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Lidocaine Hydrochloride (Local)

Pronunciation

Class: Local Anesthetics
VA Class: CN204
CAS Number: 6108-05-0
Brands: Xylocaine, Xylocaine with Epinephrine, Xylocaine Dental

Introduction

Intermediate-acting local anesthetic (amide type).211 213 214 a

Uses for Lidocaine Hydrochloride (Local)

Local or Regional Anesthesia

Local or regional anesthesia in surgical procedures (including oral surgery), diagnostic and therapeutic procedures, and obstetrical procedures.211 213 214

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Lidocaine Hydrochloride (Local) Dosage and Administration

General

  • Determine dosage based on type and extent of surgical procedure, area to be anesthetized, vascularity of tissues, depth and duration of anesthesia, degree of muscular relaxation, and condition of the patient.211 213 Use lowest concentration and smallest dose required to produce the desired effect.211 213 214

Administration

Injection

For solution and drug compatibility information, see Compatibility under Stability.

Administer by local infiltration, peripheral nerve block, paracervical block, sympathetic nerve block, central neural block (e.g., epidural block), caudal block, or subarachnoid (spinal) block.211 213 214 Has been administered by continuous intra-articular infusion (e.g., for control of postoperative pain); however, such use associated with chondrolysis.200 201 202 203 204 205 206 207 208 209 211 212 (See Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics under Cautions.)

Consult specialized references for specific techniques and procedures for administering local anesthetics.211 213 214

For IV regional anesthesia, use 50-mL single-dose vials containing lidocaine hydrochloride 0.5% only.211

For paracervical block, inject slowly; allow a 5-minute interval between sides.211

For caudal or lumbar epidural block, avoid rapid injection of large volumes; when feasible, administer in fractional (incremental) doses.211

For epidural or spinal block, avoid using preparations containing antimicrobial preservatives (e.g., methylparaben), since safety of intrathecal administration using these preparations not established.211

For spinal block, inject slowly.214

Aspirate prior to injections to avoid inadvertent intravascular administration.211 212 213 214

For dental anesthesia, lidocaine hydrochloride 2% solution with epinephrine 1:100,000 preferred for most routine procedures; when greater depth and a more pronounced hemostasis are required, use preparation containing epinephrine 1:50,000.213

For chemical disinfection of container surface, moisten cotton or gauze with isopropyl (rubbing) alcohol (91%) or ethyl alcohol (70%) and wipe surface thoroughly just prior to use.211 213 Do not use alcohol brands that are not of USP grade, since these preparations may contain denaturants that may be injurious to rubber.211 213

Dilution

Dilute with 0.9% sodium chloride injection to obtain desired concentration.211

Dosage

Available as lidocaine hydrochloride, as fixed combination containing lidocaine hydrochloride and epinephrine bitartrate or epinephrine hydrochloride, and as lidocaine hydrochloride in dextrose injection.211 213 214 Dosage expressed in terms of lidocaine hydrochloride.211 213 214

When larger dosages (volumes) are required, use preparations containing epinephrine (unless contraindicated).211

Pediatric Patients

Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block

Use lower dosages than those suggested for healthy adults (see Adults under Dosage and Administration).211

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

Children <10 years of age: 18–20 mg (0.9–1 mL) of lidocaine hydrochloride 2% solution is adequate for a procedure involving 1 tooth (local infiltration), 2–3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).213

Adults

Local or Regional Anesthesia
Local Infiltration

Percutaneous: 5–300 mg (1–60 mL) of lidocaine hydrochloride 0.5 or 1% solution (without epinephrine).211

IV regional: 50–300 mg (10–60 mL) of lidocaine hydrochloride 0.5% solution (without epinephrine).211

Peripheral Nerve Block

Brachial: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).211

Dental: 20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution (without epinephrine).211

Intercostal: 30 mg (3 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Paravertebral: 30–50 mg (3–5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Pudendal: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).211

Paracervical Block

Obstetrical analgesia: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).211

Sympathetic Nerve Block

Cervical (stellate ganglion): 50 mg (5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Lumbar: 50–100 mg (5–10 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Retrobulbar Block

120–200 mg (3–5 mL) or 1.7–3 mg/kg of lidocaine hydrochloride 4% solution is suggested; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve.212

