lidocaine hydrochloride


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lidocaine hydrochloride

Anesticaine, Anesticon, Laryng-O-Jet (UK), Lidodan (CA), Lidoderm, Lidomax (CA), LidoPen Auto-Injector, LTA Pediatric, Lurocaine (CA), Xylocaine, Xylocaine-MPF, Xylocard (CA)

Pharmacologic class: Amide

Therapeutic class: Antiarrhythmic (class IB), local anesthetic

Pregnancy risk category B

Action

Suppresses automaticity of ventricular cells, decreasing diastolic depolarization and increasing ventricular fibrillation threshold. Produces local anesthesia by reducing sodium permeability of sensory nerves, which blocks impulse generation and conduction.

Availability

Injection for I.M. use: 300 mg/3 ml (automatic injection device)

Injection for direct I.V. use: 1% and 2% in syringes and vials

Injection for I.V. infusion: 2 mg/ml, 4 mg/ml, 8 mg/ml

Injection for I.V injection admixtures: 40 mg/ml, 100 mg/ml, 200 mg/ml

Patch: 5%

Topical cream: 0.5%, 4%

Topical gel: 0.5%, 2.5%

Topical jelly: 2%

Topical liquid, ointment: 2.5%, 5%

Topical solution: 4%

Topical solution (viscous): 2%

Topical spray: 0.5%

Indications and dosages

Ventricular arrhythmias

Adults: Initially, 50 to 100 mg I.V. bolus given at rate of 25 to 50 mg/minute. If desired response doesn't occur after 5 minutes, give repeat dose at 25 to 50 mg/minute; maximum dosage is 300 mg given over 1 hour. Maintenance dosage is 1 to 4 mg/minute by continuous I.V. infusion for no more than 24 hours.

Children: Initially, 1 mg/kg I.V. bolus, then repeated based on patient response; don't exceed 5 mg/kg. Maintenance dosage is 30 mcg/kg/minute by continuous I.V. infusion.

Caudal anesthesia (without epinephrine)

Adults: For obstetric analgesia, 200 to 300 mg caudally as 1% solution. For surgical anesthesia, 225 to 300 mg as 1.5% solution. For continuous caudal anesthesia, don't repeat maximum dosage at intervals of less than 90 minutes.

Epidural anesthesia (without epinephrine)

Adults: For lumbar analgesia, 250 to 300 mg epidurally as 1% solution, 225 to 300 mg as 1.5% solution, or 200 to 300 mg as 2% solution. For thoracic anesthesia, 200 to 300 mg as 1% solution. For continuous epidural anesthesia, don't repeat maximum dosage at intervals of less than 90 minutes.

I.V. regional infiltration (without epinephrine)

Adults: 50 to 300 mg I.V. as 0.5% solution. For I.V. regional anesthesia, maximum dosage is 4 mg/kg.

I.V. local infiltration (without epinephrine)

Children: Up to 4.5 mg/kg I.V. as 0.25% to 1% solution

Spinal anesthesia (without epinephrine)

Adults: For obstetric low-spinal or saddle-block anesthesia (normal vaginal delivery), 50 mg of 5% Xylocaine-MPF with glucose 7.5%, or 9 to 15 mg of 1.5% Xylocaine-MPF with dextrose 7.5%. For cesarean section, 75 mg of 5% Xylocaine-MPF with glucose 7.5%. For surgical anesthesia, 75 to 100 mg of 5% Xylocaine-MPF with glucose 7.5%.

Paracervical anesthesia (without epinephrine)

Adults: For obstetric analgesia, 100 mg paracervically as 1% solution (each side). For paracervical block, maximum dosage is 200 mg over each 90-minute period (half administered on each side).

Peripheral nerve block

Adults: For brachial nerve block, 225 to 300 mg as 1.5% solution. For dental nerve block, 20 to 100 mg as 2% solution with epinephrine 1:100,000 or 1:50,000. For intercostal nerve block, 30 mg as 1% solution. For pudendal nerve block, 100 mg as 1% solution. For paravertebral nerve block, 30 mg to 50 mg as 1% solution.

Sympathetic nerve block (without epinephrine)

Adults: For cervical nerve block, 50 mg as 1% solution. For lumbar nerve block, 50 to 100 mg as 1% solution.

