Brilokain -adrenaline - instructions for use, dose, side effects, contraindications

Brilokain®-adrenaline injection 1/200000 is a combined preparation for local anesthesia in dentistry. Included in its composition articaine - local anesthetic of the amide type of the thiafen group. The effect of the drug begins quickly - after 1-3 minutes. The duration of anesthesia is at least 45 minutes. The drug provides a reliable anesthetic effect. Wound healing proceeds without complications, which is due to good tissue tolerance and minimal vasoconstrictive effect.

Due to the low content of adrenaline in the drug, its effect on the cardiovascular system is poorly expressed: there is almost no increase in blood pressure and an increase in heart rate.

Pharmacokinetics:Artikain with submucosal introduction in the oral cavity has a high diffuse capacity. Binding to proteins is 95%. Active substances penetrate to the minimum degree through the placental barrier, practically do not stand out with breast milk, the elimination half-life is 25 minutes. Metabolised in the liver. Excretion by the kidneys - 54-63% (for 6 hours).

Indications:

Infiltration and conductive anesthesia in dentistry (especially in patients with concomitant severe physical illnesses), including the following manipulations:

uncomplicated removal of one or more teeth;

Preparation of carious cavities and teeth before prosthetics.

Contraindications:

Hypersensitivity to articaine, adrenaline, sulfites, as well as to any of the auxiliary components of the drug;

Paroxysmal tachycardia and other tachyarrhythmias;

Bronchial asthma with hypersensitivity to sulfites;

Closed-angle glaucoma, simultaneous reception of non-selective beta-blockers;

Severe form of hepatic insufficiency (porphyria);

Intravascular injection;

Hyperthyroidism;

Patients undergoing treatment with MAO inhibitors or tricyclic antidepressants;

CNS diseases;

Pernicious anemia.

Pregnancy and lactation:

Possible use of the drug during pregnancy.

If it is necessary to use the drug in a nursing mother, there is no need to interrupt feeding, since the active substances are not excreted in breast milk in clinically significant amounts.

Dosing and Administration:

With uncomplicated removal of the teeth of the upper jaw, in the absence of inflammation, a submucosal in the region of the transitional fold from the vestibular side is usually injected with 1.8 ml of the preparation (per tooth). In some cases, additional administration of 1 to 1.8 ml of the drug may be required to achieve complete anesthesia. In most cases, there is no need to perform painful injections from the palatal side. For anesthesia with palatine incisions and suturing with the purpose of creating a palatine depot, about 0.1 ml of the drug per shot is needed.When several adjacent teeth are removed, the number of injections is usually limited. In the case of removal of the premolars of the lower jaw in the absence of inflammation, mandibular anesthesia can be dispensed with, as the infiltration anesthesia provided by injecting 1.8 ml per tooth is usually sufficient. If this method fails to achieve the desired effect, an additional injection of 1-1.8 ml of the drug into the submucosa should be performed in the region of the transitional fold of the lower jaw from the vestibular side. If, in this case, it was not possible to achieve complete anesthesia, it is necessary to blockade the mandibular nerve.

To prepare the cavity or prepare for the crown of any tooth, with the exception of lower molars, the administration of the drug in a dose of 0.5 to 1.8 ml per tooth according to the type of infiltration anesthesia from the vestibular side is shown. The exact amount depends on the desired depth of the procedure. When performing one treatment procedure, adults can administer up to 7 mg of articaine per 1 kg of body weight.

The duration of anesthesia, during which the intervention can be performed, is 30 ~ 45 minutes.

Side effects:

The drug is usually well tolerated by patients, however, the following side effects may occur:

From the side of the central nervous system: depending on the dose used, cases of a violation of consciousness are possible, even until it is lost; disturbances of breathing until it stops; muscular tremor; involuntary twitching of the muscles; sometimes progressing up to generalized seizures; nausea, vomiting.

From the side of the organ of vision: occasionally - blurred vision, transitory blindness, diplopia.

From the cardiovascular system: moderately expressed violations of hemodynamics, manifested in a decrease in blood pressure, tachycardia or bradycardia, inhibition of cardiovascular activity, which in extreme manifestation may lead to collapse and cardiac arrest.

Allergic reactions: edema or inflammation at the injection site; in other areas - redness skin, itching, conjunctivitis, rhinitis, angioedema, varying degrees of severity (including edema of the upper and / or lower hum and / or cheeks, glottis swallowing difficulty, hives, difficulty breathing). All these phenomena can progress to the development of anaphylactic shock.

