Lidocaine

What is Lidocaine?

• Lidocaine (Xylocaine) is a local anesthetic of the amide type used. It is also used to treat ventricular tachycardia.
• Lidocaine viscous, a local anesthetic, is used to treat the pain of a sore or irritated mouth and throat often associated with cancer chemotherapy and certain medical procedures.
• Prescription lidocaine transdermal (Dermalid, Lidoderm, Ztildo) is used to relieve the pain of post-herpetic neuralgia (PHN; burning, stabbing pains, or aches that may last for months or years after a shingles infection).
• Nonprescription (over-the-counter) lidocaine (Absorbine Jr, Aspercreme, Lidocare, Salonpas, others) is also available to relieve minor pain in shoulders, arms, neck and legs in adults and children 12 years of age and older.

Lidocaine

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What are the uses of this medicine?

Lidocaine Hydrochloride Injection, USP is indicated a local anesthetic of the amide type.

• It is also used to treat ventricular tachycardia.
• Lidocaine viscous, a local anesthetic, is used to treat the pain of a sore or irritated mouth and throat often associated with cancer chemotherapy and certain medical procedures.
• Prescription lidocaine transdermal (Dermalid, Lidoderm, Ztildo) is used to relieve the pain of post-herpetic neuralgia (PHN; burning, stabbing pains, or aches that may last for months or years after a shingles infection).
• Nonprescription (over-the-counter) lidocaine (Absorbine Jr, Aspercreme, Lidocare, Salonpas, others) is also available to relieve minor pain in shoulders, arms, neck and legs in adults and children 12 years of age and older.

How does this medicine work?

• Their mechanism of anesthetic action is believed to be based upon inhibition of voltage-gated sodium channels, which results in membrane stabilization and slowing of membrane depolarization and repolarization.
• Local anesthetics have been shown to be effective and are used widely in preventing or reducing pain from minor surgery, incisions, biopsies, dental and obstetrical procedures and pain from wounds.
• They are usually given as a single injection locally into a lesion or the area of incision, but can be given as infusions for hours or for several days by epidural or wound-based catheters.
• Local anesthetic infusions can also be used for postoperative pain management.
• They have excellent tolerance and safety.
• Local anesthetics have variable durations of action, and short acting versions are often given with epinephrine, which decreases the rate of absorption limiting systemic exposure and prolonging the duration of action.

Who Should Not Use this medicine ?

This medicine cannot be used in patients:

• with a known history of hypersensitivity to local anesthetics of the amide type.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention any of the following:

• propranolol
• metoprolol
• nadolol
• Nitrates/Nitrites
• Local anesthetics
• Antineoplastic agents
• Antibiotics
• Antimalarials
• Anticonvulsants
• acetaminophen
• metoclopramide
• quinine
• sulfasalazine

Is this medicine FDA approved?

• Lidocaine was approved for use as a local anesthetic in the 1948 originally under the commercial name Xylocaine, ropivacaine in 1990 (Naropin), and bupivacaine in 1990 (Marcaine).

How should this medicine be used?

Recommended dosage: Adults:

• For normal healthy adults, the individual maximum recommended dose of lidocaine HCl with epinephrine should not exceed 7 mg/kg (3.5 mg/lb) of body weight, and in general it is recommended that the maximum total dose not exceed 500 mg.
• When used without epinephrine the maximum individual dose should not exceed 4.5 mg/kg (2 mg/lb) of body weight, and in general it is recommended that the maximum total dose does not exceed 300 mg. For continuous epidural or caudal anesthesia, the maximum recommended dosage should not be administered at intervals of less than 90 minutes.
• The maximum recommended dose per 90 minute period of lidocaine hydrochloride for paracervical block in obstetrical patients and non-obstetrical patients is 200 mg total.
• For intravenous regional anesthesia, the dose administered should not exceed 4 mg/kg in adults.

