Lyumjev
Lyumjev
Generic Name
Lyumjev
Mechanism
- Voltage‑gated Na⁺ channel blockade: Mepivacaine reversibly binds to the inner pore of the sodium channel in the neuronal membrane, stabilizing the inactivated state.
- Inhibition of depolarization: By preventing the generation and propagation of action potentials, it produces a reversible loss of sensation.
- Short‑duration effect: Rapid redistribution into plasma limits the duration of nerve block (~60–90 min).
Pharmacokinetics
| Parameter | Typical value in adults |
| Onset | 5–10 min (subcutaneous) |
| Duration | 60–120 min (short‑duration procedures) |
| Bioavailability | ~100 % (subcutaneous) |
| Distribution | Low protein binding (~10–20 %) |
| Half‑life | 1.8–2.2 h |
| Metabolism | Hepatic esterases → inactive metabolites |
| Excretion | Renal (urine) 30–40 % unchanged |
Indications
- Superficial surgical procedures (e.g., dental cleaning, ear suction, laceration repair).
- Minor dermatologic or ophthalmologic interventions.
- Short‑duration endoscopic procedures.
> Key takeaway: Lyumjev’s formulation provides a 30–60 % faster onset than traditional mepivacaine solutions, making it ideal when quick anesthesia is desired.
Contraindications
- Hypersensitivity to mepivacaine or other amide local anesthetics.
- Severe cardiac conduction abnormalities (e.g., second‑degree AV block).
- Severe hepatic impairment: reduced metabolism, prolonged toxicity.
Warnings
• Systemic toxicity: Monitor for CNS (seizures, vertigo) and cardiovascular (arrhythmias, hypotension) signs.
• CNS depression: Avoid concomitant CNS depressants (benzodiazepines, opioids).
• Pregnancy/Breastfeeding: Category B; generally safe in pregnancy but use lowest effective dose.
Dosing
- Typical dose: 1 – 1.5 ml (≈ 15 – 22.5 mg) per injection site.
- Maximum: Not to exceed 200 mg total or 4 mg/kg within 24 h, whichever is lower.
- Administration: Subcutaneous or superficial infiltration using a 27–30 G needle; avoid intramuscular or deep injection.
- Adjuncts: Combining with lidocaine (10–20 mg) is permitted for prolonged duration but watch for cumulative systemic dose.
Adverse Effects
- Common
- Injection site pain/burning
- Mild erythema or edema
- Drowsiness, dizziness (≤ 10 %)
- Serious
- Allergic reactions (urticaria, angioedema)
- Cardiovascular arrest or ventricular arrhythmias
- CNS toxicity (seizures, coma)
Monitoring
| Parameter | Frequency | Rationale |
| Vital signs (BP, HR) | Pre‑ and post‑dose, then every 5–10 min until stable | Detect early toxicity |
| ECG | Before procedure in patients >50 kg; repeat if symptomatic | Identify arrhythmias |
| Signs of CNS toxicity | Continuous visual observation | Early seizure or vertigo management |
| Injection site | 30 min post‑admin | Assess for hematoma or excessive bleeding |
Clinical Pearls
- Fast onset, small volume: A 1 ml aliquot of Lyumjev can anesthetize a 3 cm segment of skin, making it ideal for small, quick procedures.
- Pregnancy safety: Category B, but use the lowest effective dose; avoid large volumes that could increase maternal systemic exposure.
- Temperature effect: Lyumjev’s onset is slightly delayed at temperatures <20 °C; store at 2–25 °C.
- Potential drug interactions: Avoid concomitant benzodiazepines (synergistic CNS depression) or other Na⁺ channel blockers (e.g., quinidine).
- Post‑procedure care: Instruct patients to report any tingling beyond the anesthetic area or sudden dizziness, as these may signal systemic spread.
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• *References: FDA prescribing information for Lyumjev (Mepivacaine), Goodman & Gilman's The Pharmacological Basis of Therapeutics, and recent peer‑reviewed literature on amide local anesthetics.*