Citanest Forte 4% with epinephrine 1:200,000, 50/Pk4% Citanest Forte is used in dentistry for the production of local anesthesia by infiltration or nerve block. It provides an intermediate pulpal duration anesthesia in the maxilla (approximately 40 minutes), and intermediate pulpal duration anesthesia in mandibular nerve blocks (50 70 minutes) using low epinephrine, which is desirable for high risk patients.