Dental anesthesia

Adults: 1 to 5 ml of lidocaine 2% with epinephrine 1:50,000 or 1:100,000. Maximum dosage is less than 500 mg (7 mg/kg).

Children: 20 to 30 mg as 2% solution with epinephrine 1:100,000

Topical anesthesia for skin or mucous membranes

Adults: Apply thin layer of gel, jelly, or ointment to skin or mucous membranes as needed before procedure; or apply 5% patch to most painful areas and intact skin (up to three patches at a time for up to 12 hours within a 24-hour period). For new denture fittings, use 5-g ointment (250 mg) per single dose or 20 g/day. For oropharyngeal use, apply to desired area or to instrument before insertion.

Children: Apply thin layer of ointment to skin or mucous membranes p.r.n. before procedure. Maximum dosage is 2.5 g ointment per 6 hours or 4.5 mg/kg.

Prevention or treatment of pain during procedures involving male or female urethra

Adults: For female urethral examination, apply 3 to 5 ml of 2% jelly topically several minutes before exam. For male sounding or cystoscopy, apply 5 to 10 ml of 2% jelly topically before procedure, or apply 30 ml to fill or dilate urethra in divided doses using penile clamp for several minutes between doses. For male catheterization, apply 5 to 10 ml of 2% jelly to anterior urethra before procedure. Don't use more than 600 mg/12 hours.

Oral cavity disorders; pharyngeal disorders

Adults: For oral cavity disorders, 300 mg (15 ml) of viscous oral topical solution swished and then expelled, or applied with cotton swab q 3 hours p.r.n. For pharyngeal disorders, use same dosage, but solution may be swallowed.

Children older than age 3: Dosage individualized based on age, weight, and physical condition. Maximum dosage is 4.5 mg/kg q 3 hours.

Children up to age 3: 1.25 ml applied with swab q 3 hours

Local anesthesia (oral or nasal mucosa)

Adults: 0.6 to 3 mg/kg or 40 to 200 mg of 4% topical solution, not to exceed 4.5 mg/kg or 300 mg (7.5 ml)

Children: Dosage individualized

Off-label uses

• Pediatric patients with cardiac arrest who develop frequent premature ventricular contractions

• Status epilepticus

Contraindications

• Hypersensitivity to drug, its components, or other amide local anesthetics

• Heart failure, cardiogenic shock, second- or third-degree heart block, intraventricular block in absence of a pacemaker

• Wolff-Parkinson-White or Adams-Stokes syndrome

• Severe hemorrhage, shock, or heart block (lidocaine with dextrose)

• Local infection at puncture site (lidocaine with dextrose)

• Septicemia (lidocaine with dextrose)

Precautions

Use cautiously in:

• renal or hepatic disorders, inflammation or sepsis in injection area

• labor or delivery

• breastfeeding patients.

Administration

Know that I.V. lidocaine is a high-alert drug.

Make sure resuscitation equipment and oxygen are available before giving I.V. lidocaine.

• Dilute injection in additive syringe and single-use vial according to manufacturer's instructions before administering as I.V. infusion.

• Add 1 g lidocaine to 1 L dextrose 5% in water to yield a solution of 1 mg/ml.

• For I.V. bolus injection, give doses of 25 to 50 mg over at least 1 minute. Deliver continuous infusion by infusion pump no faster than 4 mg/minute.

Know that too-rapid infusion may cause seizures.

• Be aware that drug can be given I.M. using 10% parenteral solution only.

Adverse reactions

CNS: anxiety; confusion; difficulty speaking; dizziness; hallucinations; lethargy; paresthesia; light-headedness; fatigue; drowsiness; headache; persistent sensory, motor, or autonomic deficit of lower spinal segment; septic meningitis; seizures

CV: bradycardia, hypotension, new or worsening arrhythmias, cardiac arrest

EENT: diplopia, abnormal vision

GI: nausea, vomiting, dry mouth

GU: urinary retention

Metabolic: methemoglobinemia

Respiratory: suppressed cough reflex, respiratory depression, respiratory arrest

Skin: rash; urticaria; pruritus; erythema; contact dermatitis; cutaneous lesions; tissue irritation, sloughing, and necrosis

Other: fever; edema; infection, burning, stinging, tenderness, and swelling at injection site; anaphylaxis

Interactions

Drug-drug. Beta-adrenergic blockers, cimetidine: increased lidocaine blood level

MAO inhibitors, tricyclic antidepressants: prolonged hypertension

Mexiletine, tocainide: additive cardiac effects

Phenytoin, procainamide: increased cardiac depression

Drug-diagnostic tests. Creatine kinase: increased level (with I.M. use)

Patient monitoring

Monitor vital signs and ECG continuously. Watch for cardiac depression.

