Articaine with adrenaline forte injection solution 40mg+0.01mg/ml cartridge 1.7ml N50

General information, release form

Articaine was first synthesized in 1969, and its widespread use began in 1976. Nowadays, medications based on Articaine are produced by many pharmaceutical companies.

Basic requirements for local anesthetics:

• significant depth of penetration of the product;
• long duration of action;
• high degree of security.

These parameters are influenced by:

• activity of the anesthetic used;
• peripheral vascular tone.

The drug Articaine does not contain a special preservative - paraben, which most often causes hypersensitivity reactions. Contains a minimal amount of the antioxidant adrenaline (metabisulfite).

The stability of the local anesthetic is achieved through high quality glass, rubber components of the carpule, and high activity of the active substance.

It is insoluble in aqueous media, so it is used in the form of a salt, which is water soluble. For the main effects to manifest, its destruction in tissues is required with the formation of fat-soluble substances that are able to penetrate the lipid membrane of the nerve ending. It undergoes changes in tissue structures quite quickly, so the analgesic effect is noted within 1-2 minutes.

Articaine has a slight ability to expand the lumen of blood vessels, so it is advisable to use it with epinephrine (adrenaline). It quickly penetrates into soft tissues, as well as into bone structures, which ensures a rapid onset of effect, as a result of which it is widely used in therapeutic, surgical, and orthopedic interventions in dentistry.

Available in the form of cartridges and solutions for injection in ampoules. Packed in cardboard boxes.

Manufacturers Articaine

On the Russian pharmaceutical market, the anesthetic Articaine and its analogues are represented by domestic and foreign manufacturers. You can buy articaine in St. Petersburg and Moscow using the link.

The products of the following enterprises are most in demand:

• JSC "Biokhimik" (Russia);
• CJSC "Binergy" (Russia);
• LABORATORY INIBSA, SA (Spain);
• Welfarm LLC (Russia);
• Armavir biofactory FKP (Russia);
• Borisov Medical Preparations Plant (Republic of Belarus);
• Sanofi-Aventis Deutschland GmbH (Germany).

Preparations based on articaine, created at different enterprises, may have certain differences due to production technology, quantitative and qualitative composition of excipients, but at the same time retain the main direction of action of the active substance.

pharmachologic effect

The mechanism is based on the effect on the endings of both sensory nerves and nerve fibers, which creates conditions for disrupting the generation of an exciting impulse and its conduction to other structures. Articaine interacts with receptors that are responsible for the functioning of sodium channels. By influencing them, the flow of sodium ions through them is blocked, as a result of which an anesthetic effect develops.

The duration of action is about 20 minutes. It is destroyed into products that are non-toxic to the body, which makes it possible to re-introduce the substance. In an acidic environment, the effectiveness of the drug decreases.

Pharmacology

Pharmacological action: local anesthetic.
In tissues (in a slightly alkaline environment) it undergoes hydrolysis and releases a base that has lipophilic properties and easily penetrates the membrane into the nerve fiber. Ionizes (due to lower pH) and transforms into a cation. Interacts with receptors, inhibits the entry of sodium ions into the cell during the depolarization phase and blocks the conduction of impulses along the nerve fiber. With intramuscular administration, Cmax is achieved within 20–40 minutes. T1/2 - about 40 minutes. During infiltration anesthesia in the oral cavity, it has a high diffusion ability. Biotransformed in the liver. Penetrates the placental barrier, penetrates the BBB in small quantities, and is practically not excreted in breast milk. Excreted by the kidneys (54–63% in 6 hours). The duration of anesthesia is 60 and 180 minutes with the addition of vasoconstrictors. In an acidic environment the effect is reduced.

Analogs

Articaine-containing medicinal substances are produced by many pharmaceutical companies. They bear the following patented names:

• Alfacaine (manufactured in France);
• Articaine Inbisa (producing country - Spain);
• Ubestezin (made in Germany);
• Primacaine (manufacturing country – France);
• Cytocorine (made in Italy);
• Ultracaine (manufacturing country – Germany);
• Septanest (made in France).

Pharmacokinetics and pharmacodynamics

Articaine provides a high degree of action and a minimal number of adverse reactions of the body. Has minimal toxicity. The maximum concentration after administration into the submucosal membrane of the oral cavity is observed 25 minutes after administration. With infiltration anesthesia, the effect is noted after 1-2 minutes, with conduction anesthesia - after 2-2.5 minutes.

