Lidocaine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Pulseless ventricular fibrillation or ventricular tachycardia 1-1.5 mg/kg, repeat if needed. Max: 3 mg/kg. In more stable patients: 50-100 mg. May repeat once or twice if needed, up to a max of 200-300 mg in 1 hr, then 1-4 mg/min via continuous infusion. Regional anaesth As 0.5% soln w/o epinephrine: 50-300 mg. Max: 4 mg/kg IM Ventricular arrhythmia emergency 300 mg, repeat after 60-90 min if needed. Parenteral Sympathetic nerve block As 1% soln: 50 mg for cervical block; 50-100 mg for lumbar block. Peripheral nerve block As 1.5% soln: Brachial plexus block: 225-300 mg. As 2% soln: Dental nerve block: 20-100 mg. As 1% soln: Intercostal nerve block: 30 mg; paracervical block: 100 mg on each side, repeated not more often than 1.5 hrly; paravertebral block: 30-50 mg; pudendal block: 100 mg on each side. As 4% soln: Retrobulbar block: 120-200 mg. Percutaneous infiltration anaesth As 0.5% or 1% soln: 5-300 mg. Epidural Epidural anaesth 2-3 mL soln for each dermatome to be anaesthesised. Lumbar epidural: 250-300 mg (as 1% soln) for analgesia and 225-300 mg (as 1.5% soln) or 200-300 mg (as 2% soln) for anaesth; thoracic epidural: 200-300 mg (as 1% soln). In obstetric caudal analgesia: 200-300 mg (as 0.5 or 1% soln). For surgical caudal anaesth: 225-300 mg (as 1.5% soln). For continuous epidural or caudal anaesth, not to repeat max doses more often than 1.5 hrly. Intraspinal Spinal anaesth Normal delivery: Up to 50 mg (as 5% hyperbaric soln) or 9-15 mg (as 1.5% hyperbaric soln). Caesarean operation: Up to 75 mg (as 5% hyperbaric soln). Other surgical procedures: 75-100 mg. Transdermal Postherpetic neuralgia As 5% patch: Apply patch once daily for up to 12 hr w/in a 24-hr period. Max: Up to 3 patches in a single application. Mouth/Throat Surface anaesth As 2% soln: For pain: 300 mg, not more often than 3 hrly. As 4% soln: Before procedures in the mouth and throat: 40-200 mg. As 10% soln: For dentistry and otorhinolaryngology procedures: Spray 10-50 mg. As 4% soln: For laryngotracheal anaesth: Spray or instill 160 mg as a single dose. Topical Surface anaesth As 5% oint: Max: 20 g in 24 hr. As 2% gel: Approx 120-220 mg into urethra several min before examination. As 4% foam: Apply 3-4 times/day. As soln: Apply 40-200 mg to affected area. As patch: Apply patch for up to 12 hr w/in a 24-hr period. Max: 1 patch/24 hr. Rectal Haemorrhoids; Painful perianal conditions Apply topically or using applicator insert rectally, up to 6 times/day. Urethral Surface anaesth As 2% gel: Female: 60-100 mg inserted into the urethra several min before examination. Male: 100-200 mg before catheterisation and 600 mg before sounding or cytoscopy. Ophth Surface anaesth Apply 2 drops; may reapply to maintain effect.
Dosage Details
Epidural
Epidural anaesthesia
Adult: 2-3 mL administered for each dermatome to be anaesthesised. Recommended doses are: Lumbar epidural 250-300 mg (as 1% soln) for analgesia and 225-300 mg (as 1.5% soln) or 200-300 mg (as 2% soln) for anaesth; for thoracic epidural: 200-300 mg (as 1% soln). For obstetric caudal analgesia, 200-300 mg (as 1% soln); for surgical caudal anaesth: 225-300 mg (as 1.5% soln). For continuous epidural or caudal anaesth, not to repeat max doses more frequently than 1.5 hrly.

Intramuscular
Emergency treatment of ventricular arrhythmias
Adult: 300 mg injected into the deltoid muscle, repeat after 60-90 min if necessary.

Intraspinal
Spinal anaesthesia
Adult: As hyperbaric soln of 1.5% or 5% lidocaine in 7.5% glucose soln. Normal vaginal delivery: Up to 50 mg (as 5% soln) or 9-15 mg (as 1.5% soln). Caesarian operation: Up to 75 mg (as 5% soln). Other surgical procedures: 75-100 mg.

Intravenous
Pulseless ventricular fibrillation or ventricular tachycardia
Adult: 1-1.5 mg/kg repeated as necessary. Max: 3 mg/kg. For ventricular arrhythmias in more stable patients: Usual loading dose: 50-100 mg as an IV inj at 25-50 mg/min, may repeat once or twice up to a max of 200-300 mg in 1 hr, followed by 1-4 mg/min via continuous IV infusion. May need to reduce dose if the infusion is longer than 24 hr.

Intravenous
Intravenous regional anaesthesia
Adult: As 0.5% soln w/o epinephrine: 50-300 mg. Max: 4 mg/kg.

Mouth/Throat
Surface anaesthesia
Adult: As 2% soln: For pain: 300 mg rinsed and ejected for mouth and throat pain; or gargled and swallowed if necessary for pharyngeal pain. Not to be used more frequently than every 3 hr. Max (topical oral soln): 2.4 g/day. As 4% soln: Before bronchoscopy, bronchography, laryngoscopy, oesophagoscopy, endotracheal intubation, and biopsy in the mouth and throat: 40-200 mg. As 10% soln: For dentistry and otorhinolaryngology procedures: 10-50 mg sprayed to mucous membrane. As 4% soln: For laryngotracheal anaesth: 160 mg sprayed or instilled as a single dose into the lumen of the larynx and trachea.

