Maximum doses of dental local anesthetics: what the six cartridge labels actually say, in mg, mg/kg and cartridges

What it says#

This entry reports what the manufacturers' FDA-approved labels say, and nothing more. The treating dentist calculates the dose for the patient in the chair. A healthy adult maximum is not a target, it is a fence, and every one of these labels asks for the least volume of solution that results in effective local anesthesia.

Each label sets its maximum in one or two ways: a milligram ceiling for an adult, a milligram-per-kilogram or milligram-per-pound rate, or both. The cartridge count is not printed on most of them, so where it appears below it is arithmetic from the label's own numbers and the arithmetic is shown.

Lidocaine 2% with epinephrine. 2% Xylocaine DENTAL with Epinephrine 1:50,000 and 1:100,000, from Dentsply Pharmaceutical, is labeled "Lidocaine HCl 2% (34 mg/1.7 mL) (20 mg/mL)" and supplied in single-dose cartridges of 1.7 mL. The adult paragraph reads: "For normal healthy adults, the amount of lidocaine HCI administered should be kept below 500 mg, and in any case, should not exceed 7 mg/kg (3.2 mg/lb) of body weight." At 34 mg per cartridge, 500 divided by 34 is 14.7, so staying below 500 mg means staying under about 14.7 cartridges. The 7 mg/kg rate binds first in anyone under about 71 kg, since 7 times 71 is 497. For routine work the label says initial dosages of 1.0 to 5.0 mL, which it calls one half to two and a half cartridges, are usually effective.

Articaine 4% with epinephrine. ARTICADENT, also Dentsply, is the modern-format label: "The maximum recommended dosage of ARTICADENT is 7 mg/kg of articaine and 0.0017 mg/kg of epinephrine (equivalent to 0.175 mL/kg for either product presentation, articaine HCl and 1:100,000 or 1:200,000 epinephrine)." The solution is articaine HCl 4% (40 mg/mL) in 1.7 mL single-dose cartridges, so a cartridge is 40 times 1.7, or 68 mg. There is no fixed milligram ceiling anywhere in the label. For a 70 kg adult, 7 times 70 is 490 mg, and 490 divided by 68 is 7.2 cartridges. Septodont's Septocaine label states the same rate in both units: "the maximum dose of articaine HCl administered by submucosal infiltration and/or nerve block should not exceed 7 mg/kg (0.175 mL/kg) or 3.2 mg/lb (0.0795 mL/lb) of body weight," and gives a procedure table of 20 to 100 mg for infiltration, 20 to 136 mg for a nerve block and 40 to 204 mg for oral surgery.

Mepivacaine 3% plain and 2% with levonordefrin. Polocaine DENTAL from Dentsply and Scandonest 3% Plain and Carbocaine from Septodont all carry the same dosing paragraph. "Each cartridge contains 1.7 mL (34 mg of 2% or 51 mg of 3%)." Then: "A dose of up to 3 mg per pound of body weight may be administered. At any single dental sitting the total dose for all injected sites should not exceed 400 mg in adults." At 51 mg, 400 divided by 51 is 7.8 cartridges of the 3% plain; at 34 mg, 400 divided by 34 is 11.7 cartridges of the 2% with levonordefrin. The labels separately say 5.3 cartridges, which they price at 270 mg of the 3% or 180 mg of the 2%, are usually adequate to anesthetize the entire oral cavity, and the pediatric table calls that same 5.3 cartridges "the maximum recommended adult dose." Those two statements do not agree with each other; 400 mg is the number printed in the adult sentence, and 5.3 cartridges is the number the pediatric table is built on. Both are reported here because both are in the label.

Cartridge volume is not universal for mepivacaine. Septodont's older Isocaine label uses 1.8 mL cartridges and states "Each cartridge contains 1.8 mL (36 mg of 2% or 54 mg of 3%)," with five cartridges rather than 5.3 giving the same 180 mg and 270 mg. Read the box in front of you before you count cartridges.

