongly advised to avoid alcohol if you are using Epinephrine Bitartrate, especially if you use the inhalation form for asthma. Alcohol can increase your heart rate and, when combined with epinephrine, may lead to dangerous heart rhythms or a significant spike in blood pressure. Furthermore, alcohol can mask the symptoms of a severe allergic reaction, making it harder for you to realize when you need to use your emergency medication. If you have used an epinephrine injection in an emergency, you should not consume alcohol until you have been fully evaluated by a doctor. Always prioritize your safety by remaining sober when managing conditions that require epinephrine.
Epinephrine Bitartrate is considered a Pregnancy Category C medication, meaning there are no definitive studies in humans to prove its safety. It is known to cross the placenta and can potentially affect the fetal heart rate or reduce blood flow to the uterus. However, in a life-threatening emergency like anaphylaxis, the danger of the mother losing oxygen is a much greater risk to the baby than the medication itself. Doctors generally agree that epinephrine should be used during pregnancy for emergencies without hesitation. If you are pregnant, discuss your allergy or asthma plan with your obstetrician to ensure you are prepared for an emergency.
Epinephrine Bitartrate is designed for rapid action. When used as an inhalation for asthma, most patients feel relief within 1 to 5 minutes. When administered as an intramuscular injection for a severe allergic reaction, the medication begins working almost immediately, with peak effects on blood pressure and heart rate occurring within 5 to 10 minutes. Because the drug works so quickly, it is the preferred treatment for rapidly progressing emergencies. However, because its effects also wear off quickly (within 20-30 minutes), it is vital to seek emergency medical care even if you feel better after the first dose.
Since Epinephrine Bitartrate is almost always used on an 'as-needed' basis for emergencies or acute symptoms, there is no physical 'withdrawal' associated with stopping it. However, if you have been using an epinephrine inhaler frequently for asthma, stopping it may cause your asthma symptoms to return or worsen. Frequent use of epinephrine (more than a few times a week) is usually a sign that your asthma is not well-controlled. In such cases, you should not simply stop the medication but rather talk to your doctor about starting a long-term 'controller' medication like an inhaled steroid. Never stop carrying your emergency autoinjector if you have a known severe allergy.
Epinephrine Bitartrate does not have a regular dosing schedule like a daily vitamin or antibiotic. It is only used when you are experiencing an emergency allergic reaction or an acute asthma attack. Therefore, you cannot 'miss' a dose in the traditional sense. If you are experiencing symptoms and realize you do not have your medication, you must call 911 or go to the nearest emergency room immediately. Do not try to take a double dose later to make up for not having it during the attack; only use the medication when symptoms are present as directed by your healthcare provider.
No, Epinephrine Bitartrate does not cause weight gain. In fact, epinephrine is a catabolic hormone, meaning it helps the body break down fats and sugars for quick energy during a 'fight or flight' scenario. Because it is used only intermittently or in emergencies, it does not stay in the body long enough to have any significant impact on your weight or metabolism. If you are experiencing unexplained weight gain while managing allergies or asthma, it is more likely related to other medications, such as oral corticosteroids (like Prednisone), or other underlying health factors. Discuss any weight concerns with your doctor.
Epinephrine Bitartrate can interact with several other drugs, so it is vital that your doctor knows your full medication list. It has serious interactions with beta-blockers, which can cause a dangerous spike in blood pressure, and with certain antidepressants (like TCAs or MAOIs) that can intensify the drug's effects on the heart. It may also interact with heart rhythm medications like Digoxin. While these interactions are important, you should still use your epinephrine in a life-threatening emergency regardless of what other drugs you are taking. The medical team at the hospital will then manage any interactions that occur during your follow-up care.
Yes, Epinephrine Bitartrate is available in several generic forms. It is the active ingredient in many store-brand and generic versions of over-the-counter asthma inhalers. Additionally, while many brand-name autoinjectors (like EpiPen) use Epinephrine Hydrochloride, there are generic versions of epinephrine injectors that may use the bitartrate salt. Generic versions are required by the FDA to be 'bioequivalent' to the brand-name versions, meaning they must work the same way in the body. Always check with your pharmacist to ensure you are receiving the correct form and strength prescribed by your doctor.
Other drugs with the same active ingredient (Epinephrine Bitartrate)