Transtracheal Injection

80–120 mg (2–3 mL) of lidocaine hydrochloride 4% solution is administered rapidly.212

If both transtracheal injection and topical application (oropharyngeal spray) are needed to achieve complete analgesia, combined total dose from transtracheal injection and oropharyngeal spray should be ≤200 mg (5 mL) of 4% solution or ≤3 mg/kg.212

Central Neural Block

Prior to lumbar epidural block, administer test dose to detect accidental intravascular injection.211 Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.211 Repeat test dose if patient is moved in a manner that could displace catheter.211

Thoracic epidural: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211 Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).211

Lumbar epidural (for analgesia): 250–300 mg (25–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Lumbar epidural (for anesthesia): 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine) or 200–300 mg (10–15 mL) of lidocaine hydrochloride 2% solution (without epinephrine).211 Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).211

Caudal Block

Prior to caudal block, administer test dose to detect accidental intravascular injection.211 Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.211 Repeat test dose if patient is moved in a manner that could displace catheter.211

Obstetrical analgesia: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211

Surgical anesthesia: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).211

Subarachnoid (Spinal) Block

Vaginal delivery: Approximately 50 mg (1 mL) of lidocaine hydrochloride 5% in dextrose 7.5% injection.214

Cesarean section or delivery requiring intrauterine manipulations: 75 mg (1.5 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.214

Surgical anesthesia (abdominal): 75–100 mg (1.5–2 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.214

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution with epinephrine 1:50,000 or 1:100,000.213

Prescribing Limits

Pediatric Patients

Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block

For children >3 years of age with normal lean body mass and normal development, maximum dose is determined by child’s age and weight.211 For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).211 For IV regional anesthesia, maximum 3 mg/kg (1.4 mg/lb), using more dilute solutions (e.g., lidocaine hydrochloride 0.25 or 0.5% solution).211 (See Dilution under Dosage and Administration: Administration.)

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

For children <10 years of age with normal lean body mass and normal development, maximum dose is determined by using standard pediatric drug formulas (e.g., Clark’s rule).213 For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).213

Maximum 4.5 mg/kg (2 mg/lb) of body weight (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (with epinephrine).213

Adults

Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block

Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 300 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 500 mg) (with epinephrine).211

IV regional: Maximum 4 mg/kg.211

Paracervical Block

Obstetric or nonobstetric use: Maximum 200 mg (100 mg each side) per 90-minute period.211

Continuous Epidural/Caudal Block

Maximum recommended dosage should not be administered at intervals of <90 minutes.211

Subarachnoid (Spinal) Block

Dosages >100 mg not required if technique and needle placement are correct.214

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 500 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 300 mg) (with epinephrine).213

Special Populations

Hepatic Impairment

Reduce dosage in patients with hepatic impairment.211

Geriatric Patients

Reduce dosage in geriatric patients.211 212 213 214

Other Populations

Reduce dosage in patients with cardiac disease, debilitated patients, and acutely ill patients.211 212 213 214

Cautions for Lidocaine Hydrochloride (Local)

Contraindications

  • Contraindications to spinal anesthesia: severe hemorrhage, shock, heart block, local infection at site of proposed puncture, and septicemia.214

  • Known hypersensitivity to local anesthetics of the amide type or to any ingredient in the formulation.211 213 214

Warnings/Precautions

Warnings

Experience of Supervising Clinician

Should be used only by clinicians who are sufficiently knowledgeable in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise. 211 212 213 214 Oxygen, resuscitative equipment, drugs, and personnel required for treatment of adverse reactions must be immediately available.211 212 213 214 Delay in proper management of dose-related toxicity, underventilation, and/or altered sensitivity may result in acidosis, cardiac arrest, and, possibly, death.211 212 213 214

Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics

Chondrolysis (necrosis and destruction of articular cartilage) reported in patients receiving continuous intra-articular infusions of local anesthetics, administered for 48–72 hours via elastomeric infusion devices, for treatment of postoperative pain.200 201 202 203 204 205 206 207 208 209 211 212 Primarily observed in the shoulder joint following arthroscopic or other shoulder surgery.200 211 212 May result in long-term disability; often requires intervention (e.g., debridement, arthroplasty).200 202 203 204 205 206 209 211 212 Not known whether the drug, infusion device, and/or other factors contributed to the development of chondrolysis.200 201 Neither local anesthetics nor elastomeric infusion devices are approved for use for continuous intra-articular infusion therapy.200 201 211 212

Accidental Intravascular Injection

Accidental intravascular injection may result in confusion, seizures, CNS excitement and/or depression, myocardial depression, coma, and/or respiratory arrest.211 213 214 (See Nervous System Effects and also see Cardiovascular Effects, under Cautions.)