Prilocaine 4%, plain and with epinephrine. 4% Citanest Plain Dental and 4% Citanest Forte DENTAL with Epinephrine 1:200,000, both Dentsply, are labeled "Prilocaine HCl 4% (72 mg/1.8 mL) (40 mg/mL)" and supplied in 1.8 mL cartridges. Both give the same rule: "In patients weighing <150 lb (70 kg), no more than 4 mg/lb (8 mg/kg) should be administered. In patients weighing ≥150 lb, no more than 600 mg (8 cartridges) of prilocaine HCl should be administered as a single injection." The dosing table states the same ceiling as "600 mg (15 mL) or 8 cartridges." Note that 600 divided by 72 is 8.3, so the label's own 8 cartridges is the conservative rounding, and 15 mL divided by 1.8 is also 8.3. The label also frames this as the maximum that should ever be administered within a two-hour period.

Bupivacaine 0.5% with epinephrine 1:200,000. Marcaine 0.5% (5 mg/mL) with epinephrine 1:200,000 from Septodont comes in 1.8 mL cartridges and the label does the arithmetic itself: "The average dose of 1.8 mL (9 mg) per injection site will usually suffice," and "it is recommended that the total dose for all injection sites, spread out over a single dental sitting, should not ordinarily exceed 90 mg for a healthy adult patient (ten 1.8 mL injections of bupivacaine with epinephrine)." The same label says bupivacaine in dentistry is not recommended for children younger than 12 years.

Who it applies to#

The adult numbers above are written for what the labels call normal healthy adults. Children get a different calculation, not a smaller share of the same one, and that is covered in the companion entry on local anesthetic dosing for children. Every label on this page also asks for reduced doses in debilitated, elderly and acutely ill patients, and the articaine labels add patients with severe hepatic disease, in whom no studies have been performed.

These maximums are per sitting, not per appointment block or per day, and the prilocaine label attaches a two-hour window to its number. They are also not a license: the operative instruction in each label is the least volume that produces effective anesthesia, with aspiration before injection and slow delivery.

What these numbers do not settle is the vasoconstrictor. A patient can be far under the anesthetic milligram cap and still be at the practical limit for epinephrine because of cardiac history, and the labels reprint the American Heart Association's position that the minimum possible amount of vasoconstrictor should be used. That is a separate calculation and a separate entry.

What changed#

Nothing in the adult maximums moved recently. What has moved is the format. Articaine now carries a modern Physician Labeling Rule label that states an epinephrine maximum in mg/kg alongside the articaine maximum, which none of the older dental labels do. Lidocaine, mepivacaine, prilocaine and bupivacaine dental cartridges still carry the older narrative format, in which the maximum sits in a paragraph rather than a highlights box.

The other change across all of them is the methemoglobinemia language the FDA standardized for prescription local anesthetics in 2018, which now appears in identical wording in the articaine, prilocaine, mepivacaine and lidocaine dental labels.

Where the source is#

Every number above comes from the FDA-approved labeling as published on DailyMed, the National Library of Medicine's index of current prescribing information, and was read there for this entry. The link under the title opens the Xylocaine DENTAL label; the download buttons open ARTICADENT, Polocaine DENTAL, Citanest Plain Dental, Marcaine dental and Septocaine. The versions read were: Xylocaine DENTAL published August 17, 2026; ARTICADENT and Citanest Forte DENTAL published March 4, 2024; Polocaine DENTAL and Carbocaine published February 23, 2024; Citanest Plain Dental published November 15, 2021; Scandonest 3% Plain published June 2, 2025; Marcaine dental published November 17, 2025; Septocaine published September 6, 2007; Isocaine published April 26, 2007. DailyMed is free, carries no subscription limit, and shows a version history for each label, so you can confirm that the label in your operatory drawer matches the one quoted here.