Its transformation mostly occurs in the liver; the inactivation process also occurs in the bloodstream and tissue structures under the action of blood plasma enzymes (cholinesterase). The resulting metabolites do not have an anesthetic effect. Binds to blood proteins and is excreted by the kidneys. On the first day, about half of the administered dose is eliminated.

Reviews about Articaine

In dentistry, provided that the dentist and the patient comply with all recommendations and contraindications for use, the drug Articaine is highly effective and has no side effects.

Before use, the patient must immediately inform the doctor about all chronic and acute diseases occurring at the current time or observed in the past. In turn, the doctor must do an allergy test to avoid severe adverse reactions.

Indications

In commonly used concentrations, the drug in question does not have surface anesthetic activity, but when administered by injection, its effect is superior to other drugs of the same group (Lidocaine, Mepivacaine). Therefore, the main indication for the use of Articaine is local anesthesia of a conduction or infiltrative type.

Articaine with adrenaline is used for pain relief during traumatic dental procedures in the form of the following types of local anesthesia:

• infiltration (impregnation of tissues of the surgical field);
• conduction (introduction of a substance along the nerve);
• intraligamentary (intraligamentous);
• intraseptal (intraseptal - the substance is injected into the septum of the bone between the sockets of the teeth);
• intrapulpal (injection of anesthetic into the dental pulp).

It is also used for:

• uncomplicated removal of one or more teeth;
• preparation of carious cavities and teeth before prosthetics.

Articaine in combination with epinephrine has found use in the following concentrations:

• 1:200000;
• 1:100000.

The use of a local anesthetic with a higher content of adrenaline (1:100,000) significantly increases the risk of adverse reactions in patients with periodontal tissue pathology, as well as during injection into the palate.

Reviews from dentists about the drug Articaine

Most practicing dentists consider Articaine to be the best representative of local anesthetics due to its high effectiveness. At the same time, when using the medication, there is a low incidence of allergic reactions, the possibility of safe use in pregnant women, and the absence of addiction. The only small drawback of Articaine, according to experts, is the inability to prescribe it to children under 4 years of age. In all other cases, Articaine is rightly called one of the drugs of choice.

This information is intended for medical professionals and specialists.

Contraindications

The use of local anesthetic Articaine is prohibited in the following cases:

• in the presence of a hypersensitivity reaction to Articaine, Adrenaline, sulfites, as well as to any other auxiliary component of the drug;
• for various forms of tachyaarthymia, including paroxysmal tachycardia, atrial fibrillation;
• if you have a history of bronchial asthma with excessive sensitivity to sulfites;
• with existing angle-closure glaucoma;
• with simultaneous therapy with non-selective beta-blockers (Propranolol, Timolol, Nadolol, Carvedilol);
• severe liver dysfunction;
• excessive concentrations of thyroid hormones in the bloodstream (hyperthyroidism);
• undergoing a course of therapy with drugs that inhibit monoamine oxidase (Selegiline, Pirlindol, Garmaline, Nialamid) or tricyclic antidepressants (Fluoxetine, Amitriptyline, Imipramine, Trimipramine);
• with existing B12-deficiency anemia, methemoglominemia;
• in the presence of severe cardiac conduction disturbances (severe bradycardia, atrioventricular block of II-III degrees);
• in the presence of diseases of the central nervous system;
• with severe arterial hypotension;
• condition of acute heart failure;
• extensive maxillofacial surgical interventions, as well as surgical procedures lasting more than 20 minutes;
• children under 4 years old.

Use with caution:

• during pregnancy;
• in postpartum women with gestosis;
• if there is bleeding in the last trimester of pregnancy;
• with a lack of blood cholinesterase;
• with insufficient kidney function;
• in the presence of diabetes mellitus;
• with hypertension.

Directions for use and dosage

The main feature of Articaine is its high ability to penetrate tissue structures when administered by injection. Therefore, the drug allows you to carry out many interventions (for example, preparing teeth for prosthetics, surgical interventions on soft tissues, tooth extraction) under infiltration anesthesia in the upper and lower jaws.

The absence of side effects during local anesthesia largely depends on the correct calculation of the required dosage of the drug used for anesthesia.