Children:

• For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child's age and weight.
• For example, in a child of 5 years weighing 50 lbs the dose of lidocaine HCl should not exceed 75 to 100 mg (1.5 to 2 mg/lb).

ventricular arrhythmias: Adults:

• The usual dose is 50 to 100 mg administered intravenously under ECG monitoring. This dose may be administered at the rate of approximately 25 to 50 mg/min.
• If the initial injection of 50 to 100 mg does not produce a desired response, a second dose may be repeated after 5 minutes.
• NO MORE THAN 200 TO 300 MG OF LIDOCAINE HYDROCHLORIDE INJECTION, USP SHOULD BE ADMINISTERED DURING A ONE HOUR PERIOD.

Pediatric:

• Although controlled clinical studies to establish pediatric dosing schedules have not been conducted, the American Heart Association’s Standards and Guidelines recommends a bolus dose of 1 mg/kg followed by an infusion rate of 30 mcg/kg/min.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Lidocaine hydrochloride injection
• Lidocaine hydrochloride 1% solution for injection
• Topical lidocaine spray
• 2% viscous lidocaine

This medicine is available in fallowing brand namesː

• Xylocaine

What side effects can this medication cause?

The most common side effects of this medicine include:

• CNS excitation: nervousness, agitation, anxiety, apprehension, tingling around the mouth (circumoral paraesthesia), headache, hyperesthesia, tremor, dizziness, pupillary changes, psychosis, euphoria, hallucinations, and seizures
• CNS depression with increasingly heavier exposure: drowsiness, lethargy, slurred speech, hypoesthesia, confusion, disorientation, loss of consciousness, respiratory depression and apnea.
• Cardiovascular: hypotension, bradycardia, arrhythmias, flushing, venous insufficiency, increased defibrillator threshold, edema, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.
• Respiratory: bronchospasm, dyspnea, respiratory depression or arrest
• Gastrointestinal: metallic taste, nausea, vomiting
• Ears: tinnitus
• Eyes: local burning, conjunctival hyperemia, corneal epithelial changes/ulceration, diplopia, visual changes (opacification)
• Skin: itching, depigmentation, rash, urticaria, edema, angioedema, bruising, inflammation of the vein at the injection site, irritation of the skin when applied topically
• Blood: methemoglobinemia
• Allergy

What special precautions should I follow?

• Cases of methemoglobinemia have been reported in association with local anesthetic use. Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood. Discontinue lidocaine hydrochloride and any other oxidizing agents. Depending on the severity of the signs and symptoms, patients may respond to supportive care, i.e., oxygen therapy, hydration.
• Intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use
• Local anesthetic solutions containing antimicrobial preservatives (e.g., methylparaben) should not be used for epidural or spinal anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental.
• Anaphylactic reactions may occur following administration of lidocaine hydrochloride. In the case of severe reaction, discontinue the use of the drug.
• When appropriate, patients should be informed in advance that they may experience temporary loss of sensation and motor activity, usually in the lower half of the body, following proper administration of epidural anesthesia.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• convulsions
• apnea
• hypoxia
• acidosis
• bradycardia
• arrhythmias
• cardiac arrest

Management of overdosage:

• The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered.
• The first step in the management of convulsions, as well as underventilation or apnea due to unintended subarachnoid injection of drug solution.
• Should convulsions persist despite adequate respiratory support, and if the status of the circulation permits, small increments of an ultra-short acting barbiturate (such as thiopental or thiamylal) or a benzodiazepine (such as diazepam) may be administered intravenously.
• Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor as directed by the clinical situation (e.g., ephedrine).
• Dialysis is of negligible value in the treatment of acute overdosage with lidocaine HCl.

Can this medicine be used in pregnancy?

• There are, however, no adequate and well-controlled studies in pregnant women.

Can this medicine be used in children?

• Dosages in children should be reduced, commensurate with age, body weight and physical condition.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• lidocaine hydrochloride

Inactive ingredients:

• none

Who manufactures and distributes this medicine?

• Distributed by Hospira, Inc., Lake Forest, IL USA

What should I know about storage and disposal of this medication?

• Store at 20 to 25°C (68 to 77°F).

• Dailymed label info on Lidocaine
• FDA Lidocaine

Lidocaine Resources
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