Aspirate prior to administration to guard against intravascular injection.211 212 213 214

Injection During Uterine Contractions

Do not inject spinal anesthetics during uterine contractions, since spinal fluid current may carry drug further cephalad than desired.214

Epinephrine Administration

Some lidocaine hydrochloride preparations contain epinephrine, which may cause ischemic injury or necrosis.211 213 Consider usual precautions associated with epinephrine administration.211 213 (See Cardiovascular Effects under Cautions.)

Sensitivity Reactions

Hypersensitivity Reactions and Cross Hypersensitivity

Possible cutaneous lesions, urticaria, edema, or anaphylactoid reactions.211 213 214

No cross hypersensitivity reported in patients allergic to para-aminobenzoic derivatives (e.g., benzocaine, procaine, tetracaine).211 213 214

Use with caution in patients with known drug sensitivities.211 213 214

Sulfite Sensitivity

Some epinephrine-containing lidocaine preparations contain sodium metabisulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.211 213

General Precautions

Nervous System Effects

Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse CNS effects (e.g., lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, seizures, unconsciousness, respiratory arrest).211 214 Carefully monitor level of consciousness after each local anesthetic injection.211 213 214

Spinal anesthesia may be associated with adverse neurologic effects (e.g., loss of perineal sensation and sexual function, persistent anesthesia, paresthesia, weakness and paralysis of the lower extremities, headache).214

Risk of nerve injury with use of small-bore needles and microcatheters for spinal anesthesia; possibly a result of drug pooling and inconsistent distribution of concentrated anesthetic within the subarachnoid space.214 If an incomplete or patchy block occurs and is not responsive to patient repositioning, the drug may be missplaced or inadequately distributed.214 Use of a spinal needle of sufficient gauge may facilitate intrathecal distribution; in clinical trials, 22- and 25-gauge spinal needles were used safely for single-injection lidocaine spinal anesthesia.214 Animal studies suggest that dilution of 5% lidocaine hydrochloride with an equal volume of CSF or preservative-free 0.9% sodium chloride may decrease risk of nerve injury from pooling of concentrated drug.214

Cardiovascular Effects

Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse cardiovascular effects (e.g., bradycardia, hypotension, and cardiovascular collapse, cardiac arrest).211 213 214 Carefully monitor cardiovascular and respiratory vital signs after each local anesthetic injection.211 213 214

Use with caution in patients with impaired cardiovascular function, severe shock, or heart block.211 213 214

Some lidocaine hydrochloride preparations contain epinephrine; risk of exaggerated vasoconstrictor response in patients with peripheral or hypertensive vascular disease.211 213 Use with caution and in carefully restricted quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply (e.g., digits, nose, external ear, penis).211 213

Familial Malignant Hyperthermia

Many drugs used during the conduct of anesthesia may trigger familial malignant hyperthermia; not known whether amide-type local anesthetics trigger this reaction.211 213 214 However, standard protocol for management should be available.211 213 214 Early unexplained signs of tachycardia, tachypnea, labile BP, and metabolic acidosis may precede temperature elevation.211 213 214 If familial malignant hyperthermia is confirmed, discontinue triggering agent and initiate appropriate therapy (e.g., oxygen, dantrolene) and other supportive measures.211 213 214

Preexisting Conditions

Employ lumbar epidural and caudal block with extreme caution in patients with preexisting neurological disease, spinal deformities, septicemia, and severe hypertension.211

Conditions that may preclude the use of spinal anesthesia (depending upon the clinician’s evaluation of the situation and ability to manage potential complications) include preexisting CNS disease (e.g., disease associated with pernicious anemia, poliomyelitis, paralysis from nerve injuries and syphilis); hematological disorders predisposing to coagulopathies; current anticoagulant therapy; chronic backache; preoperative headache; hypotension or hypertension; technical problems (persistent paresthesias, persistent bloody spinal tap); arthritis or spinal deformity; extremes of age; and psychosis or other causes of poor patient cooperation.214

Risks Associated with Various Administration Techniques

Paracervical block: Possible rapid systemic absorption.211 Maternal seizures and cardiovascular collapse reported following paracervical block with certain local anesthetics (used to induce anesthesia for elective abortion).211 Administer dose slowly; do not exceed recommended maximum dose.211 (See Administration and see Prescribing Limits, under Dosage and Administration and also see Labor and Delivery under Cautions.)

