What is the maximum recommended dose of articaine with epinephrine?

• A. 4 mg/kg up to 300 mg total.
• B. 2 mg/kg up to 90 mg total.
• C. 8 mg/kg up to 600 mg total.
• D. 7 mg/kg up to 500 mg total.

Answer: (D)

In dentistry, the maximum recommended dose is based on safety to prevent systemic toxicity while still allowing effective anesthesia. For articaine with epinephrine, the limit is 7 mg per kilogram of body weight, with an absolute cap of 500 mg per procedure. This higher per‑kilogram allowance, compared with some other local anesthetics, reflects articaine’s rapid metabolism by plasma esterases, which reduces peak systemic exposure, and the vasoconstrictive effect of epinephrine that helps keep the drug localized. In practical terms, an adult can typically receive up to about 500 mg (roughly 12.5 mL of a 4% solution, depending on concentration and injection). The other option ranges are either too low for adequate anesthesia or exceed the safe absolute maximum.