Abstract:
The present invention improves the bad taste of injected anesthetics and analgesics by incorporating a flavoring or cooling agent such as menthol into the parenteral composition.

Description:
PRIORITY CLAIM AND CROSS REFERENCE 
       [0001]    This application claims priority to U.S. provisional patent application No. 61/784,351 filed on Mar. 14, 2013, the contents of which are expressly incorporated by reference. The contents of all cited references are expressly incorporated by reference. 
     
    
     BACKGROUND 
       [0002]    In the current practice of dentistry, injectable anesthetics are administered to provide comfort and a more desirable experience for the patient. Lidocaine, Carbocaine, Bupivacaine and other injectable anesthetics and analgesic drugs show a metallic/bitter aftertaste after injection. This taste can last up to 2 hours after the anesthetic dissipates. This taste is highly objectionable to all patients and in many it can cause upset stomach and sometimes nausea. Frequently, patients describe the unpleasant taste of injectable anesthetics as a factor contributing to the unpleasantness of the procedure. This experience may impact an individual from obtaining more timely treatments due to this unpleasantness. Historically, very little has been done to help mitigate this problem. 
         [0003]    Bonaparte J P, Corsten M, Rourke R. Reducing the flavour of oral lidocaine: randomized controlled trial assessing the efficacy of mint-flavoured mouthwash. J Otolaryngeal Head Neck Surgery 2010 February; 39 (1): 96-101 tried an oral rinse using peppermint or spearmint mouth type washes to eliminate the taste with limited success. To date, the efforts to eliminate the bad taste of drugs injected into the oral cavity have been unsuccessful. A bad experience by a patient may prevent an individual from obtaining treatment due to the unpleasantness of the anesthetic. 
         [0004]    While menthol has been used as an injectable anesthetic alone, the art does not show its use to mask the taste of other injectable agents. Water-soluble menthol β-hydroxypropyl cyclodextrin has been developed as a long-acting injection painkiller. There remains a need in the art for an anesthetic which does not have an objectional taste. 
       BRIEF SUMMARY OF THE INVENTION 
       [0005]    To improve the taste issue of injected anesthetics and analgesics, the use of a flavor agent in the parental solution should be employed. In a preferred embodiment the anesthetics are selected from lidocaine, mepivicaine, septocaine or bupivacaine in combination with a taste masking agent such as menthol in an acceptable solvent. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0006]    It has been surprisingly discovered that the bad tastes that a patient experiences from certain injectable compositions can be masked by adding a flavor masking agent to the injectable composition. 
         [0007]    To improve the taste issue of anesthetics and analgesic injections, the use of a flavor agent in the parental solution should be employed. Suitable active agents include, but are not limited to, lidocaine (also called xylocaine or lignocaine), novocaine and procaine, articaine, septocaine, marcainemidazolam, ketamine, propofol and fentanyl (a long-acting anesthetic), bupivacaine, and mepivacaine (Carbocaine). In a preferred embodiment the anesthetics are selected from lidocaine, mepivacaine, septocaine or bupivacaine in combination with a taste masking agent such as menthol in an acceptable solvent. A combination of these may be used depending on the situation. Also, most agents come in two forms: with and without epinephrine. The flavor masking agents may cause a temporary loss of taste sensation to the taste buds. 
         [0008]    Suitable flavoring agents include, but are not limited to, ascorbic acid, menthol, peppermint, spearmint, wintergreen, butterscotch, chocolate, cocoa, pineapple, orange, any citrus based flavor, any mint based flavor, any cooling agent or any natural flavor. 
         [0009]    Cooling agents are known to provide a “cool” sensation or cooling effect on or following application to a body surface; and substances that, on or following topical application can ameliorate a hot sensation or a heating effect are called “cooling agents”. Any agent which, when incorporated in the injectable composition in a concentration sufficient to exert a cooling sensation or effect or to ameliorate a hot sensation or heating effect, is suitable for use a cooling agent in accordance with the present invention. The cooling agent may be an excipient, an active ingredient or pharmaceutical, therapeutic or cosmetic agent or a propellant or combinations of two or more agents. Non limiting examples of cooling agents, which are all incorporated herein by reference are provided in U.S. Pat. Nos. 3,419,543, 4,020,153, 4,032,661, 4,033,994, 4,034,109, 4,059,118, 4,060,091, 4,070,449, 4,070,496, 4,136,163, 4,150,052, 4, 4,153,679, 157,384, 4,178,459, 4,193,936, 4,226,988, 4,230,688, 4,296,255, 4,459,425, 5,266,592, 5,608,119, 5,725,865, 5,773,410, 5,843,466, 5,959,161, 6,214,788, 6,267,974, 6,303,817, 6,328,982, 6,359,168, 6,482,983, 6,592,884, 6,884,906 and 7,030,273 US Patent Application 20040067970, DE 2,202,535, DE 2,205,255, DE 2,503,555, DE 2,608,226, DE 4,226,043, GB 1,351,761, GB 1,351,762, GB 1,421,744, J P 2004059474 and WO 2005049553; and in Watson et al, J. Soc. Cosmet. Chem. 29, 185-200 (1978); and Ottinger et al in J. Agric. Food Chem., 49, 5383-5390 (2001). 