Retrobulbar block: Possible permanent injury to extraocular muscles requiring surgical repair.211 213

Serious Adverse Effects Associated with Local Anesthetics

Risk of serious adverse effects (e.g., seizures, coma, irregular heart beat, respiratory depression) with use of topical local anesthetics; generally reported following application of extemporaneously prepared topical preparations containing high concentrations of anesthetics.e

Potential for life-threatening adverse effects (e.g., irregular heart beat, seizures, breathing difficulties, coma, death) when topical local anesthetics are applied to a large area of skin, when the area of application is covered with an occlusive dressing, if a large amount of topical anesthetic is applied, if the anesthetic is applied to irritated or broken skin, or if the skin temperature increases (from exercise or use of a heating pad).101 102

Lidocaine 4% gel has been investigated to reduce discomfort during mammography.101 103 Whether such use could result in serious reactions has not been determined.101 103 Patients should speak with their clinician if they are considering using a topical anesthetic before obtaining a mammogram.101

When a topical anesthetic is needed for a procedure, use of an FDA-approved preparation has been recommended.e Use a preparation containing the lowest concentration of anesthetic likely to be effective; apply a small amount of the preparation to the affected area for the shortest period necessary for the desired effect, and do not apply to broken or irritated skin.101

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category B.211 213 214

Labor and Delivery

Maternal hypotension reported.211 214 To prevent decreases in BP, elevate patient’s legs and position patient on her left side.211 214 Monitor fetal heart rate continuously; electronic fetal monitoring highly advisable.211 214

Accidental intravascular or fetal intracranial injection following paracervical and/or may result in unexplained neonatal depression at birth or seizures within 6 hours after birth.211

Paracervical block may decrease duration of first stage labor and facilitate cervical dilation.211 214 Possible fetal bradycardia and acidosis; always monitor fetal heart rate.211 For paracervical block in prematurity, toxemia of pregnancy, or presence of fetal distress, weigh benefit of therapy versus risk.211

Epidural and spinal anesthesia may prolong second stage of labor (by removing parturient’s reflex urge to bear down or by interfering with motor function); may increase need for forceps assistance.211 214

Possible diminished muscle strength and tone on neonate’s first or second day of life.211

Lactation

Not known whether lidocaine is distributed into milk.211 213 214 Caution if used in nursing women.211 213 214

Pediatric Use

Safety and efficacy of lidocaine hydrochloride in dextrose injection not established in pediatric patients <16 years of age.214

Geriatric Use

Dosage reduction recommended.211 213 214

Hepatic Impairment

Possible increased risk of toxicity, particularly in patients with severe hepatic impairment.211 213 214 Use with caution.211 214 Dosage adjustments recommended.211

Common Adverse Effects

Adverse nervous system and cardiovascular effects.211 213 214 (See Nervous System Effects and Cardiovascular Effects, under Cautions.)

Spinal block: Positional headache, hypotension, backache, shivering.211 214

Interactions for Lidocaine Hydrochloride (Local)

Consider usual drug interactions associated with epinephrine administration.211 213 214

Specific Drugs and Laboratory Tests

Drug

Interaction

Comments

Anesthetics, general

Possible cardiac arrhythmias due to epinephrine component.211 213

Use with caution.

