Felypressin

Summary

Felypressin (2-phenylalanine-8-lysine vasopressin) is a synthetic vasopressin analogue used as a vasoconstrictor in dental local anaesthetic cartridges, most commonly in combination with prilocaine (e.g., Citanest with Octapressin). It provides haemostasis and prolongs anaesthesia with minimal cardiac and adrenergic side effects, making it an alternative to adrenaline (epinephrine)-based formulations in certain patient groups.

Mechanism of Action

Selective agonist at V1 vasopressin receptors on vascular smooth muscle, causing vasoconstriction without significant antidiuretic (V2) activity; used as a vasoconstrictor additive in local anaesthetic formulations to prolong duration of action and reduce systemic absorption.

Routes of Administration

Goals & Uses

• Prolongation of local anaesthesiaAnaesthesiaHigh
• Safe vasoconstriction in patients with cardiovascular contraindications to adrenalineCardiovascular Risk ReductionModerate
• Haemostasis in dental proceduresSurgical HaemostasisModerate

Contraindications

• Raynaud's disease / peripheral vascular diseaseVascularModerate
• PregnancyPopulationHighPotential fetal risk or insufficient safety data
• Severe cardiovascular diseaseCardiovascularModerate
• Known hypersensitivity to felypressin or vasopressin analoguesAllergy / ImmunologyHigh

Adverse Effects

• Hypersensitivity / allergic reactionImmunologicalRare
• Uterine contractionsObstetricUnknown
• Local tissue ischaemiaVascularUncommon
• Pallor at injection siteVascularCommon
• BradycardiaCardiovascularRare

Drug Interactions

• Other vasopressors / vasoconstrictorsModerate
• Tricyclic antidepressantsLow
• OxytocinHigh

Population Constraints

• Patients with renal impairmentOrgan ImpairmentRelative
• Paediatric patientsAgeRelative
• Patients with severe hypertensionCardiovascularRelative
• Pregnant womenReproductiveAbsolute

Regulatory Status

• European UnionApprovedApproved: Vasoconstrictor adjunct in dental local anaesthesiaApproved in several EU member states as part of local anaesthetic combination products.
• United StatesUnapprovedNot FDA-approved or commercially available in the United States; epinephrine-based formulations are standard.
• United KingdomApprovedApproved: Vasoconstrictor in dental local anaesthetic formulations (e.g., prilocaine 3% with felypressin 0.03 IU/mL)Available as Citanest with Octapressin; licensed for dental use.

Approved and in clinical use in the UK, EU, and various other countries as a component of dental local anaesthetic formulations. Not widely approved or marketed in the United States. Regulatory status varies by jurisdiction.

Evidence & Sources

No sources recorded yet.