Comprehensive medication guide to Carbocaine With Neo-Cobefrin including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
No separate patient cost — anesthetic fees are bundled into dental procedure codes and covered as part of covered procedures. Coverage depends on the dental procedure performed and your plan's benefits.
Estimated Cash Pricing
$75–$150 per box of 50 cartridges at dental supply distributors; approximately $1.50–$3.00 per cartridge. This is a dental office supply and is not dispensed to patients at retail pharmacies.
Medfinder Findability Score
62/100
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Carbocaine 2% with Neo-Cobefrin is a brand-name combination dental anesthetic containing mepivacaine hydrochloride 2% (the local anesthetic) and levonordefrin 1:20,000 (the vasoconstrictor). It is manufactured by Septodont, Inc. and supplied in 1.7 mL single-dose dental cartridges, 50 per box.
This medication is intended exclusively for dental use and is administered by injection — by infiltration or nerve block — to produce local anesthesia during dental procedures. It is FDA-approved for use in adults and pediatric patients.
Other brand names for the same active combination include Polocaine Dental and Scandonest 2% L. The drug was first introduced in 1960 as a 2% solution with levonordefrin and is the third most widely used dental local anesthetic in parts of the world, after articaine and lidocaine.
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Mepivacaine works by blocking voltage-gated sodium channels in nerve cell membranes. Pain signals travel through nerves as electrical impulses triggered by sodium flowing through these channels. By binding to and blocking sodium channels, mepivacaine prevents nerves from generating or transmitting electrical pain signals, effectively "turning off" sensation in the targeted area.
Levonordefrin (Neo-Cobefrin) acts as a sympathomimetic vasoconstrictor. By stimulating alpha-adrenergic receptors in blood vessel walls, it causes local vasoconstriction — narrowing blood vessels at the injection site. This reduces blood flow, slowing absorption of mepivacaine and significantly prolonging the duration of anesthesia: up to 2.5 hours in the upper jaw and 5.5 hours in the lower jaw.
A key advantage of levonordefrin over epinephrine (the more common vasoconstrictor) is its reduced beta-adrenergic activity — meaning less cardiac stimulation, less heart rate increase, and less patient anxiety. Mepivacaine itself is also notable for having weaker vasodilatory properties than other amide anesthetics, contributing to useful duration even in its plain (no vasoconstrictor) formulation.
Mepivacaine HCl 2% / Levonordefrin 1:20,000 — injection (dental cartridge)
1.7 mL single-dose cartridge (34 mg mepivacaine per cartridge). Max dose: 6.6 mg/kg up to 400 mg.
Carbocaine 2% with Neo-Cobefrin is generally available through major dental supply distributors in 2026, but it is among the more supply-vulnerable dental anesthetics due to its niche vasoconstrictor ingredient (levonordefrin) and limited manufacturing base. The product has experienced historical supply disruptions, including a documented discontinuation when a key raw ingredient was no longer available.
Regional and distributor-level supply gaps can occur without official FDA shortage designation. Dental offices may need to check multiple distributors, or source generic equivalents (Polocaine Dental, Scandonest 2% L) when Carbocaine brand supply is constrained. We give this medication a findability score of 62/100 — generally available with intermittent stocking gaps.
If your dental office or patient is struggling to locate this anesthetic, medfinder can contact dental providers near you to check availability — saving time and effort for both patients and dental teams.
Carbocaine with Neo-Cobefrin is not a controlled substance and is not subject to DEA Schedule prescribing restrictions. However, it is a prescription dental injectable that must be administered by or under the direct supervision of a licensed dental professional. It is a dental office supply ordered through dental supply distributors — not dispensed to patients at retail pharmacies.
Licensed providers who can administer Carbocaine with Neo-Cobefrin include:
General dentists (DMD or DDS) — most common for routine dental procedures
Oral and maxillofacial surgeons — extractions, implants, reconstructive procedures
Periodontists — gum surgery and periodontal procedures
Endodontists — root canal procedures requiring deep anesthesia
Dental anesthesiologists — pain and anxiety management specialists
Dental hygienists — in supervised settings in states that permit extended-function hygiene
Telehealth is not applicable for the administration of Carbocaine with Neo-Cobefrin itself. However, a telehealth consultation with a dentist can help patients discuss their anesthetic needs, review medical history considerations, and obtain a referral to an appropriate in-person provider before scheduling their procedure.
