Alternatives to Citanest if You Can't Fill Your Prescription

If your dental office has run out of Citanest or you have been told it is no longer available, you are not without options. Prilocaine was just one of several excellent amide-type local anesthetics used in dentistry. This guide breaks down the best alternatives, their strengths and limitations, and how to decide which one is right for your situation in 2026.

Why Citanest Is No Longer Available

Citanest Plain Dental (4% prilocaine without epinephrine) has been formally discontinued in the United States. The Citanest Forte formulation (with epinephrine 1:200,000) may have limited availability through dental supply distributors. Given this situation, dentists and patients need reliable substitutes — particularly for patients who required Citanest Plain specifically because it contains no vasoconstrictor.

Option 1: Mepivacaine 3% Plain (Carbocaine, Polocaine) — Best Direct Substitute

For patients who needed Citanest Plain specifically because they cannot receive a vasoconstrictor,

mepivacaine 3% plain is the closest available substitute. It is widely available, has mild vasodilatory effects, and does not require a vasoconstrictor to produce adequate anesthesia. For infiltrations it provides 20-40 minutes of pulpal anesthesia; for nerve blocks, approximately 40-60 minutes. It is suitable for cardiovascular patients, pregnant patients, and those on medications that preclude epinephrine.

Best for: Patients who cannot tolerate epinephrine or sulfites; short to medium-length procedures; cardiovascular-compromised patients.

Option 2: Articaine 4% (Septocaine, Zorcaine) — Most Widely Used Alternative

Articaine has become one of the most popular dental local anesthetics worldwide. It contains a thiophene ring instead of a benzene ring, which improves lipid solubility and allows it to diffuse more readily through hard and soft tissues. Articaine has the shortest elimination half-life of all dental local anesthetics — approximately 27 to 42 minutes — which contributes to its favorable safety profile.

Articaine comes with epinephrine (either 1:100,000 or 1:200,000), so it is not suitable for patients who absolutely cannot receive any vasoconstrictor. However, for most patients who previously received Citanest Forte (the epinephrine-containing formulation), articaine is an excellent substitute.

Best for: Patients who need good tissue penetration, mandibular procedures, patients who can tolerate low doses of epinephrine.

Option 3: Lidocaine 2% with Epinephrine (Xylocaine) — The Gold Standard

Lidocaine with epinephrine 1:100,000 or 1:50,000 remains the most widely used dental local anesthetic in the United States. It has the longest track record of safety and efficacy. For the vast majority of routine dental procedures, lidocaine with epinephrine is available at every dental office and works well for most patients.

Best for: Routine fillings, extractions, root canals; patients without epinephrine contraindications; situations requiring longer procedure times.

Option 4: Bupivacaine 0.5% (Marcaine) — For Post-Operative Pain Management

Bupivacaine provides a prolonged duration of anesthesia and is used primarily for longer surgical procedures and post-operative pain management. It is not typically chosen for routine fillings or short dental procedures. Duration of anesthesia extends 6-9 hours, which may be bothersome for some patients.

Best for: Oral surgery, extractions where postoperative pain is expected; longer procedures.

Comparison Table: Citanest Alternatives at a Glance

Mepivacaine 3% (no vasoconstrictor): Pulpal duration 20-40 min infiltration / 40-60 min block; no epinephrine; widely available

Articaine 4% (with epinephrine): Pulpal duration 60-90 min; excellent tissue penetration; shortest half-life (27-42 min); widely available

Lidocaine 2% (with epinephrine): Pulpal duration 60 min; gold standard; half-life 90 min; universally available

Bupivacaine 0.5% (with epinephrine): Pulpal duration 90-180 min; very long soft tissue numbness (6-9 hr); used for surgical procedures

What to Tell Your Dentist

When switching from Citanest, tell your dentist:

• Whether you have a medical reason for needing an epinephrine-free anesthetic
• Any medications you take that may interact with vasoconstrictors (e.g., MAO inhibitors, certain antidepressants, beta-blockers)
• Any history of reactions to dental anesthetics
• Cardiovascular conditions such as uncontrolled hypertension, arrhythmias, or recent cardiac events

Finding the Right Option Near You

If your dental practice is having trouble locating any specific anesthetic, medfinder can help you check availability. medfinder contacts pharmacies and supply sources to find which ones carry the medication you need and texts the results to you.

For more background, see our article on why Citanest is so hard to find in 2026.