Ophthalmic
Surface anaesthesia
Adult: Apply 2 drops to ocular area where procedure will take place; may reapply to maintain effect.

Parenteral
Percutaneous infiltration anaesthesia
Adult: As 0.5% or 1% soln: 5-300 mg.

Parenteral
Sympathetic nerve block
Adult: As 1% soln: 50 mg for cervical block or 50-100 mg for lumbar block.

Parenteral
Peripheral nerve block
Adult: As 1.5% soln: For brachial plexus block: 225-300 mg. As 2% soln: For dental nerve block: 20-100 mg. As 1% soln: For intercostal nerve block: 30 mg; for paracervical block: 100 mg on each side, repeated not more frequently than every 90 min; for paravertebral block: 30-50 mg; for pudendal block: 100 mg on each side. As 4% soln: For retrobulbar block: 120-200 mg.

Rectal
Haemorrhoids, Perianal pain and itching
Adult: Apply topically or using applicator insert rectally, up to 6 times daily.
Child: ≥12 yr Apply topically or using applicator insert rectally, up to 6 times daily.

Topical/Cutaneous
Surface anaesthesia
Adult: As 5% oint: Max: 20 g in 24 hr for skin and mucous membrane. As 2% gel: Approx 120-220 mg into urethra several min before examination. As 4% foam: Apply 3-4 times daily for pain relief. As soln: Apply 40-200 mg to affected area. As patch: Apply patch to painful area for up to 12 hr w/in a 24-hr period. Max: 1 patch/24 hr.

Transdermal
Postherpetic neuralgia
Adult: As 5% patch: Apply to most painful area once daily for up to 12 hr w/in a 24-hr period. Max: Up to 3 patches in a single application.

Urethral
Surface anaesthesia
Adult: As 2% gel: Female: 60-100 mg inserted into the urethra several min before examination. Male: 100-200 mg before catheterisation and 600 mg before sounding or cystoscopy.
Hepatic Impairment
Parenteral:
Dosage reduction may be needed.
Incompatibility
Amphotericin B, sulfadiazine Na, methohexital Na, cefazolin Na, phenytoin Na, pantoprazole, metoprolol.
Contraindications
Hypovolaemia, complete heart block, Adam-Stokes syndrome, Wolff-Parkinson-White syndrome. Must not be applied to inflamed or injured skin.
Special Precautions
Patient w/ pseudocholinesterase deficiency, resp depression. Hepatic and renal impairment. Elderly or debilitated patients. Pregnancy and lactation.
Adverse Reactions
Arrhythmia, bradycardia, arterial spasms, CV collapse, oedema, flushing, hert block, hypotension, sinus node suppression, agitation, anxiety, coma, confusion, drowsiness, hallucinations, euphoria, headache, hyperaesthesia, hypoaesthesia, lightheadedness, lethargy, nervousness, psychosis, seizure, slurred speech, unconsciousness, somnolence, nausea, vomiting, metallic taste, tinnitus, disorientation, dizziness, paraesthesia, resp depression and convulsions. Patch: Bruising, depigmentation, petechiae, irritation. Ophth: Conjunctival hyperaemia, corneal epithelial changes, diplopia,visual changes.
Buccal/Dental/Endotracheal/Epidural/IM/Intradermal/IV/Mouth/Throat/Ophth/Parenteral/Perineural/Rectal/SC/Topical/Transdermal/Urethral: B
Patient Counseling Information
May cause temporary loss of sensation and motor activity.
MonitoringParameters
Monitor CV and resp vital signs, LFTs and careful ECG observation.
Overdosage
Symptoms: Severe hypotension, asystole, bradycardia, apnoea, seizures, coma, cardiac arrest, resp arrest and death. Management: Maintain oxygenation, stop convulsion and support the circulation.
Drug Interactions
May increase serum levels w/ cimetidine and propranolol. Increased risk of cardiac depression w/ β-blockers and other antiarrhythmics. Additive cardiac effects w/ IV phenytoin. Hypokalaemia caused by acetazolamide, loop diuretics and thiazides may antagonise effect of lidocaine. Dose requirements may be increased w/ long-term use of phenytoin and other enzyme-inducers.
Food Interaction
Decreased levels w/ St John's wort.
Lab Interference
IM admin of lidocaine increases creatine phosphokinase levels interfering w/ diagnosis of MI.
Action
Description: Lidocaine is an amide type local anaesth. It stabilises the neuronal membrane and inhibits Na ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces depolarisation of the ventricles during diastole and automaticity in the His-Purkinje system. Duration of action potential and effective refractory period are also reduced.
Onset: 45-90 sec (IV); approx 4 hr (transdermal); 20 sec to 5 min (ophth). .
Duration: 10-20 min (IV); 5-30 min (ophth).
Pharmacokinetics:
Absorption: Readily absorbed from the GI tract, mucous membranes, damaged skin, inj sites, including muscle; poor absorption through intact skin.
Distribution: Crosses the placenta, blood-brain barrier and enters breast milk. Protein-binding: 66% (α1-acid glycoprotein).
Metabolism: Undergoes rapid metabolism and approx 90% is dealkylated to monoethylglycinexylidide and glycinexylidide. First-pass metabolism is extensive.
Excretion: Via urine (<10% unchanged). Elimination half-life: biphasic; initial: 7-30 min; terminal: 1.5-2 hr.
Storage
Store below 25°C.
Disclaimer: This information is independently developed by MIMS based on Lidocaine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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