Evaluate level of consciousness closely.

Watch for adverse reactions, particularly anaphylaxis.

Stay alert for seizures.

Monitor neurologic status for lower spinal segment deficits.

• Give supportive oxygen therapy, as indicated and prescribed.

• Monitor electrolyte, blood urea nitrogen, and creatinine levels.

• Assess topical site for adverse reactions.

Patient teaching

• Discuss reason for drug therapy with patient and family, when appropriate.

• Explain that patient will be monitored continuously during therapy.

Instruct patient to promptly report discomfort at I.V. site as well as adverse effects, especially cardiovascular, respiratory, or neurologic problems or allergic reactions.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

li·do·caine hy·dro·chlor·ide

(lī'dō-kān hī'drō-klōr'īd),
An amide local anesthetic with antiarrhythmic and anticonvulsant properties; has a quick onset of action with medium duration.

lidocaine hydrochloride (lignocaine hydrochloride)

A local anaesthetic of the amide type used in eye surgery. It is used in 1-4% solution. Its action starts in less than 1 minute and lasts about 1 hour.
References in periodicals archive ?
As per Table 1 it can be seen that iontophoresis is definitely beneficial in decreasing symptoms of PF, but iontophoresis given with dexamethasone and lidocaine hydrochloride is significantly more effective in treating PF.
Iontophoresis itself is effective in treating PF, but if given with dexamethasone and lidocaine hydrochloride, it is significantly more effective in treating PF.
The Influence of dexamethasone with lidocaine hydrochloride iontophoresis in recreational tennis players suffering from lateral elbow tendinopathy.
Pain after administration of lidocaine hydrochloride 20 mg (Preservative free) and metoclopramide 10 mg combination in group 3 cases decreased incidence of pain as the time elapsed in comparison with group 1 and 2.
DISCUSSION: Result of this study, it is identified that combination of lidocaine hydrochloride and metoclopramide is most effective for prevention of pain during propofol injection than by lidocaine hydrochloride alone.
Thus it is evident that combination of lidocaine hydrochloride and metoclopramide is most effective for prevention of pain during propofol injection followed by lidocaine.
An extensive literature review shows that there are only few reports concerning stability indicating method for simultaneous determination of both pharmacological active compounds: hydrocortisone acetate and lidocaine hydrochloride in combined dosage forms.
The objective of this study was to develop the chromatographic conditions suitable for separation and simultaneous determination of hydrocortisone acetate and lidocaine hydrochloride in the presence of substances related to hydrocortisone acetate (hydrocortisone, prednisolone, and cortisone acetate) in combined dosage injection solution (market available) by the use of TLC-densitometry.
Grade) produced by Fluka Chemicals (Milwaukee, USA), lidocaine hydrochloride (>99%, Sigma-Aldrich, St.
The FT-IR spectra of blank Na-alginate, chitosan, Hap, and lidocaine hydrochloride were obtained and used as references.
Lidocaine hydrochloride content was determined using high-performance liquid chromatography (HPLC, Waters 2695 Alliance Separations Module with Waters 2487 Dual [lambda] Absorbance Detector) with UV detection ([lambda] = 210 nm) and C18 (YMC-Pack Hydrosphere C18 (5 [micro]m), 12 nm, 150 x 3.0 mm, YMC Separation Technology) column.
Generally, placebo effects from injections do not exceed 50% improvement.[6] If lidocaine hydrochloride is used, its possible beneficial effects may come from washing out irritant chemicals (substance P) from the area, from local vasodilation that facilitates the removal of metabolites, or from the interruption of the neural feedback mechanism.[13] However, the local anesthetic effect is too short to explain lasting relief, and a randomized controlled study of injection therapy of the iliac crest syndrome showed no difference in pain outcome between lidocaine hydrochloride and saline.[14] This would tend to support the possibility that multiple puncture, rather than the injected material, is effective because it lessens the tension of the innervated fibrous capsule.