Felypressin
Also known as: PLV-2, Octapressin, 2-phenylalanine-8-lysine vasopressin, Felipressin
Synthetic vasopressin analogue / vasoconstrictor peptide
What it is
Dentists use felypressin as a vasoconstrictor alongside prilocaine local anesthetic to reduce bleeding and prolong numbness during dental procedures. It is considered a safer epinephrine alternative for patients with cardiovascular conditions because it acts on vasopressin receptors rather than adrenergic receptors.
The scientific side
felypressin is a synthetic analogue of arginine vasopressin (AVP) that exerts its vasoconstricting effect primarily through vasopressin V1 receptor agonism rather than through adrenergic receptor stimulation. This receptor selectivity distinguishes it mechanistically from epinephrine (adrenaline), which acts on alpha- and beta-adrenergic receptors. Because felypressin does not stimulate adrenergic pathways, it avoids the tachycardia and increase in myocardial oxygen demand typically associated with epinephrine, making it a theoretically preferable vasoconstrictor in patients with certain cardiovascular comorbidities. When injected alongside a local anesthetic such as prilocaine, felypressin causes local vasoconstriction that slows systemic absorption of the anesthetic, prolongs the duration of anesthesia, reduces intraoperative bleeding, and limits peak plasma concentrations of the co-administered drug. Animal studies reported in the retrieved abstracts (Tachibana et al., PMID 34911066) showed that injection of 3% prilocaine with 0.03 IU felypressin transiently and significantly reduced pulpal blood flow (PBF) and pulpal oxygen tension (PpulpO2) in rabbits, with both measures recovering more rapidly than with lidocaine-epinephrine, suggesting a shorter duration of pulpal ischaemia with felypressin. Despite its non-adrenergic mechanism, felypressin is not without cardiovascular effect. A randomized controlled trial by Kyosaka et al. (PMID 31545671) found that prilocaine with felypressin increased both systolic and diastolic blood pressure in older adults, consistent with V1 receptor-mediated peripheral vasoconstriction. A separate study (Yamashita et al., PMID 31654643) demonstrated that prilocaine-felypressin increased sympathetic nervous activity during tooth extraction, in contrast to the parasympathetic suppression seen with lidocaine-epinephrine. Felypressin also carries oxytocic activity through its structural similarity to oxytocin: a 2025 systematic review (PMID 40649147) identified felypressin as contraindicated in pregnancy due to its capacity to stimulate uterine smooth muscle and induce contractions, which poses a risk to fetal wellbeing.
Class: Synthetic vasopressin analogue / vasoconstrictor peptide
Administration & storage
- Administration
- Buccal infiltration (supraperiosteal)Inferior alveolar nerve block (IANB)Intraligamentary (periodontal ligament) injectionInfiltration anesthesia under general anesthesia (intraoperative)
- Storage
- No specific storage data were reported in the retrieved abstracts. Standard pharmaceutical guidance for dental local anesthetic cartridges applies (protect from light, store at controlled room temperature, do not freeze).
Legal & regulatory status
Not approved as a standalone dental vasoconstrictor in the United States; epinephrine-containing formulations are standard. Felypressin is not available in US dental cartridges.
Not listed on the WADA Prohibited List as of the abstracts reviewed; no doping-related data identified in the retrieved literature.
Available in Canada as a component of dental local anesthetic formulations (e.g., prilocaine with felypressin 0.03 IU/mL).
What it's studied for
- Vasoconstrictor adjunct in dental local anesthesia Tier 1 — Multiple RCTs and systematic reviews
- Local anesthesia in patients with cardiovascular disease Tier 2 — RCTs and observational studies with specific cardiac populations
- Local anesthesia in diabetic patients Tier 2 — Double-blind RCT
- Anesthesia for irreversible pulpitis (endodontic procedures) Tier 2 — Multiple RCTs
- Local anesthesia in patients with hepatic or renal impairment Tier 3 — Animal studies
- Intraoperative local anesthesia under general anesthesia in pediatric and special-needs patients Tier 3 — Case reports and Cochrane review
- Local infiltration anesthesia for oculoplastic surgery Tier 2 — Network meta-analysis of RCTs
Safety signals
- Contraindicated in pregnancy due to oxytocic effects
- Blood pressure elevation (systolic and diastolic) in older adults
- Increased pulse pressure in male diabetic patients with coronary heart disease
- Sympathetic nervous system activation during dental surgery
- Transient reduction in pulpal blood flow and oxygen tension
- Methemoglobinemia risk associated with prilocaine component
- Anesthesia failure at clinically relevant rates for inflamed tissue
- Favorable hepatic safety profile relative to some comparators in animal models
All studies (4)
Frequently asked
Is felypressin safer than epinephrine for people with heart conditions?
The published literature suggests felypressin does not stimulate adrenergic receptors, which means it avoids the heart rate increases associated with epinephrine. However, clinical studies have found that prilocaine-felypressin still raises blood pressure in older adults and increases sympathetic nervous activity during surgery. A study in diabetic men with coronary heart disease found a greater increase in pulse pressure with this combination. Your dentist or physician is best placed to weigh these effects against your specific cardiac history.
Can felypressin be used during pregnancy?
According to a 2025 systematic review identified in the literature, felypressin is contraindicated during pregnancy. It shares structural similarity with oxytocin and can stimulate uterine muscle contractions, potentially harming fetal wellbeing. Epinephrine at low dental doses is considered the only vasoconstrictor with an acceptable safety profile in pregnancy, according to this review. Always disclose pregnancy to your dental provider before receiving any local anesthetic.
Why did my prilocaine injection cause low oxygen levels during my dental procedure?
Two case reports in the literature describe a condition called methemoglobinemia — where hemoglobin loses its ability to carry oxygen — following prilocaine injections (which are often combined with felypressin). This occurred even at doses below the maximum recommended level in patients with certain predisposing conditions. If you experienced SpO2 changes during a dental procedure, this should be reported to and evaluated by your medical provider.
How does felypressin compare to epinephrine for numbing teeth during a root canal on an infected tooth?
Multiple randomized trials found that 3% prilocaine with felypressin achieves measurable but imperfect anesthesia success rates in teeth with irreversible pulpitis. In one trial, the success rate for inferior alveolar nerve block with prilocaine-felypressin was 78–88% for the early stages of root canal access and dropped to around 32% during initial instrumentation. Supplemental injections are commonly needed. Results varied by tooth type and stage of procedure across studies.
Is felypressin available in the United States?
Based on the reviewed literature, felypressin-containing dental cartridges are not a standard product in the United States dental market, where epinephrine-based formulations dominate. Felypressin is more commonly used in countries such as Japan, the UK, Brazil, and parts of the Middle East. It is not known to be available as a research peptide for self-administration; all studied uses are clinical dental procedures performed by licensed providers.