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Volume IV, Number 1 January/February 2001. Return to Pharmacotherapy Update Index, although the incidence of allergic reactions to local anesthetics has decreased, they are still documented.
Allergic reactions to local anesthetic agents may occur as a result of sensitivity to 1) either the ester or amide component, 2) the methylparaben used as a preservative in the multiple dose vials, or 3) the antioxidants used in some formulations. Allergic reactions may consist of cutaneous lesions, urticaria, edema, or anaphylactoid reactions.
Comparison of Local Anesthetics.
Injectable Prescription Local Anesthetics, some Formulations May Contain: Generic, brand, epinephrine.
Methylparaben, antioxidants, esters, procaine, novocain x procaine (Abbott n/A.
Tetracaine, pontocaine x chloroprocaine, nesacaine x, amides, lidocaine, xylocaine x x x#.
Mepivacaine, carbocaine, Polocaine x, bupivacaine, marcaine, Sensorcaine x x x, ropivacaine, naropin, preservative Free.
Ester local anesthetics are associated with a higher incidence of allergic reactions due to one inhalers of their metabolites, para-amino benzoic acid (paba). Paba is structurally similar to methylparaben. Amide local anesthetics do not undergo metabolism to paba, and therefore hypersensitivity to amide local anesthetics is rare.