         [0010]    In additional embodiment, the cooling agent is an isomer or a derivative of menthol. Additional examples of menthol derivatives are monomenthyl esters of di- and polycarboxylic acids. Some derivatives have been developed to be substantially without smell. Useful exemplary menthol derivatives are menthol ethylene glycol carbonate, which is now known as Frescolat® type MGC, enthol Propylene Glycol Carbonate (Frescolat® type MPC), menthyl lactate (Frescolat ML®) and Menthone Glycerin Acetal (Frescolat MGA®).Additional widely used menthol derivatives are 3-(/-Menthoxy)-1,2-propanediol, known as Cooling Agent 10; and the same structure with an additional methyl group in the glycerin part of the molecule: Menthoxy-coolants are additional cooling menthol derivatives Cubebol is an example of a coolant with a C—C bond in the 3d position of p-menthane. 
         [0011]    Cooling agents, which are not menthol derivatives, are also suitable for use in accordance with the present invention. Examples of such cooling agents are provided below: Exemplary cooling agents which can be used in the invention include, but are not limited to, menthol, isopulegol, 3-(1-menthoxy)propane-1,2-diol, 3-(1-menthoxy)-2-methylpropane-1,2-diol, p-menthane-2,3-diol, p-menthane-3,8-diol, 6-isopropyl-9-methyl-1,4-dioxas-piro[4,5]decane-2-methanol, menthyl succinate and its alkaline earth metal salts, trimethylcyclohexanol, N-ethyl-2-isopropyl-5-methylcyclohexanecarb-oxamide, Japanese mint (Mentha arvensis) oil, peppermint oil, menthone, menthone glycerol ketal, menthyl lactate, 3-(1-menthoxy)ethan-1-ol, 3-(I-menthoxy)propan-1-ol, 3-(I-menthoxy)butan-1-ol, I-menthylacetic acid N-ethylamide, I-menthyl-4-hydroxypentanoate, I-menthyl-3-hydroxybutyrate, N,2,3-trimethyl-2-(1-methylethyl)-butanamide, and spearmint oil. 
         [0012]    The solvents that can be used are any solvent capable of solubilizing the components preferred: PEG (Polyethylene Glycols), Chloroform, Ethanol, Carvone, Dimethylsulfoxide, Citral, Tauroglycolate, Eugenol, Sodium Lauryl Sulfate, Oleic acid, Tween, N Methyl 2 pyrrilidione, 2 pyrol, PVP (Polyvinylpyrrilidones) or any alcohol and water. In a one embodiment, the solvent is PEG in a range of 0.5-70% by weight with 5 to 25% by weight preferred, with 5-10% by weight most preferred.Plasticizers that can be used for the product are: Glycerol and esters, Glycol derivatives, phthalix acid esters, oleic acid esters, sugar alcohols, citric acid esters, tartaric acid esters, PEG (Polyethylene Glycols), PVP, Eugradit (methyl acrylates), Cellulose esters. Plastisizers can be utilized to improve water dispersion of the flavor agent and prevent crystallization in the water solution. 
         [0013]    The dose of any local anesthetic administered varies with the anesthetic procedure, the area to be anesthetized, the vascularity of the tissues, the number of neuronal segments to be blocked, the depth of anesthesia and degree of muscle relaxation required, the duration of anesthesia desired, individual tolerance and the physical condition of the patient. The smallest dose and concentration required to produce the desired result should be administered. The rapid injection of a large volume of local anesthetic solution should be avoided and fractional doses should be used when feasible. 
         [0014]    Currently marketed products for local anesthesia by injection for dentistry include, but are not limited to Mepivacaine 3% and Mepivicaine 2% with Levonordefrin sold under the brand Isocaine by Novocol; Carbocain 2% with Neo-Cobefrin sole by Cook-Waite; Lidocaine 2% with epinepherine 1:100,000 and Lidocaine 2% with epinepherine 1:50,000 sold by Superdent; Lidocaine 2% with epinepherine 1:100,000 sold by Patterson Dental Supply, Inc.; articain 4% and epinepherine 1:100,000 sold under the brand name Septocaine by Septodont; Mepivacaine 3% sold under the brand name Scandonest by Septodont; Lidocaine 2% with epinepherine 1:50,000 and Lidocaine 2% with epinepherine 1:100,000 sold under the brand name Xylocaine Dental by Dentsply Pharmaceutical; sold under the brand name Xylocaine Dental by Dentsply Pharmaceutica; the instructions for use for which are expressly incorporated by reference. 
         [0015]    While the specific examples below are described in terms of dental formulations, one of skill in the art will readily understand they can be used anytime taste masking is required for an injectable composition. 
       EXAMPLE 1  
     Lidocaine 
       [0016]    Table 1 shows an example of a lidocaine type product: 
         [0000]    
       