Particular attention is paid to this in pediatric dentistry, which is explained both by the child’s lower body weight and by the peculiarities of the functioning of organs and systems that take part in the change and elimination of drugs, as well as in patients at high risk.

The “gold” standard is the use of a minimal amount of local anesthetic to achieve maximum pain control. Also, the choice of dosage is based on the depth of penetration of the required anesthesia and the time of the required intervention.

4% Articaine with Adrenaline provides a reliable analgesic effect, which manifests itself 1-3 minutes after injection of the drug. Duration of action – 45-150 minutes. In this case note:

• good penetrating ability;
• good tolerance;
• minimal vasospasm;
• no increase in blood pressure;
• no increase in heart rate;
• minimal penetration through the placental barrier.

Therapeutic dentistry

Articaine is used in the indicated dosage and is used for both infiltration and conduction anesthesia for the following purposes:

• preparation of carious cavities;
• treatment of pulpitis;
• carrying out therapy for periodontitis;
• performing periodontal surgical interventions.

To obtain an analgesic effect lasting from 30 to 45 minutes, the drug is administered from the external (vestibular) side in a dosage of 0.5 to 1.8 ml per tooth.

Surgical dentistry

Instillation of the drug into the submucosal area of ​​the required tooth is used in a volume of 1.8 ml. If the need arises, additional administration of the medication in the same volume is possible in order to achieve complete pain relief. Used for conduction and infiltration anesthesia. Indication: removal of one or more adjacent teeth.

For surgical interventions on the palate (suturing, incisions), administering the drug in a volume of 0.1 ml per injection is sufficient.

Orthopedic dentistry

Used for both conduction and infiltration local anesthesia. From 0.5 to 1.8 ml is injected from the outside of the jaw into the submucous membrane of the area of ​​the required tooth. Additional administration of the drug is possible if necessary, but not more than 7 mg per 1 kg of patient body weight. Indication: odontopreparation.

Uncomplicated tooth extraction, preparation for filling, preparation for placement under a crown should be accompanied by the administration of 0.5 to 1.8 ml of local anesthetic with a vasoconstrictor drug (no more than 1 carpule). If there is a need to administer Articaine from the palatal side, then use 0.1 ml of a local anesthetic.

The maximum dosage allowed for injection of Articaine is:

• for children from 4 to 12 years – 5 mg/kg;
• for children over 12 years of age and adults – 7 mg/kg.

In an outpatient setting, the recommended dose of anesthetic is ½ of the maximum allowable dose.

Before direct administration of the drug, an aspiration test is required to avoid intravascular administration of the drug. The pressure exerted on the piston during administration of the product must be adjusted depending on the sensitivity of the tissue. It is not recommended to administer the drug to areas of the mucosa that show signs of inflammation.

The drug is intended for use in the oral cavity.

In order to avoid accidental release of the drug into the blood vessels, a two-stage aspiration test should always be performed before its administration, rotating the needle 90 and 180°. The main systemic reactions that may develop as a result of accidental intravascular administration of the drug can be avoided by following the injection technique: after an aspiration test, 0.1 - 0.2 ml of the drug is slowly injected, then, no earlier than 20 - 30 seconds later, slowly injected the remaining dose of the drug. The injection pressure should correspond to the sensitivity of the tissue.

To prevent infection (including with the hepatitis virus), it is necessary to ensure that new sterile syringes and needles are always used when taking the drug from ampoules. Opened cartridges must not be reused for other patients (risk of hepatitis infection)! Damaged cartridges must not be used.

The drug should not be used if it has changed color or becomes cloudy. Dosage regimen

For anesthesia during uncomplicated extraction of teeth of the upper jaw in the absence of inflammation, it is usually sufficient to create a depot of the drug Articaine with adrenaline forte in the area

transitional fold by introducing it into the submucosa from the vestibular side (1.7 ml of the drug per tooth). In some cases, it may be necessary to achieve complete anesthesia.

additional administration from 1 ml to 1.7 ml. In most cases, this eliminates the need for a painful palatal injection.

For anesthesia for incisions and sutures in the palate in order to create a palatal depot, about 0.1 ml of the drug per injection is required.

When removing several adjacent teeth, the number of injections can usually be limited.

In the case of removal of mandibular premolars in the absence of inflammation, as a rule, it is sufficient to administer 1.7 ml of the drug per tooth. If in this way it was not possible to achieve the desired

effect, an additional injection of 1 - 1.7 ml of anesthetic should be performed into the submucosa in the area of ​​the transitional fold of the mandible on the vestibular side.