No. Carbocaine 2% with Neo-Cobefrin is not a DEA-scheduled controlled substance. Mepivacaine hydrochloride and levonordefrin have no abuse potential and are not subject to the prescribing restrictions, refill limitations, or special DEA tracking requirements that apply to controlled substances such as opioids or benzodiazepines.
Carbocaine with Neo-Cobefrin is a prescription dental injectable — it requires a licensed dental professional to administer and is not dispensed to patients at retail pharmacies. As a dental office supply, it is ordered through dental supply distributors and administered chairside during dental procedures.
Most patients tolerate Carbocaine with Neo-Cobefrin well. Common expected effects include:
Prolonged numbness (1–5.5 hours depending on jaw location)
Injection site soreness or bruising (24–48 hours)
Temporary numbness extending beyond the target area
Mild dizziness immediately after injection (usually anxiety-related)
Metallic taste in the mouth
Methemoglobinemia: Pale, gray, or blue skin/lips (cyanosis), rapid heart rate, shortness of breath, extreme fatigue — call 911
Severe allergic reaction (anaphylaxis): Hives, throat swelling, difficulty breathing — call 911
CNS toxicity: Excitation, confusion, seizures — medical emergency
Cardiovascular collapse: Chest pain, irregular heartbeat, loss of consciousness — call 911
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Lidocaine 2% with Epinephrine (Xylocaine)
Gold standard dental anesthetic; ~49% US market share; available with 1:100,000 or 1:50,000 epi; stronger cardiovascular stimulation than levonordefrin.
Articaine 4% with Epinephrine (Septocaine)
Second most popular dental anesthetic; ~35.6% US market share; excellent bone penetration; available with 1:100,000 or 1:200,000 epi.
Mepivacaine 3% Plain (Carbocaine 3%)
Same base drug without vasoconstrictor; shorter duration (20-40 min); preferred for cardiac patients where all vasoconstrictors are contraindicated.
Prilocaine 4% Plain or with Epinephrine (Citanest)
Lower toxicity; vasoconstrictor-free option provides intermediate duration for nerve blocks; small methemoglobinemia risk at high doses.
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MAO Inhibitors (MAOIs)
majorSevere, prolonged hypertension risk. Concurrent use should be avoided.
Tricyclic Antidepressants (TCAs)
majorPotentiation of vasopressor effect; risk of severe hypertension and cardiac arrhythmias.
Ergot-type oxytocic drugs
majorSevere persistent hypertension or cerebrovascular accident risk.
Potent halogenated inhalation anesthetics
majorRisk of serious cardiac arrhythmias when used concurrently with vasopressors.
Non-selective beta-blockers
moderateMay potentiate alpha-adrenergic vasopressor effects, elevating blood pressure.
Phenothiazines and butyrophenones
moderateMay reduce or reverse pressor effect of levonordefrin.
Carbocaine 2% with Neo-Cobefrin has been a trusted dental anesthetic for over 60 years. Its combination of an amide local anesthetic (mepivacaine) with a gentler vasoconstrictor (levonordefrin) makes it a clinically valuable option — especially for patients with cardiovascular concerns who need prolonged dental anesthesia. The product has demonstrated clinical efficacy comparable to lidocaine with epinephrine across most dental procedure types.
Supply challenges stem from levonordefrin's niche manufacturing base and the product's limited number of producers. Dental practices benefit from maintaining relationships with multiple distributors and being aware of generic equivalents (Polocaine Dental, Scandonest 2% L) for when the Carbocaine brand is unavailable. For most patients, a clinically appropriate alternative exists when this anesthetic cannot be sourced.
If you are a patient who needs dental care requiring a specific anesthetic and your dental provider is having trouble sourcing it, medfinder can contact dental providers near you to check availability — so you can get the care you need without spending hours on the phone.
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