         
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                   
                   
                 mg/ serving 
                 Concentrate 
                 INGREDIENT 
                   
                   
               
               
                 factor 
                 mg/ unit 
                 final dosage mg 
                 content mg 
                 DESCRIPTION 
                 EXC 
                 gm/BATCH 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 0.97 
                 10 
                 10 
                 10.3092784 
                 Lidocaine USP 97% 
                 1.00 
                 20.6186 
               
               
                 0.99 
                 0.005 
                 0.005 
                 0.00505051 
                 Epinephrine USP 99% 
                 1.00 
                 0.0101 
               
               
                 1 
                 1000 
                 1000 
                 1000 
                 water for injection 
                 1.00 
                 2000.00 
               
               
                   
                   
                   
                   
                 USP, sterile 
               
               
                 1 
                 1 
                 1 
                 1 
                 Ascorbic Acid 
                 1.00 
                 2.00 
               
               
                   
                   
                   
                   
                 98% Inj USP 
               
               
                 1 
                 1 
                 1 
                 1 
                 Menthol EP 
                 1.00 
                 2.00 
               
               
                 1 
                 0.5 
                 0.5 
                 0.5 
                 Sodium 
                 1.00 
                 1.00 
               
               
                   
                   
                   
                   
                 Metabisulfate USP 
                   
                   
               
               
                   
                 1012.51 
                 1012.505 
                 1012.81433 
                   
                   
                 2025.629 
               
               
                   
               
             
          
         
       
     
         [0017]    Process
   1. Add lidocaine 100 cc to sterile 250 cc beaker   2. Weigh out 0.05 gm of L-Menthol EP   3. Weigh out 0.99 gm Sodium Chloride USP   4. Add Menthol and Sodium Chloride to 10 cc of Ethanol is a 50 ml beaker and stir the solution at 75 rpm for 5 minutes until dissolved.   5. Filter resulting solution using a   6. Add the ethanol solution to the lidocaine solution and stir the solution at 75 rpm for 5 minutes   7. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter   8. Fill 20 cc of solution into 20 cc clear vials.   9. Seal and label vials.   
 
       EXAMPLE 2  
     Lidocaine with Epinephrine 
       [0027]      
         [0000]    
       
         
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                   
                   
                 g/serving 
                 Concentrate 
                 INGREDIENT 
                   
                   
               
               
                 factor 
                 g/unit 
                 final dosage 
                 content g 
                 DESCRIPTION 
                 EXC 
                 gm/BATCH 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 1 
                 50 
                 50 
                 50 
                 Lidocaine 2% Epinephrine 
                 1.00 
                 50.0000 
               
               
                   
                   
                   
                   
                 1:100000 sterile 
               
               
                   
                   
                   
                   
                 solution 
               
               
                   
                   
                   
                   
                 water for injection 
               
               
                   
                   
                   
                   
                 USP, sterile 
               
               
                   
                   
                   
                   
                 PEG 400 USP/EP 
               
               
                   
                   
                   
                   
                 Sodium 
               
               
                   
                   
                   
                   
                 Chloride USP 
               
               
                   
                   
                   
                   
                 L-Menthol EP 
               
               
                 1 
                 43 
                 43 
                 43 
                   
                 1.00 
                 43.0000 
               
               
                 1 
                 7 
                 7 
                 7 
                   
                 1.00 
                 7.0000 
               
               
                 1 
                 0.9 
                 0.9 
                 0.900 
                   
                 1.00 
                 0.9000 
               
               
                 1 
                 0.05 
                 0.05 
                 0.05 
                   
                 1.00 
                 0.0500 
               
               
                   
                 100.95 
                 100.95 
                 100.95 
                   
                   
                 100.950 
               
               
                   
               
             
          
         
       
       
         1. Add lidocaine 50 g to sterile 250 cc beaker 
         2. Weigh out 0.05 gm of L-Menthol EP 
         3. Weigh out 0.900 gm Sodium Chloride USP 
         4. Add Menthol and Sodium Chloride to 10 cc of Ethanol is a 50 ml beaker and stir the solution at 
         75 rpm for 5 minutes until dissolved. 
         5. Filter resulting solution using 
         6. Add the ethanol solution to the lidocaine solution and stir the solution at 75 rpm for 5 minutes 
         7. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter 
         8. Fill 20 cc of solution into 20 cc clear vials. 
         9. Seal and label vials. 
       
