From the Guidelines
Articaine should be avoided by children under 4 years of age, individuals with a known allergy to articaine or other amide-type local anesthetics, patients with severe heart block, and those with porphyria. According to the most recent guidelines 1, use in pediatric patients under 4 years of age is not recommended due to limited safety data in this age group.
- Patients with significant liver or kidney disease should use articaine with caution as these organs are involved in drug metabolism and elimination.
- Pregnant women, especially in the first trimester, should avoid articaine unless absolutely necessary as safety during pregnancy has not been fully established 1.
- People taking certain medications like beta-blockers may experience increased effects of articaine and should inform their dentist or doctor about all medications they're taking.
- Articaine should be used cautiously in patients with cardiovascular disease or seizure disorders. These precautions exist because articaine, while generally safe, can cause systemic toxicity if it enters the bloodstream in high concentrations, and allergic reactions can range from mild to life-threatening in susceptible individuals. The maximum recommended dose of articaine is not specified, but it is recommended to calculate the maximum allowable safe dosage before administration to avoid excessive dose 1. It is also recommended to aspirate frequently to minimize the likelihood that the needle is in a blood vessel and to use lower doses when injecting into vascular tissues 1.
From the FDA Drug Label
Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Septocaine 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. Septocaine® should also be used with caution in patients 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 However, because no studies have been performed in patients with liver dysfunction, caution should be used in patients with severe hepatic disease. The administration of local anesthetic solutions containing epinephrine to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension. Phenothiazines and butyrophenones may reduce or reverse the pressor effect of epinephrine. Use in pediatric patients under 4 years of age is not recommended.
The following patients should avoid or use articaine with caution:
- Patients with peripheral vascular disease
- Patients with hypertensive vascular disease
- Patients with impaired cardiovascular function
- Patients with severe hepatic disease
- Patients receiving monoamine oxidase inhibitors or tricyclic antidepressants
- Patients receiving phenothiazines or butyrophenones
- Pediatric patients under 4 years of age 2 2
From the Research
Individuals Who Should Avoid Articaine
- Patients with a confirmed allergy to articaine, as reported in a case study where a 51-year-old woman had an immediate skin reaction after subcutaneous administration of articaine 3
- Individuals who have experienced an allergic reaction to other amide local anesthetics, although true allergic reactions to amide local anesthetics are extremely rare 4, 5
- Patients who have tested positive for an allergy to articaine through skin prick tests or other allergy testing methods 3
Important Considerations
- Allergic reactions to local anesthetics, including articaine, can be life-threatening and require rapid diagnosis and treatment 6
- Careful history-taking and allergy testing should be performed to choose an alternative local anesthetic agent in patients with suspected allergy to local anesthetics or a history of allergic reactions 7, 4
- Alternative local anesthetic agents, such as lidocaine or mepivacaine, may be used in patients who are allergic to articaine, but allergy testing and careful consideration should be taken to ensure safe use 5, 3