If in this case it was not possible to achieve complete anesthesia, it is necessary to conduct a conduction block of the mandibular nerve.

During surgical interventions, depending on their severity and duration, the drug Articaine with adrenaline forte is dosed individually.

When performing one treatment procedure, adults can be administered up to 7 mg of articaine per 1 kg of body weight. It was noted that patients tolerated doses up to 500 mg well (corresponding to 12.5 ml of the drug).

Elderly patients and patients with severe renal and hepatic impairment

In elderly patients and all patients with severe renal and hepatic insufficiency, increased plasma concentrations of articaine may occur. For these

Patients should be treated with the minimum dose necessary to achieve a sufficient depth of anesthesia.

Children

• For pediatric patients (over 4 years of age), the minimum doses necessary to achieve adequate anesthesia should be used. The dose of Articaine with adrenaline forte is selected depending on the age and body weight of the child, but it should not exceed 7 mg of articaine per 1 kg of body weight (0.175 ml/kg). The use of the drug in children under 1 year of age has not been studied. Side effect
• The incidence of side effects is presented in accordance with the classification recommended by the World Health Organization: very often (2 1/10); often (2 1/100, < 1/10); uncommon (2 1/1000, <1/100); rare (2 1/10000, <1/1000); very rare (<1/10000), including isolated reports; frequency unknown (cannot be determined from available data). Immune system disorders Not known
• Allergic or allergy-like reactions. They can be expressed in the form of swelling and (or) inflammation at the injection site, but can also occur regardless of the injection site and manifest themselves in the form of redness, itching, conjunctivitis, rhinitis, angioedema of the face with swelling of the upper and (or) lower lip, cheeks, swelling of the larynx with a feeling of a “lump in the throat” and difficulty swallowing, urticaria and difficulty breathing, which can lead to anaphylactic shock.
• From the central nervous system / Often

Paresthesia, hypoesthesia, headache (due to the presence of epinephrine in the drug).

Infrequently

Dizziness.

Frequency unknown

- dose-dependent reactions from the central nervous system (including at excessively high doses or after accidental intravascular injection): anxiety, nervousness, stupor, confusion up to loss of consciousness, coma, respiratory failure up to respiratory arrest, muscle tremors and twitching muscles up to generalized convulsions;

- if the correct technique for administering the drug is violated or due to anatomical features in the injection area, damage to the facial nerve is possible, which can lead to paralysis of the facial nerve and a decrease in taste sensations.

Visual disorders

Frequency unknown

Visual disturbances (blurred vision, mydriasis, blindness, double vision), usually reversible and occurring during or shortly after injection of a local anesthetic.

Articaine with adrenaline forte, solution for injection (40 mg+0.01 mg)/ml, ampoules 2 ml No. 10 price: 870.00 rub. (on order)

Articaine with adrenaline forte 40+0.01 mg/ml cartridges (1: 100,000) 1.7 ml No. 50 price: RUB 1,785.00

Also purchased with this product:

• Dental materials, instruments and equipment
• Articaine INIBSA
• Articaine, Articaine with adrenaline, Articaine with adrenaline forte
• Brilocaine - adrenaline forte
• Cathejell with Lidocaine
• Dental injection kit AERS (disposable carpule syringe+carpule+needle)
• Disposable carpule syringe
• Orabloc®, injection solution
• Primacaine adrenaline
• Septanest with Adrenaline
• Scandinibsa® 3% (Scandinibsa 3%)
• Ultracain DS, Ultracain DS forte
• Ubistezin forte
• Carpule syringe
• Carpule needles
• Lidocaine

Side effects

Articaine may cause a number of adverse effects:

• from the nervous system: stupor, loss of consciousness, respiratory disorders, respiratory arrest, tremor, twitching of muscle groups, generalized convulsions, dizziness, cephalalgia, hypoesthesia (change in pain sensitivity), paresthesia (burning sensation, pointing), damage to the facial nerve (muscle paralysis faces);
• from the organ of vision: blurred vision, diplopia (double vision), decreased visual acuity, blindness;
• from the cardiovascular system: low blood pressure, poor heart function, cardiogenic shock;
• from the digestive tract: nausea, vomiting;
• from the immune system: hypersensitivity reactions at the injection site - hyperemia, edema, hyperemia of the skin, angioedema (swelling of the upper and lower lips, cheeks, vocal cords), rhinitis, conjunctivitis, urticaria, impaired respiratory function.