     
       EXAMPLE 3  
     Mepivicaine 
       [0038]    Table 2 shows an example of a Mepivacaine type product: 
         [0000]    
       
         
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                   
                   
                 mg/serving 
                 Concentrate 
                 INGREDIENT 
                   
                   
               
               
                 factor 
                 mg/unit 
                 final dosage mg 
                 content mg 
                 DESCRIPTION 
                 EXC 
                 gm/BATCH 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 0.97 
                 10 
                 10 
                 10.30927835 
                 Mepivacaine 98% 
                 .00 
                 2.0619 
               
               
                   
                   
                   
                   
                 Inj USP 
               
               
                 1 
                 6.6 
                 6.6 
                 6.6 
                 Sodium Chloride USP 
                 .00 
                 1.3200 
               
               
                 1 
                 1000 
                 1000 
                 1000 
                 water for injection USP, sterile 
                 .00 
                 200.0000 
               
               
                 1 
                 0.5 
                 0.5 
                 0.5 
                 Menthol EP 
                 .00 
                 0.1000 
               
               
                 1 
                 0.3 
                 0.3 
                 0.3 
                 Potassium Chloride USP 
                 .00 
                 0.0600 
               
               
                 1 
                 0.33 
                 0.33 
                 0.33 
                 Calcium Chloride 
                 .00 
                 0.0660 
               
               
                   
                   
                   
                   
                 USP 
               
               
                 1 
                 1 
                 1 
                 1 
                 Methylparaben USP 
                 .00 
                 0.2000 
               
               
                   
                 1048.53 
                 1048.53 
                 1048.839278 
                   
                 waste 
                 209.768 
               
               
                   
               
             
          
         
       
     
         [0039]    Process
   1. Add 2.0619 gm mepivicain 100 cc to sterile 250 cc beaker   2. Add 1.3200 gm Sodium Chloride   3. Add 200 ml water for injection USP to beaker and stir the solution at 75 rpm for 5 minutes   4. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter   5. Add 0.1 gm of L-Menthol EP   6. Add 0.0600 gm of potassium chloride   7. Add 0.0660 gm of calcium chloride   8. Add 0.200 gm of Methylparaben USP   9. stir the solution at 75 rpm for 5 minutes   10. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter   11. Fill 20 cc of solution into 20 cc clear vials.   12. Seal and label vials.   
 
       EXAMPLE 4  
     Bupivacaine 
       [0052]    Table 3 shows an example of a bupivacaine type product: 
         [0000]    
       
         
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                   
                   
                 mg/serving 
                 Concentrate 
                 INGREDIENT 
                   
                   
               
               
                 factor 
                 mg/unit 
                 final dosage mg 
                 content mg 
                 DESCRIPTION 
                 EXC 
                 gm/BATCH 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 1 
                 5 
                 5 
                 5 
                 bupivacaine HCl USP 
                 .00 
                 1.0000 
               
               
                 0.99 
                 0.005 
                 0.005 
                 0.005050505 
                 epinephrine USP 99% 
                 .00 
                 0.0010 
               
               
                 1 
                 1000 
                 1000 
                 1000 
                 water for injection 
                 .00 
                 200.0000 
               
               
                   
                   
                   
                   
                 USP, sterile 
               
               
                 1 
                 0.5 
                 0.5 
                 0.5 
                 menthol EP 
                 .00 
                 0.1000 
               
               
                 1 
                 8.5 
                 8.5 
                 8.5 
                 sodium chloride USP 
                 .00 
                 1.7000 
               
               
                 1 
                 0.1 
                 0.1 
                 0.1 
                 edetate calcium 
                 .00 
                 0.0200 
               
               
                   
                   
                   
                   
                 disodium, anhydrous 
               
               
                 1 
                 0.1 
                 0.1 
                 0.1 
                 sodium 
                 1.00 
                 0.0200 
               
               
                   
                   
                   
                   
                 metabisulfate USP 
                   
                   
               
               
                   
                 1014.205 
                 1014.205 
                 1014.205051 
                   
                 waste 
                 202.841 
               
               
                   
               
             
          
         
       
     
         [0053]    Process
   1. Add bupivacaine HCl 1 gm to sterile 250 cc beaker.   2. Add 0.0010 gm Epinephrine USP 99%.   3. Add 200 ml water for injection USP to beaker and stir the solution at 75 rpm for 5 minutes.   4. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter.   5. Add 0.100 gm of L-Menthol EP.   6. Add 1.7 gm of sodium chloride.   7. Add 0.020 gm of edetate calcium disodium, anhydrous.   8. Add 0.020 gm of Sodium Metabisulfate USP.   9. stir the solution at 75 rpm for 5 minutes.   10. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter.   11. Fill 20 cc of solution into 20 cc clear vials.   12. Seal and label vials.   
 
