Updated: January 18, 2026

Citanest Shortage Update: What Patients Need to Know in 2026

Author

Peter Daggett

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Current Status of Citanest in 2026
What Does This Mean for Patients Who Need Citanest?
Patients Who Cannot Receive Epinephrine
The Methemoglobinemia Warning: What Patients Should Know
Should You Be Worried About Your Upcoming Dental Appointment?
Finding a Dentist Who Uses the Right Anesthetic
The Latest on Citanest Availability

Citanest Plain Dental has been discontinued in the US. Here is the latest update for patients, what it means for your dental care, and your options.

The news about Citanest (prilocaine) dental anesthetic has been concerning for many dental patients: Citanest Plain Dental, the epinephrine-free formulation, has been discontinued in the United States. Here is everything you need to know about this development, what it means for your upcoming dental appointments, and what alternatives your dentist can offer in 2026.

Current Status of Citanest in 2026

As of the latest information available:

Citanest Plain Dental (4% prilocaine without epinephrine): Discontinued in the United States. The brand name and all generics have been pulled from the US market.
Citanest Forte Dental (4% prilocaine with epinephrine 1:200,000): May still be available from some dental supply distributors, but availability is inconsistent and not guaranteed.

What Does This Mean for Patients Who Need Citanest?

For most patients, the discontinuation of Citanest Plain will not significantly impact their dental care. The majority of dental procedures can be performed using lidocaine, articaine, or mepivacaine. However, there is a specific patient population that will feel this more acutely:

Patients Who Cannot Receive Epinephrine

Some patients have medical conditions or take medications that make epinephrine in dental anesthetics a concern. These include:

Patients taking MAO inhibitors or certain tricyclic antidepressants
Patients with uncontrolled or severe hypertension
Patients with hyperthyroidism
Patients with bisulfite allergy (relevant for Citanest Forte, which contains sodium metabisulfite)

If you are in one of these categories, it is important to tell your dentist so they can plan ahead. The primary alternative for epinephrine-free dental anesthesia is now mepivacaine 3% plain (Carbocaine or Polocaine), which is widely available.

The Methemoglobinemia Warning: What Patients Should Know

One of the key safety concerns with prilocaine was the risk of methemoglobinemia — a condition where red blood cells lose their ability to carry oxygen effectively. This risk is dose-related and generally only occurs when prilocaine is administered in amounts exceeding 600 mg (8 cartridges) in adults. At normal dental doses of 40-80 mg (1-2 cartridges), this risk is extremely remote. However, certain patients were at higher risk and should note that their new anesthetic should be discussed with their dentist:

Patients with G6PD deficiency
Patients with sickle cell anemia or other oxygen-carrying disorders
Infants under 6 months of age
Patients taking medications that increase methemoglobin levels (acetaminophen in very high doses, phenazopyridine, dapsone, sulfonamides)

Should You Be Worried About Your Upcoming Dental Appointment?

In short, no — not for most patients. Dentists have excellent alternatives to Citanest and will select the most appropriate anesthetic based on your medical history and the procedure. If you have specific concerns about which anesthetic your dentist uses, call ahead and ask. This gives them time to prepare and make any necessary accommodations.

Finding a Dentist Who Uses the Right Anesthetic

If you are searching for a dentist or dental office that has specific anesthetic options available, medfinder can help. medfinder contacts pharmacies and dental supply sources near you to confirm which medications are available, then texts you the results. This takes the guesswork out of calling around.

The Latest on Citanest Availability

There is currently no indication that Citanest Plain Dental will return to the US market. The discontinuation appears to be permanent. For Citanest Forte, while some stock may exist in the supply chain, it is not a product you can reliably count on long-term. Dental offices and patients should plan around alternatives rather than waiting for Citanest to return.

Learn more about the best alternatives to Citanest for your dental care needs.

Frequently Asked Questions

Citanest Plain Dental has been permanently discontinued in the United States — this is not a temporary shortage. The brand name and all generic equivalents have been withdrawn from the US market. Citanest Forte may remain available from some distributors on a limited basis, but its long-term availability is uncertain.

For most patients, the answer is no. Dentists have excellent alternatives including mepivacaine (Carbocaine), articaine (Septocaine), and lidocaine (Xylocaine). The main patients affected are those who specifically needed an epinephrine-free anesthetic, for whom mepivacaine 3% plain is now the primary substitute.

Tell your dentist about your medical condition as early as possible — ideally when scheduling your appointment. Explain that you previously used Citanest Plain because you cannot receive a vasoconstrictor. Your dentist can then prepare mepivacaine 3% plain (Carbocaine) or another appropriate epinephrine-free option for your procedure.

The discontinuation reported by drugs.com and the FDA is specific to the United States market. In Canada and some other countries, prilocaine formulations may still be available under the Citanest name or under other labels. International availability varies by manufacturer and distributor.

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