Local reactions: swelling or inflammation at the injection site.

Other: headaches are often associated, probably with the presence of adrenaline in the formulation. Other side effects caused by the action of adrenaline (tachycardia, arrhythmia, increased blood pressure) are extremely rare. Very rarely, a random intravascular injection can lead to the development of ischemic zones at the site of administration, sometimes progressing to tissue necrosis.

Overdose:

When the first signs of the development of side effects or toxic effects (dizziness, motor anxiety, impaired consciousness), it is necessary to urgently stop the injection and give the patient a horizontal position. It is necessary to carefully monitor the parameters of hemodynamics (pulse, blood pressure) and airway patency. Even if the symptoms do not seem heavy, you should prepare everything you need for intravenous infusion and, at the very least, carry out venipuncture. Depending on the degree of disturbance of breathing, oxygen, carry out artificial respiration and, if necessary, endotracheal intubation with controlled ventilation of the lungs.The use of analeptic drugs of central action is contraindicated. In case of involuntary muscular twitching or generalized convulsions, intravenous administration of barbiturates of short or ultrashort action is indicated. The introduction should be carried out slowly, under the constant control of parameters of hemodynamics and respiration. At the same time, intravenous fluid infusion through a pre-established cannula should be performed. It should also be given patient oxygen.

With tachycardia, bradycardia, or a marked decrease in blood pressure, the patient should be given a horizontal position with raised legs. With severe circulatory disturbances and shock, injection of the drug should be discontinued. Provide the patient with a horizontal position with raised legs, oxygen inhalation and intravenous infusion of balanced electrolyte and plasma-substituting solutions, intravenously injecting glucocorticoids (250-1000 mg of methylprednisolone). In case of threatening vascular collapse and increasing bradycardia, 25-100 μg of epinephrine (0.25-1.0 ml of a solution with a concentration of 100 μg / ml) should be administered intravenously. Introduction is carried out slowly, under the control of pulse and blood pressure.Do not administer more than 100 μg of epinephrine (1 ml of solution per time). When adding additional amounts of epinephrine it should be added to the infusion solution. The infusion rate should correlate with the heart rate and blood pressure level.

Severe forms of tachycardia and tachyarrhythmias can be eliminated by the use of antiarrhythmic drugs, however, non-selective beta-blockers should not be used. In these cases, the use of oxygen and monitoring of hemodynamic parameters is necessary.

With an increase in blood pressure in patients with arterial hypertension should, if necessary, use peripheral vasodilators.

Interaction:

The hypertensive effect of sympathomimetic amines such as epinephrine can be enhanced by tricyclic antidepressants and monoamine oxidase inhibitors.

Do not prescribe the drug on the background of treatment with non-selective beta-blockers, since in this case the risk of hypertensive crisis and severe bradycardia is high.

Special instructions:

The drug contains sulfites, which can enhance the anaphylactic reaction.

The drug can not be administered intravenously. Do not inject into the area of inflammation.Increased sensitivity to sulfites is more often observed in patients with bronchial asthma.

In patients with cholinostaris deficiency, the drug can be used only for urgent indications, as these patients have a chance of prolonging and sometimes enhancing the effect of the drug.

Effect on the ability to drive transp. cf. and fur:AT Special tests did not reveal a clear effect of the drug on operator activity. However, due to the fact that the preoperative anxiety of the patient and the stress caused by surgical intervention can influence the effectiveness of the activity, the dentist must individually, in each case, decide whether the patient is allowed to operate the vehicle or work with the mechanisms.

Form release / dosage:

Injection.

Packaging:Solution for injection of 1.7 ml or 1.8 ml in liners glass (cartridges).

Storage conditions:

List B. Keep in a place protected from light, out of reach of children, at a temperature of no higher than 25 ° C, not allowing freezing.

Shelf life:2 years. Do not use after the expiry date printed on the package

Terms of leave from pharmacies:On prescription

Registration number:P N000688 / 01-2001

Date of registration:08.07.2008

Expiration Date:Unlimited

The owner of the registration certificate:BRYNTSALOV-A, CJSC BRYNTSALOV-A, CJSC Russia

Manufacturer: & nbsp

BRYNTSALOV-A, CJSC Russia

Information update date: & nbsp24.02.2017

Illustrated instructions

Instructions

Brilokain®-epinephrine (Brilocaine®-adrenaline)