       EXAMPLE 5  
     Lidocaine with Epinephrine 
       [0066]    Table 4 shows an example of a Lidocaine with Epinephrine type product: 
         [0000]    
       
         
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
             
           
               
                   
               
               
                   
                   
                 mg/serving 
                 Concentrate 
                 INGREDIENT 
                   
                   
               
               
                 factor 
                 mg/unit 
                 final dosage mg 
                 content mg 
                 DESCRIPTION 
                 EXC 
                 gm/BATCH 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 0.97 
                 10 
                 10 
                 10.3092784 
                 lidocaine USP 97% 
                 1.00 
                 10.3093 
               
               
                 0.99 
                 0.005 
                 0.005 
                 0.00505051 
                 epinephrine USP 99% 
                 1.00 
                 0.0051 
               
               
                 1 
                 1000 
                 1000 
                 1000 
                 water for injection USP, 
                 1.00 
                 1000.0000 
               
               
                   
                   
                   
                   
                 sterile 
               
               
                 1 
                 30 
                 30 
                 30 
                 ethanol 100% USP 
                 1.00 
                 30.0000 
               
               
                 1 
                 9.27 
                 9.27 
                 9.27 
                 sodium Chloride USP 
                 1.00 
                 9.2700 
               
               
                 1 
                 0.3 
                 0.3 
                 0.3 
                 menthol EP 
                 1.00 
                 0.3000 
               
               
                 1 
                 0.5 
                 0.5 
                 0.5 
                 sodium metabisulfate USP 
                 1.00 
                 0.5000 
               
               
                   
                 1050.08 
                 1050.075 
                 1050.38433 
                   
                 waste 
                 1050.384 
               
               
                   
               
             
          
         
       
       
         1. Add Lidocain 10.3 gm to sterile 250 cc beaker. 
         2. Add 0.0051 gm Epinephrine USP 99%. 
         3. Add 1000 ml water for injection USP and 30 m1 ethanol 100% USP to beaker and stir the solution at 75 rpm for 5 minutes. 
         4. Filter the solution using a sterile filter bottle SVB 002 and vacuum pump VP001 to filter. 
         5. Add 0.300 gm of L-Menthol EP. 
         6. Add 9.27 gm of sodium chloride. 
         7. Add 0.5 gm of Sodium Metabisulfate USP. 
         8. stir the solution at 75 rpm for 5 minutes. 
         9. Filter the solution using a 500 cc sterile filter bottle SVB 002 and vacuum pump VP001 to filter. 
         10. Fill 20 cc of solution into 20 cc clear vials. 
         11. Seal and label vials. 
       
     
       EXAMPLE 6  
     Testing Protocol 
       [0078]    Compositions of the present invention can be tested by using a split mouth design protocol administering, via mental block, the control, non-taste masked formulation on one side, while administering the present invention on the other side. We will then be able to assess the efficacy of the anesthetic by seeing if there is any change in duration. Taste will be tested utilizing a scale for taste. Either VAS (visual analogue scale) or another test. 
       EXAMPLE 7  
     Lidocaine Administration 
       [0079]    Local administration in dental procedures 
         [0080]    When used for local anesthesia in dental procedures the dosage of Dental lidocaine HCl) Injection depends on the physical status of the patient, the area of the oral cavity to be anesthetized, the vascularity of the oral tissues, and the technique of anesthesia. The least volume of solution that results in effective local anesthesia should be administered; time should be allowed between injections to observe the patient for manifestations of an adverse reaction. For specific techniques and procedures of a local anesthesia in the oral cavity, refer to standard textbooks. 
         [0081]    For most routine dental procedures, 2% lidocaine with 1:100,000 epinephrine is preferred. However, when greater depth and a more pronounced hemostasis are required, a 1:50,000 epinephrine concentration should be used. 
         [0082]    Dosage requirements should be determined on an individual basis. In oral infiltration and/or mandibular block, initial dosages of 1.0-5.0 mL of 2% lidocaine with epinephrine 1:50,000 or 1:100,000 are usually effective. 
         [0083]    In children under 10 years of age it is rarely necessary to administer more than one-half cartridge (0.9-1.0 mL or 18-20 mg) of lidocaine per procedure to achieve local anesthesia for a procedure involving a single tooth. In maxillary infiltration, this amount will often suffice to the treatment of two or even three teeth. In the mandibular block, however, satisfactory anesthesia achieved with this amount of drug will allow treatment of the teeth in an entire quadrant. For children greater than 10 yrs of age and adults do not exceed 6.6 mg/kg 
         [0084]    Systemic Administration 
         [0085]    Single Direct Intravenous Injection (Bolus) 
         [0086]    The usual dose is 50 to 100 mg of lidocaine hydrochloride (0.70 to 1.4 mg/kg; 0.32 to 0.63 mg/lb) administered intravenously under ECG monitoring. This dose may be administered at the rate of approximately 25 to 50 mg/min (0.35 to 0.70 mg/kg/min; 0.16 to 0.32 mg/lb/min). Sufficient time should be allowed to enable a slow circulation to carry the drug to the site of action. If the initial injection of 50 to 100 mg does not produce a desired response, a second dose may be injected after 5 minutes. 
         [0087]    Continuous Intravenous Infusion 
         [0088]    Following bolus administration, intravenous infusions of Xylocaine may be initiated at the rate of 1 to 4 mg/min of lidocaine hydrochloride (0.014 to 0.057 mg/kg/min; 0.006 to 0.026 mg/lb/min). The rate of intravenous infusions should be reassessed as soon as the patient&#39;s basic cardiac rhythm appears to be stable or at the earliest signs of toxicity. It should rarely be necessary to continue intravenous infusions for lidocaine for prolonged periods. 
       EXAMPLE 8  
     Mepivacaine Administration 
       [0089]    The recommended single adult dose (or the total of a series of doses given in one procedure) of mepivacaine for unsedated, healthy, normal-sized individuals should not usually exceed 400 mg. The recommended dosage is based on requirements for the average adult and should be reduced for elderly or debilitated patients. 
         [0090]    While maximum doses of 7 mg/kg (550 mg) have been administered without adverse effect, these are not recommended, except in exceptional circumstances and under no circumstances should the administration be repeated at intervals of less than 1.5; hours. 
         [0091]    The total dose for any 24-hour period should not exceed 1,000 mg because of a slow accumulation of the anesthetic or its derivatives or slower than normal metabolic degradation or detoxification with repeat administration. 
         [0092]    Pediatric patients tolerate the local anesthetic as well as adults. However, the pediatric dose should be carefully measured as a percentage of the total adult dose based on weight, and should not exceed 5 mg/kg to 6 mg/kg (2.5 mg/lb to 3 mg/lb) in pediatric patients, especially those weighing less than 30 lb. In pediatric patients under 3 years of age or weighing less than 30 lb concentrations less than 2% (e.g., 0.5% to 1.5%) should be employed. 
         [0000]    
       
