Comprehensive medication guide to Citanest including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Local anesthesia costs are bundled into dental procedure fees under standard dental insurance plans (Delta Dental, Cigna, Aetna, MetLife). Patients typically pay their standard cost-share (co-pay or coinsurance) for the overall procedure, not a separate anesthetic charge.
Estimated Cash Pricing
Citanest is a professional dental injectable supply sourced by dental offices from dental distributors — it is not dispensed at retail pharmacies and has no consumer cash price. Dental procedure fees that include local anesthesia typically range from $50–$300 depending on the procedure.
Medfinder Findability Score
15/100
Summarize with AI
On this page
Citanest is the brand name for prilocaine hydrochloride, an amide-type local anesthetic used exclusively in dentistry to numb the mouth before and during dental procedures. It belongs to the same chemical class as lidocaine, mepivacaine, and articaine — all of which block pain signals by preventing sodium from entering nerve cells.
Citanest was available 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, with each cartridge containing 72 mg of prilocaine.
Citanest Plain was particularly valued for patients who could not tolerate epinephrine — such as those with certain cardiovascular conditions or drug interactions — and for short procedures on the maxillary anterior teeth. Its lower systemic toxicity compared to most other amide anesthetics made it a preferred choice in certain clinical situations.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Prilocaine works by blocking sodium channels in nerve cell membranes. Nerves send pain signals through electrical impulses triggered by sodium ions flowing in and out of cells. When prilocaine binds inside sodium channels, it prevents this ionic flow — stopping the nerve from generating or conducting electrical impulses. The result is numbness in the area around the injection.
Onset is rapid: under 2 minutes for infiltration injections and under 3 minutes for inferior alveolar nerve blocks. The duration of anesthesia depends on the formulation. Citanest Plain (without epinephrine) provides approximately 10-20 minutes of pulpal anesthesia and 1-2 hours of soft tissue numbness for infiltrations, while Citanest Forte (with epinephrine) extends these durations to approximately 45 minutes and 2-3 hours, respectively.
A unique feature of prilocaine's metabolism is that it is broken down not only in the liver but also in the lungs and kidneys — making it clear from the body more rapidly than most other amide anesthetics. This lower systemic toxicity was one of the key clinical advantages of prilocaine. However, prilocaine also produces a metabolite (ortho-toluidine) that can convert hemoglobin to methemoglobin at high doses, creating a rare but serious risk called methemoglobinemia.
4% (40 mg/mL) — injection solution (Citanest Plain)
1.8 mL single-dose cartridges; 72 mg per cartridge; DISCONTINUED in US
4% with epinephrine 1:200,000 — injection solution (Citanest Forte)
1.8 mL single-dose cartridges; 72 mg prilocaine + 0.009 mg epinephrine per cartridge; limited availability
Citanest Plain Dental has been permanently discontinued in the United States. The brand name and all generic equivalents have been withdrawn from the US market. This is not a temporary shortage — dental offices can no longer order Citanest Plain from any US distributor. Citanest Forte (with epinephrine 1:200,000) may still be available from some dental supply distributors on an inconsistent basis.
Because Citanest is a professional dental injectable and not a retail pharmacy product, patients do not typically look for it at pharmacies. Dental offices source it through supply distributors. The findability score for Citanest Plain is 15 out of 100 — effectively unavailable in the US market.
If you need help locating any medication — including dental anesthetics and their alternatives — medfinder contacts pharmacies and supply sources near you to confirm current availability and texts you the results.
Citanest is not a controlled substance and does not require a DEA registration to administer. It is a professional dental injectable supplied to licensed dental practices through dental supply distributors. It is administered chairside by trained dental professionals — not dispensed at pharmacies.
Healthcare providers who administer dental local anesthetics include:
Telehealth cannot be used to administer dental injectable anesthetics, as these are in-office procedures. However, tele-dentistry consultations may help patients discuss their anesthetic needs and medical history before an in-person visit.
No. Citanest (prilocaine hydrochloride) is not a controlled substance under the DEA Controlled Substances Act. It is not scheduled (Schedule I through V) and does not have recognized abuse potential. It does not require DEA registration or special tracking to prescribe or dispense.
Because Citanest is a professional dental injectable administered in the dental office, it is not subject to retail pharmacy dispensing requirements at all. Dental offices order it as a clinical supply from dental distributors without the prescription drug controls that apply to controlled substances. Patients do not receive a take-home prescription for it.
Common, expected effects at normal dental doses:
Know what you need? Skip the search.
Mepivacaine (Carbocaine, Polocaine)
Primary substitute for Citanest Plain. Available as 3% plain (no vasoconstrictor) or 2% with levonordefrin. Widely stocked by all dental distributors.
Articaine (Septocaine, Zorcaine)
4% with epinephrine 1:100,000 or 1:200,000. Excellent tissue penetration; shortest half-life of all dental anesthetics (27-42 min). Leading dental anesthetic in Europe and Canada.
Lidocaine (Xylocaine)
2% with epinephrine 1:100,000 or 1:50,000. Gold standard dental anesthetic. Longest track record of safety and efficacy. Available at all dental offices.
Bupivacaine (Marcaine)
0.5% with epinephrine 1:200,000. Long duration (6-9 hours); used for oral surgery and procedures where postoperative pain is anticipated.
Prefer Citanest? We can find it.
Phenazopyridine (AZO, Pyridium)
majorSignificantly increases methemoglobinemia risk when combined with prilocaine. Avoid concurrent use.
Sulfonamide antibiotics (sulfamethoxazole-TMP)
majorAdditive methemoglobinemia risk. Use with caution and monitor for cyanosis.
MAO inhibitors (phenelzine, selegiline, tranylcypromine)
majorPotentiate epinephrine cardiovascular effects (relevant for Citanest Forte only). Risk of hypertensive crisis. Avoid epinephrine-containing formulations.
Tricyclic antidepressants (amitriptyline, nortriptyline)
moderateIncrease cardiovascular effects of epinephrine (Citanest Forte). Use minimal epinephrine dose and monitor.
Non-selective beta-blockers (nadolol, propranolol)
moderateCan cause paradoxical hypertension when epinephrine is administered (Citanest Forte). Use with extreme caution.
Dapsone, nitrates, metoclopramide
moderateIncrease methemoglobinemia risk when combined with prilocaine.
Hyaluronidase
minorIncreases systemic absorption of prilocaine, potentially shortening anesthesia duration and increasing systemic concentrations.
Citanest (prilocaine) served as an important dental local anesthetic for decades, valued for its lower systemic toxicity and its epinephrine-free formulation. However, Citanest Plain Dental has been permanently discontinued in the United States, and Citanest Forte's availability is inconsistent. For most dental patients, the transition to alternative anesthetics — primarily mepivacaine 3% plain for epinephrine-free needs, or articaine/lidocaine for patients who can tolerate a vasoconstrictor — can be made seamlessly.
The key action items are: patients with a medical reason for epinephrine-free anesthesia should inform their dentist before their next appointment; dental offices should stock mepivacaine 3% plain as a reliable Citanest Plain substitute; and clinicians should update their protocols to remove Citanest Plain from their anesthetic selection.
If you need help confirming the availability of any dental anesthetic or other medication, medfinder helps patients and providers locate medications by contacting pharmacies and supply sources near you.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini