Lidocaine use while Breastfeeding
Drugs containing Lidocaine: Lidoderm, Lidocaine Viscous, Terocin, Emla, LidoPro, Xylocaine Viscous, Xylocaine Jelly, Xylocaine Topical, Lidoject 1, Lidocream, Show all 93 »LMX 4, Bactine, Akten, Aloe Vera Burn Relief Spray with Lidocaine, Xylocaine-MPF, Xylocaine 10% Oral, Topicaine, Synera, Pliaglis, AnaMantle HC, LidaMantle, Uro-Jet, LidoSite, Nervocaine, Senatec, FIRST Mouthwash BLM, Dermaflex, Xylocaine Dental Cartridges, AneCream with Tegaderm, Lidosense 5, LMX 5, Anestacon, Anestacaine, Dilocaine, LMX 4 with Tegaderm, Mercuroclear, First Aid Antiseptic, Regenecare HA, Lidomar, RectaGel HC, LMX Plus, Ela-Max, Solarcaine Burn Relief, Terramycin IM, Derma Numb, Emla Anesthetic Disc, S-Caine Peel, AneCream, Oraqix, Anestafoam, Laryng-O-Jet Spray, Ela-Max 5, Protech First Aid Stik, LTA Preattached 360 Kit, LTA Pediatric Kit, Zingo, LTA II Kit, Uro-Jet AC, Medi-Quik Spray, L-Caine, Xylocaine with Epinephrine, Xylocaine with Epinephrine Dental Cartridges, Xylocaine-MPF-Epinephrine, Lets Kit, Lidocort, Rectacreme HC, LidaMantle HC, Xylocaine HCl with Epinephrine, FIRST BXN Mouthwash, Dr Scholl's Cracked Heel Relief, A + D Cracked Skin Relief, Duocaine, Rocephin IM Convenience Kit, Decadron with Xylocaine, Unguentine Plus, Lidazone HC, AnaMantle HC Forte, Xylocaine Duo-Trach Kit, Lidoject 2, Xylocaine HCl, Xylocaine HCl For Spinal, Regenecare, UAD Caine, Truxacaine, LidoProfen, Xyralid RC, Peranex HC, Senatec HC, LidaMantle HC Relief, Xyralid LP, BP Ana-Lex HC, Xyralid, DentiPatch
Lidocaine Levels and Effects while Breastfeeding
Summary of Use during Lactation
Lidocaine concentrations in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause any adverse effects in breastfed infants. No special precautions are required.
Maternal Levels. A nursing mother who was 10 months postpartum was given intravenous lidocaine 75 mg, then 50 mg 5 minutes later, concurrent with starting a continuous lidocaine infusion at a rate of 2 mg/minute. After 7 hours the infusion was stopped a milk sample was provided. The breastmilk contained 800 mcg/L of lidocaine; metabolites were not measured.
A woman received 20 mg of lidocaine with 5 mg of epinephrine (2 mL of a 2% lidocaine with 0.5% epinephrine) injected for a dental procedure 3 days postpartum. Milk levels 2 hours after the injection were 66 mcg/L of lidocaine and 35 mcg/L of its MEGX metabolite. At 6.5 hours after the dose, the levels were 44 mcg/L and 41 mcg/L, respectively.
Twenty-two women received epidural lidocaine 2% and bupivacaine 0.5% for pain control during cesarean delivery. Lidocaine dosage averaged 183 mg (range 60 to 500 mg). Average milk lidocaine concentrations were 860 mcg/L at 2 hours after delivery, 460 mcg/L at 4 hours after delivery and 220 mcg/L at 12 hours after delivery.
A woman undergoing tumescent liposuction received 4.2 g of lidocaine into her fat. Seventeen hours after the procedure, a milk lidocaine level was 550 mcg/L. It was previously shown that maximum serum lidocaine concentrations occur at about this time.
Six women were given 3.6 mL of lidocaine 2% without epinephrine and a seventh received lidocaine 2% without epinephrine 4.5 mL and 7.2 mL on 2 separate occasions for dental procedures. Milk lidocaine concentrations averaged 120.5 mcg/L at 3 hours after the dose and 58.3 mcg/L 6 hours after the dose. Milk MEGX levels were 97.5 and 52.7 mcg/L at 3 and 6 hours after the dose, respectively. Using the average daily intake reported in this study, an exclusively breastfed infant would receive 0.9% of the maternal weight-adjusted dosage of lidocaine and another 0.8% in the form of the metabolite MEGX.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Lidocaine in doses ranging from 60 to 500 mg administered to the mother by intrapleural or epidural routes during delivery had no effect on their 14 infants who were either breastfed or received their mother's breastmilk by bottle.
Possible Effects on Lactation
A randomized study compared three groups of women undergoing elective cesarean section who received subcutaneous infusion of 20 mL of lidocaine 1% plus epinephrine 1:100:000 at the incision site. One group received the lidocaine before incision, one group received the lidocaine after the incision, and the third received 10 mL before the incision and 10 mL after. Women in the pre-and post-incision administration group initiated breastfeeding earlier than those in the pre-incision administration (3.4 vs 4.1 hours). There was no difference between the post-incision administration group and the other groups in time to breastfeeding initiation.
Alternate Drugs to Consider
1. Zeisler JA, Gaarder TD, De Mesquita SA. Lidocaine excretion in breast milk. Drug Intell Clin Pharm. 1986;20:691-3. PMID: 3757781
2. Ortega D, Viviand X et al. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999;43:394-7. PMID: 10225071
3. Dryden RM, Lo MW. Breast milk lidocaine levels in tumescent liposuction. Plast Reconstr Surg. 2000;105:2267-8. Letter. PMID: 10839430
4. Lebedevs TH, Wojnar-Horton RE et al. Excretion of lignocaine and its metabolite monoethylglycinexylidide in breast milk following its use in a dental procedure. A case report. J Clin Peridontol. 1993;20:606-8. PMID: 8408724
5. Giuliani M, Grossi GB et al. Could local anesthesia while breast-feeding be harmful to infants? J Pediatric Gastroenterol Nutr. 2001;32:142-4. PMID: 11321382
6. Fouladi RF, Navali N, Abbassi A. Pre-incisional, post-incisional and combined pre- and post-incisional local wound infiltrations with lidocaine in elective caesarean section delivery: A randomised clinical trial. J Obstet Gynaecol. 2013;33:54-9. PMID: 23259880
CAS Registry Number
- Local Anesthetics
LactMed Record Number
Information from the National Library of Medicine's LactMed Database.
Last Revision Date
Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
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