         
               
             
               
               
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 5 
               
             
             
               
                   
               
               
                 Mepivicaine Dosing 
               
             
          
           
               
                   
                 Concen- 
                 Total Dose 
                   
               
             
          
           
               
                 Procedure 
                 tration 
                 mL 
                 mg 
                 Comments 
               
               
                   
               
               
                 Cervical, 
                 1% 
                  5-40 
                  50-400 
                 Pudendal block: one 
               
               
                 brachial, 
                 2% 
                  5-20 
                 100-400 
                 half of total dose 
               
               
                 intercostal, 
                   
                   
                   
                 injected each side. 
               
               
                 pudendal nerve 
               
               
                 block 
               
               
                 Transvaginal 
                 1% 
                 up to 30 
                 up to 300 
                 One half of total dose 
               
               
                 block (para- 
                   
                 (both 
                 (both 
                 injected each side. 
               
               
                 cervical plus 
                   
                 sides) 
                 sides) 
               
               
                 pudendal) 
               
               
                 Paracervical 
                 1% 
                 up to 20 
                 up to 200 
                 One half of total dose 
               
               
                 block 
                   
                 (both 
                 (both 
                 injected each side. 
               
               
                   
                   
                 sides) 
                 sides) 
                 This is maximum 
               
               
                   
                   
                   
                   
                 recommended dose 
               
               
                   
                   
                   
                   
                 per 90 minute period 
               
               
                   
                   
                   
                   
                 in obstetrical and 
               
               
                   
                   
                   
                   
                 non-obstetrical 
               
               
                   
                   
                   
                   
                 patients. Inject 
               
               
                   
                   
                   
                   
                 slowly, 5 minutes 
               
               
                   
                   
                   
                   
                 between sides. 
               
               
                 Caudal and 
                 1% 
                 15-30 
                 150-300 
                 Use only single-dose 
               
               
                 epidural block 
                 1.5%     
                 10-25 
                 150-375 
                 vials which do not 
               
               
                   
                 2% 
                 10-20 
                 200-400 
                 contain a preservative. 
               
               
                 Infiltration 
                 1% 
                 up to 40 
                 up to 400 
                 An equivalent 
               
               
                   
                   
                   
                   
                 amount of a 0.5% 
               
               
                   
                   
                   
                   
                 solution (prepared by 
               
               
                   
                   
                   
                   
                 diluting the 1% 
               
               
                   
                   
                   
                   
                 solution with Sodium 
               
               
                   
                   
                   
                   
                 Chloride Injection, 
               
               
                   
                   
                   
                   
                 USP) may be used 
               
               
                   
                   
                   
                   
                 for large areas. 
               
               
                 Therapeutic 
                 1% 
                 1-5 
                 10-50 
               
               
                 block (pain 
                 2% 
                 1-5 
                  20-100 
               
               
                 management) 
               
               
                   
               
             
          
         
       
     
       EXAMPLE 9  
     Bupivacaine Administration 
       [0093]    The 0.5% concentration with epinephrine is recommended for infiltration and block injection in the maxillary and mandibular area when a longer duration of local anesthetic action is desired, such as for oral surgical procedures generally associated with significant postoperative pain. The average dose of 1.8 mL (9 mg) per injection site will usually suffice; an occasional second dose of 1.8 mL (9 mg) may be used if necessary to produce adequate anesthesia after making allowance for 2 to 10 minutes onset time). The lowest effective dose should be employed and time should be allowed between injections; 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 0.5% BUPIVACAINE HCl with epinephrine). Injections should be made slowly and with frequent aspirations. 
       EXAMPLE 10  
     Clinical Testing 
       [0094]    Formulations of the present invention were tested in patients to determine if they improved the taste over commercially available dental injectable anesthetics. Four patients were administered the compositions shown below together with a non-tasted masked commercially available product. Following administration subjects would then pick from a visual analog scale ranging from 1(best tasting)-10(worst tasting). 
       A: Lidocaine Injectable: Ethanol Solvent 10% 
       [0095]    A lidocaine preparation was prepared as in Example 5 having the following ingredient concentrations: 
         [0096]    Lidocaine 1.8% 
         [0097]    Epinephrine 1:1000000 
         [0098]    Menthol 0.4% 
         [0099]    4 subjects were first administered 20 IUs of a commercially available 2% lidocaine with 1:100000 epinephrine productorally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 6 shows the results: 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 6 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 7 
               
               
                   
                 2 
                 8 
               
               
                   
                 3 
                 7 
               
               
                   
                 4 
                 7 
               
               
                   
                   
               
             
          
         
       
     
         [0100]    After subjects had water and a small white plain cracker, then 10 minutes later, all 4 subjects were administered 20 IUs of the composition of this example orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 7 shows the taste results. 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 7 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 3 
               
               
                   
                 2 
                 3 
               
               
                   
                 3 
                 3 
               
               
                   
                 4 
                 2 
               
               
                   
                   
               
             
          
         
       
     
         [0101]    After taste test was performed anesthesia was administered via a block of the mental nerve using a split mouth design in which on one side of the patients mouth 100 IUs of 2% lido w/1:100 k epi was administered via mental block. At the same time 100 IUs of the composition of this example was administered on the contralateral side. 
         [0102]    All subjects had profound anesthesia on both sides, with the test sites having slightly more then the control. This could be due to the additive effect of the menthol anesthetic property. Both test and control sides had anesthesia that lasted similar times. The test side appeared to have more soreness than the control. After evaluating the formula, it appears that the solvent, which was alcohol in this batch, may be causing this sensation at the site post administration. 
       B: Lidocaine Injectable: Ethanol Solvent 3% 
       [0103]    A lidocaine preparation was prepared as in Example 5 having the following ingredient concentrations: 
         [0104]    Lidocaine 1.9% 
         [0105]    Epinephrine 1:900000 
         [0106]    Menthol 0.4% 
         [0107]    In this formulation the alcohol content was lowered from 10% by weight to 3% by weight to try to eliminate any soreness post administration. subjects were first administered 20 IUs of a commercially available 2% lidocaine with 1:100000 epinephrine product orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 8 shows the results: 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 8 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 7 
               
               
                   
                 2 
                 8 
               
               
                   
                 3 
                 8 
               
               
                   
                 4 
                 7 
               
               
                   
                   
               
             
          
         
       
     
         [0108]    After subjects had water and a small white plain cracker, then 30 minutes later, all 4 subjects were administered 20 IUs of the composition of this example orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 9 shows the taste results. 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 9 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 3 
               
               
                   
                 2 
                 3 
               
               
                   
                 3 
                 3 
               
               
                   
                 4 
                 3 
               
               
                   
                   
               
             
          
         
       
     
         [0109]    After taste test was performed anesthesia was administered via a block of the mental nerve using a split mouth design in which on one side of the patients mouth 100 IUs of 2% lido w/1:100 k epi was administered via mental block. At the same time 100 IUs of the composition of this example was administered on the contralateral side. 
         [0110]    All subjects had profound anesthesia on both sides, with the test sites having slightly more then the control. This could be due to the additive effect of the menthol anesthetic property. Both test and control sides also had anesthesia that lasted similar times. By lowering the alcohol content, the soreness at the test site was decreased but still lingered slightly. 
       Test C: Lidocaine Injectable: PEG Solvent 
       [0111]    A lidocaine preparation was prepared as in Example 3 having the following ingredient concentrations: 
         [0112]    Lidocaine 1% 
         [0113]    Epinephrine 1:200000 
         [0114]    Menthol 40 mg per cc 
         [0115]    PEG used as solvent instead of alcohol 
         [0116]    4 subjects were first administered 20 IUs of a commercially available 2% lidocaine with 1:100000 epinephrine productorally with the composition placed directly onto dorsal of tongue. Table 10 shows the results: 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 10 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 7 
               
               
                   
                 2 
                 8 
               
               
                   
                 3 
                 8 
               
               
                   
                 4 
                 7 
               
               
                   
                   
               
             
          
