Why Is Citanest So Hard to Find? [Explained for 2026]

If you or your dentist has been trying to find Citanest (prilocaine) lately, you are not alone. This once-common dental local anesthetic has become increasingly difficult to source, and in many cases impossible to find at traditional channels. Here is exactly what happened, why it matters, and what your options are in 2026.

What Is Citanest and Why Was It Used?

Citanest is the brand name for prilocaine hydrochloride, an amide-type local anesthetic used in dentistry. It came in two formulations: Citanest Plain Dental (4% prilocaine without a vasoconstrictor) and Citanest Forte Dental (4% prilocaine with epinephrine 1:200,000). Both were delivered in 1.8 mL single-dose dental cartridges.

Dentists favored Citanest for specific clinical situations. Because it has lower systemic toxicity than many other amide anesthetics and mild vasodilating properties, it was especially popular for patients who could not tolerate epinephrine-containing formulations — such as those with certain cardiovascular conditions. Citanest Plain was also ideal for short procedures on the maxillary anterior teeth, producing pulpal anesthesia of approximately 10 minutes with rapid onset of under 2 minutes.

So Why Is Citanest Plain So Hard to Find Now?

The short answer: Citanest Plain Dental has been

discontinued in the United States. According to drugs.com, the Citanest HCl Plain brand name and all generics have been pulled from the US market. This is not a temporary shortage — it is a market withdrawal. Citanest Forte (with epinephrine) may still be available through certain dental supply distributors, but its availability is inconsistent and supply can be limited.

Several factors contributed to this situation:

• Market consolidation: Dentsply Sirona, the manufacturer, makes strategic decisions about which product lines to maintain based on volume and profit margins. A niche dental anesthetic with limited market share is vulnerable to discontinuation.
• Competition from articaine: Articaine (Septocaine, Zorcaine) has captured significant market share in dental anesthesia due to its excellent tissue penetration, shorter half-life, and strong efficacy. As demand for prilocaine declined, manufacturers had less incentive to produce it.
• Manufacturing complexity: Sterile injectable drug production requires significant infrastructure investment. When a product's sales volume falls below threshold, manufacturers often discontinue rather than maintain specialized production lines.
• Regulatory compliance costs: Meeting FDA manufacturing standards for injectable drugs involves ongoing investment. For low-demand products, these costs can exceed revenue.

Who Is Most Affected by the Citanest Shortage?

The discontinuation of Citanest Plain hits certain patient populations hardest:

• Patients who cannot receive epinephrine: Some cardiac patients, those on certain medications like MAO inhibitors, or patients with hyperthyroidism require epinephrine-free anesthetic. Citanest Plain was one of only two options (along with Carbocaine/mepivacaine) for this group.
• Pediatric patients: Citanest was frequently used in children for its favorable safety profile and lower systemic toxicity. Dentists may now need to substitute mepivacaine 3% plain.
• Dental practices with established protocols: Many dentists relied on Citanest Plain for specific procedure types (short maxillary anterior procedures) and now must re-evaluate their anesthetic selections.

Is Citanest Forte Still Available?

Citanest Forte (4% prilocaine with epinephrine 1:200,000) may still be available through dental supply distributors, though availability varies by region and distributor. Dentsply Sirona continues to list Citanest Forte on its product pages, but dental offices report inconsistent supply. If your practice uses Citanest Forte, it is worth checking with multiple distributors and ordering backup stock when available.

What Are the Best Alternatives to Citanest?

Fortunately, dentists have several well-studied alternatives. The right choice depends on the patient's medical history and the procedure type:

• Mepivacaine 3% plain (Carbocaine, Polocaine): The most direct substitute when epinephrine-free anesthetic is needed. Provides 20-40 minutes pulpal anesthesia for infiltrations.
• Articaine 4% (Septocaine, Zorcaine): Excellent tissue penetration and short half-life of 27-42 minutes. Available with epinephrine 1:100,000 or 1:200,000.
• Lidocaine 2% (Xylocaine): The time-tested gold standard for dental anesthesia, widely available in all settings.

How Can Patients and Dental Offices Respond?

If you are a patient concerned about your dental care, the most important step is to have an open conversation with your dentist about their anesthetic inventory. If you have a specific medical reason for requiring an epinephrine-free anesthetic, let your dentist know in advance so they can plan accordingly. medfinder helps patients find medications — including specialty items like dental anesthetics — by contacting pharmacies and supply sources near you.

For more detail on substitute anesthetics, see our guide: Alternatives to Citanest if You Can't Fill Your Prescription.

The Bottom Line

Citanest Plain Dental has been formally discontinued in the United States, making it essentially impossible to source through normal channels. Citanest Forte may be available on an inconsistent basis. For most patients, the impact is minimal because their dentist can switch to a comparable alternative. However, for specific patient populations that require epinephrine-free anesthesia, the discontinuation of Citanest Plain requires planning and communication with your dental provider.

Read more about the Citanest discontinuation and what it means for patients in our full Citanest shortage update for 2026.