How to Help Your Patients Find Citanest in Stock: A Provider's Guide

The discontinuation of Citanest Plain Dental (prilocaine 4% without vasoconstrictor) has created a specific clinical challenge for dental offices: a subset of patients who depended on this epinephrine-free anesthetic now need a different approach. This guide gives dental providers a practical roadmap for sourcing alternatives, communicating with affected patients, and updating their protocols with minimal disruption to care.

Step 1: Identify Affected Patients in Your Practice

The first practical step is to run a chart review or query your practice management software for patients whose medical history or past treatment notes indicate:

• Contraindication to epinephrine or vasoconstrictors
• History of receiving Citanest Plain specifically
• Documented bisulfite allergy (these patients also cannot receive sulfite-containing epinephrine formulations)
• Use of MAO inhibitors, TCAs, or beta-blockers that interact with vasoconstrictors

Flag these records proactively so you are prepared before the patient arrives for their next appointment.

Step 2: Stock the Right Alternatives

Based on the patient populations affected, here are the substitutes we recommend having on hand:

• Mepivacaine 3% plain (Carbocaine, Polocaine): Primary substitute for all patients who cannot receive epinephrine. Order 1-2 boxes as standard inventory.
• Articaine 4% with epinephrine 1:200,000 (Septocaine, Zorcaine): Best general-purpose substitute for Citanest Forte for patients who can tolerate low-dose epinephrine.
• Lidocaine 2% with epinephrine 1:100,000 (Xylocaine): Gold standard; ensure adequate stock for routine procedures.

Step 3: Communicate With Patients Before Their Appointment

Proactive communication avoids confusion at chairside. For patients who previously received Citanest Plain, send a brief notice or have your front desk call ahead. The message can be simple:

Sample script: "We wanted to let you know that Citanest, the dental anesthetic we previously used for you, has been discontinued by the manufacturer. We've selected a comparable alternative [mepivacaine 3% plain] that is also epinephrine-free and appropriate for your medical history. If you have questions, please don't hesitate to call us before your appointment."

Step 4: Use medfinder to Source Medications Efficiently

When you need to locate a specific dental anesthetic quickly, medfinder for providers takes the manual work out of calling distributors. medfinder contacts multiple supply sources near your practice and reports back which ones have the medication in stock. This saves your team time and helps you plan patient care around actual availability.

Step 5: Review and Update Your Drug Allergy Protocols

This change is also an opportunity to review how your practice documents and flags anesthetic-related allergy and contraindication information. Best practices include:

• Documenting the specific anesthetic agent used at each visit in the treatment record
• Including the dose and number of cartridges administered for medicolegal purposes
• Flagging any adverse reactions to local anesthetics, including paresthesia (which can persist weeks to months with amide-type agents including prilocaine)
• Including a current medication list in the anesthetic decision tree — particularly looking for methemoglobinemia-associated drugs (phenazopyridine, sulfonamides, dapsone, nitrates) which would have been a reason to limit prilocaine use anyway

When a Patient Asks for Citanest Specifically

Some patients may have been using Citanest for years and may ask for it by name. A clear, confident explanation helps:

"Citanest has been discontinued by the manufacturer and is no longer available in the US. The good news is that we have an excellent alternative — [mepivacaine 3% / Carbocaine] — that works the same way and is also completely epinephrine-free. Many patients who previously used Citanest have made this switch without issue."

For patient-facing resources, refer them to our Citanest shortage update for patients.