Overdose

Administration of an excessive amount of the drug can lead to a variety of manifestations from various organ systems:

• Nervous system. Both depression and excitation can be observed. In the first case, dizziness, shortness of breath, impaired consciousness up to its complete loss are observed. Excitement is characterized by anxiety, causeless restlessness, tremors of the limbs, convulsions, increased frequency of respiratory movements, and increased heart rate.
• The cardiovascular system. Detect cardiac arrhythmias, ventricular fibrillation, arterial hypotension, and cardiac arrest.

Treatment:

• stopping the administration of the drug;
• the patient is placed on a horizontal surface;
• ensures airway patency and oxygen flow;
• breathing rate, heart rate, and blood pressure are monitored;
• in case of respiratory failure - oxygen supply, intubation, artificial ventilation;
• in the presence of convulsions, short-acting barbiturates (Cyclobarbital, Thiopental, Hexobarbital, Kemital) are administered intravenously with simultaneous oxygen supply and blood circulation control;
• in case of significant disturbances of blood circulation and shock conditions - intravenous infusion of electrolytes (Ringer's, Aminol, Ringer-Locke solutions), glucocorticosteroid hormones (Dexamethasone, Prednisolone, Methylprednisolone), plasma-substituting solutions (crystalloids - saline solution, 5% glucose, colloids - dextrans, starches, gelatins; Reopoliglucin, blood plasma, fluorodecalins), albumin;
• in collaptoid conditions and bradycardia - slow intravenous administration of 0.1 ml of Epinephrine, then drip into a vein under the control of blood pressure and heart rate;
• for tachycardia and tachyarrhythmias - beta-blockers (Metoprolol, Propranolol, Esmolol, Atenolol) into the vein, blood pressure control and oxygen supply.

Drug interactions

When using Articaine simultaneously with:

• medications that depress the nervous system (general anesthetics - Halothane, Ftorotan, hypnotics - Zopiclone, Zolpidem) increase the effect of the latter;
• anticoagulants (Heparin, Warfarin, Fraxiparine, Clexane) indicate an increased risk of bleeding and hemorrhage;
• monoamine oxidase inhibitors (Selegelin, Pirlindol, Nialamid) increase the risk of developing arterial hypotension, therefore it is recommended to stop taking these drugs 10 days before the planned dental procedure;
• muscle relaxants (Suxamethonium, Tubocurarine, Orphenandrine, Dantrolene) reveal an increase in the duration of action of the latter drugs;
• with narcotic analgesics (Tramadol, Fentanyl, Codeine, Buprenorphine), an increase in the effects of these medications is observed, depression of respiratory function is noted;
• vasoconstrictor drugs (Oxymetazoline, Xylometazoline, Caffeine, Naphazoline) enhance and lengthen the local anesthetic effect of Articaine;
• cholinesterase blockers (Neostigmine, Galantamine, Physostigmine, Pyridostigmine), Thiotepa, Cyclophosphamide reduce the rate of metabolism of Articaine.

Articaine is an antagonist of drugs used to treat myasthenia gravis due to its effect on striated muscles, especially when used in high dosages, as a result of which additional correction of the treatment of myasthenia gravis is required.

When treating the injection site of a local anesthetic with disinfectant solutions that contain heavy metals, the risk of developing an adverse local reaction in the form of swelling, hyperemia and painful sensitivity increases.

special instructions

When using Articaine, some points should be observed:

• intravenous administration is contraindicated;
• in order to prevent infectious and inflammatory complications, you should ensure the sterility of the needles and syringes used when taking the drug from the ampoule;
• Infiltration mandibular anesthesia of the tongue and soft palate does not work (a conduction anesthesia method is required);
• infiltration anesthesia has the effect of conduction anesthesia during the removal of mandibular premolars;
• it is required to monitor the functions of the cardiovascular, nervous systems, and respiratory tract;
• Monoamine oxidase inhibitors should be discontinued 10 days before the administration of Articaine.

Articaine during pregnancy and lactation

The use of Articaine during pregnancy has not been established due to insufficient clinical data. It is possible to use this drug if the potential therapeutic effect outweighs the potential risk of adverse effects on the fetus.