         
       
     
         [0117]    After subjects had water and a small white plain cracker, then 10 minutes later, all 4 subjects were administered 20 IUs of the composition of this example orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 11 shows the taste results. 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 11 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 3 
               
               
                   
                 2 
                 3 
               
               
                   
                 3 
                 3 
               
               
                   
                 4 
                 2 
               
               
                   
                   
               
             
          
         
       
     
         [0118]    After taste test was performed anesthesia was administered via a block of the mental nerve using a split mouth design in which on one side of the patients mouth 100 IUs of 2% lido w/1:100 k epi was administered via mental block. At the same time 100 IUs of the composition of this example was administered on the contralateral side. 
         [0119]    All subjects had profound anesthesia on both sides, with the test sites having slightly more then the control. This could be due to the additive effect of the menthol anesthetic property. Both test and control sides also had anesthesia that lasted similar times. By changing the solvent, soreness was eliminated and taste was altered to be pleasant instead of a bitter/metallic taste. 
         [0000]    Test D: Lidocaine Injectable: PEG Solvent [what %/] 
         [0120]    A lidocaine preparation was prepared as in Example 3 having the following ingredient concentrations: 
         [0121]    Lidocaine 1% 
         [0122]    Epinephrine 1:200000 
         [0123]    Menthol 60 mg per cc 
         [0124]    PEG used as solvent instead of alcohol 
         [0125]    4 subjects were first administered 20 IUs of a commercially available 2% lidocaine with 1:100000 epinephrine product orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 12 shows the results: 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 12 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 7 
               
               
                   
                 2 
                 8 
               
               
                   
                 3 
                 8 
               
               
                   
                 4 
                 7 
               
               
                   
                   
               
             
          
         
       
     
         [0126]    After subjects had water and a small white plain cracker, then 10 minutes later, all 4 subjects were administered 20 IUs of the composition of this example orally with the composition placed directly onto dorsal of tongue and the subjects asked to evaluate taste. Table 13 shows the taste results. 
         [0000]    
       
         
               
               
               
             
           
               
                   
                 TABLE 13 
               
               
                   
                   
               
               
                   
                 Test Subject 
                 Rating 
               
               
                   
                   
               
             
             
               
                   
                 1 
                 2 
               
               
                   
                 2 
                 2 
               
               
                   
                 3 
                 3 
               
               
                   
                 4 
                 2 
               
               
                   
                   
               
             
          
         
       
     
         [0127]    After taste test was performed anesthesia was administered via a block of the mental nerve using a split mouth design in which on one side of the patients mouth 100 IUs of 2% lido w/1:100 k epi was administered via mental block. At the same time 100 IUs of the composition of this example was administered on the contralateral side. 
         [0128]    All subjects had profound anesthesia on both sides, with the test sites having slightly more then the control. This could be due to the additive effect of the menthol anesthetic property. Both test and control sides also had anesthesia that lasted similar times. By changing the solvent, soreness was greatly decreased (or should we say eliminated) and taste was altered to be pleasant instead of a bitter/metallic taste. 
         [0129]    As can be seen, the compositions of the present invention clearly taste better to taste subjects. 
         [0130]    Although the invention has been shown and described with respect to certain embodiments, it is obvious that equivalent alterations and modifications will occur to others skilled in the art upon the reading and understanding of this specification. In particular with regard to the various functions performed by the above described components, the terms (including any reference to a “means”) used to describe such components are intended to correspond, unless otherwise indicated, to any component which performs the specified function of the described component (e.g., that is functionally equivalent), even though not structurally equivalent to the disclosed structure which performs the function in the herein illustrated exemplary embodiments of the invention. In addition, while a particular feature of the invention may have been disclosed with respect to only one of several embodiments, such feature may be combined with one or more other features of the other embodiments as may be desired and advantageous for any given or particular application. 
         [0131]    One of skill in the art will appreciate that substitutions and deviations from the above formulations may be permissible without departing from the spirit of the invention. 
       REFERENCES 
       [0132]    All references cited herein are incorporated by reference in their entirety.
   1: Bonaparte J P, Corsten M, Rourke R. Reducing the flavour of oral lidocaine: randomized controlled trial assessing the efficacy of mint-flavoured mouthwash. J Otolaryngeal Head Neck Surgery 2010 February; 39 (1): 96-101   2: WHO Food Additives Series 10. 21-29 Apr. 1976. http://www.inchem.org/documents/jecfa/jecmono/v10je07.htm   3: Water-soluble menthol B hydroxypropyl cyclodextrin developed long-acting injection painkiller. Oct. 27, 2010. Can be found on http://www.cn-articles.com   4: (L)-Menthol-National Library of Medicine HSBD Database   5: Vibeke S. M. Bemson, Bertil Pettersson. The toxicity of menthol in short-term bioassays. Chemico-Biological Interactions Volume 46, Issue 2, September 1983 Pages 233-248.