Penetrates through the placental barrier. Does not have a teratogenic effect on the fetus, regardless of the technique of use and dosage.

During breastfeeding, there is no need to interrupt feeding in this manner, since no significant concentrations of Articaine are found in milk.

Articaine is a drug used in dental practice to provide local anesthesia. It has a significant effect, sufficient duration of action, and minimal risk of adverse reactions. It can be used in pediatric dentistry, as well as in the treatment of pathologies in women during pregnancy.

Sources used:

• Solovyova A. A. (2015) Fundamentals of anesthesiology. Local and general anesthesia
• https://esraeurope.org/
• Lidocaine // Medicines / M. D. Mashkovsky

Artikain

Articaine is a clear, colorless or yellowish solution for injection.

Indications for use: Infiltration and conduction anesthesia in dentistry. The drug is optimal when working with patients with a history of allergies, in gerontological and pediatric dentistry, and in patients with cardiovascular diseases. The onset of pain relief is from 1 to 3 minutes. Effective anesthesia time is at least 20 minutes. It is possible to prolong anesthesia by injecting the anesthetic.

Analogue of the drug: Ultracain D

Articaine is a local anesthetic (thiophene derivative) for infiltration and conduction anesthesia in dental practice, has a pronounced local anesthetic effect. In tissues (in a slightly alkaline environment) it undergoes hydrolysis and releases a base that has lipophilic properties and easily penetrates the membrane into the nerve fiber.

Articaine interacts with receptors, blocks sodium channels in the nerve fiber membrane, thus providing a local anesthetic effect. The effect of the drug begins quickly (the latent period is 1-3 minutes). Duration of action: 20 minutes. The rapid destruction of articaine to an inactive metabolite - articainic acid - is the reason for its very low toxicity, which allows repeated administration of the drug. In an acidic environment the effect is reduced.

Compound:

1 ml of solution contains: active substance: articaine hydrochloride - 40 mg; excipients: sodium chloride – 2.1 mg water for injection up to 1 ml.

Instructions for use

Before administering the drug, it is always recommended to perform an aspiration test in order to avoid intravascular administration of the drug. The pressure on the piston during drug administration should be adjusted depending on tissue sensitivity. Administration of the drug into inflamed areas of the mucous membrane is not recommended. Eating is allowed only after sensitivity has been restored.

For uncomplicated extraction of maxillary teeth in the non-inflammatory stage - 1.7 ml per tooth into the vestibular depot; if necessary, additionally - 1.0-1.7 ml.

For anesthesia for palatal incisions and suturing to create a palatal depot - 0.1 ml.

When removing premolars of the lower jaw (5-5) in an uncomplicated stage, infiltration anesthesia gives the effect of conduction anesthesia.

When preparing cavities and grinding teeth for crowns , with the exception of molars of the lower jaw, a vestibular injection of 0.5 - 1.7 ml per tooth.

When performing one treatment procedure, the maximum dose for adults is 4 mg/kg body weight.

Use during pregnancy and lactation: The safety of Articaine during pregnancy has not been established due to insufficient clinical data. Articaine penetrates the placental barrier. The question of using the drug by a dentist can only be accepted if the potential benefit from its use justifies the potential risk to the fetus. Has no effect on the fetus (except for possible bradycardia) with any technique of application and dose. During lactation there is no need to interrupt breastfeeding, since clinically significant concentrations of Articaine are not found in breast milk.

Contraindications: Hypersensitivity to articaine or other local anesthetic drugs of the amide group; megaloblastic B12 deficiency anemia; angle-closure glaucoma; diseases of the central nervous system; chronic hypoxia; bronchial asthma. Paroxysmal tachycardia; atrial fibrillation; severe cardiac conduction disturbances (for example, atrioventricular block II-III degree, severe bradycardia), acute heart failure, arterial hypotension. Volumetric maxillofacial operations, as well as with intervention durations exceeding 20 minutes. Children under 4 years of age (efficacy and safety have not been studied). With caution: Women in labor with preeclampsia, bleeding in the last trimester of pregnancy.

Articaine, detailed instructions for use

, Russia

Shelf life: 3 years

Articaine, solution for injection 40 mg/ml, ampoules 2 ml No. 10 price: 870.00 rub. (on order)

Articaine 40 mg/ml, cartridges 1.7 ml No. 50 price: RUB 1,820.00