Antidepressants, tricyclics

Possible severe, prolonged hypertension due to epinephrine component.211 213 214

Avoid concomitant use;211 213 214 if must be used concomitantly, careful monitoring is required.211 213 214

Butyrophenones

Possible reduction or reversal of pressor effect of epinephrine.211 214

Avoid concomitant use;211 if must be used concomitantly, careful monitoring is required.211

Ergot alkaloid oxytocics (ergonovine, methylergonovine)

Possible severe, persistent hypertension or cerebrovascular accidents due to epinephrine component.211 213 214

MAO inhibitors

Possible severe, prolonged hypertension due to epinephrine component.211 213 214

Avoid concomitant use;211 213 214 if must be used concomitantly, careful monitoring is required.211 213 214

Phenothiazines

Possible reduction or reversal of pressor effect of epinephrine.211 214

Avoid concomitant use;211 if must be used concomitantly, careful monitoring is required.211

Vasopressors

Possible severe, persistent hypertension or cerebrovascular accidents due to epinephrine component.211 213 214

Test for CPK

Possible increased CPK concentrations following IM injection of lidocaine.211 213

Accuracy as diagnostic test for AMI compromised if used without isoenzyme separation.211 213

Lidocaine Hydrochloride (Local) Pharmacokinetics

Absorption

Bioavailability

Systemic absorption dependent upon route of administration, administration site, and presence or absence of epinephrine in formulation.211 213 214 Except for intravascular administration, intercostal nerve block results in highest blood levels, and sub-Q administration results in lowest blood levels.211 213 214

Possible accumulation with repeated dosing.211 213 214

Onset

More rapid onset of anesthesia compared with procaine hydrochloride.a

For dental anesthesia, onset <2 minutes following infiltration with 2% solution (with or without epinephrine).213 Onset of 2–4 minutes following nerve block with 2% solution (with or without epinephrine).213

Duration

Longer duration of anesthesia compared with procaine hydrochloride.a

Duration of about 100 minutes following lumbar epidural block with 2% solution.a

Duration of about 75–135 minutes following caudal block with 1 or 2% solution.a

Following spinal block with 50 mg (1 mL) of 5% solution, duration of perineal anesthesia is about 100 minutes; analgesic effects continue for another 40 minutes.214 Duration of surgical anesthesia is about 2 hours with 75–100 mg (1.5–2 mL) of 5% solution.214

For dental anesthesia, pulp anesthesia persists for 5 minutes following infiltration with 2% solution without epinephrine.213 Pulp anesthesia persists for at least 60 minutes following infiltration with 2% solution with epinephrine; average duration of soft tissue anesthesia is approximately 2.5 hours.213 Following nerve block with the 2% solution with epinephrine, pulp anesthesia persists for at least 90 minutes, and soft tissue anesthesia persists for 3.25 hours.213

Distribution

Extent

Crosses blood-brain and placental barriers.211 213 214

Plasma Protein Binding

Protein binding dependent upon drug concentration and concentration of α-1-acid glycoprotein; fraction bound decreases with increasing drug concentration.211 213 214 At concentrations of 1–4 mcg/mL, 60–80% of drug is bound.211 213 214

Elimination

Metabolism

Systemically absorbed lidocaine is rapidly metabolized in the liver.211 213 214

Pharmacological or toxicological effects of metabolites are similar to but less potent than those of parent drug.211 213 214

Elimination Route

Excreted principally in urine as metabolites (90%) and small amounts (<10%) of unchanged drug.211 213 214

Half-life

1.5–2 hours following IV injection.211 213 214

Special Populations

Prolonged half-life in patients with hepatic dysfunction.211 213

Increased accumulation of metabolites in patients with renal impairment.211 213

Stability

Storage

Parenteral

Injection

Room temperature (approximately 20–25°C).211 213 214 Protect epinephrine-containing solutions from light.211 213

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Syringe CompatibilityHID

aWith epinephrine HCl 1:80,000, 1:100,000, 1:200,000 added.

Compatible

Caffeine citrate

Clonidine HCl with fentanyl citrate

Heparin sodium

Hydroxyzine HCl

Metoclopramide HCI

Milrinone lactate

Nalbuphine HCI

Incompatible

Cefazolin sodium

Dantoprazole sodium

Variable

Ampicillin sodium

Ceftriaxone sodium

Sodium bicarbonatea

Actions

  • Local anesthetics block the generation and conduction of nerve impulses by increasing the threshold for electrical excitation, slowing the propagation of the nerve impulse, and reducing the rate of rise of the action potential.211 213 214

  • Some preparations formulated with epinephrine to decrease lidocaine’s rate and extent of systemic absorption and to prolong its duration of action.a 211 213

  • Has intermediate duration of action.a

Advice to Patients

  • Prior to administration, advise patients of the possibility of temporary loss of sensation and muscle function (e.g., in lower half of body following lumbar epidural or subarachnoid block).211 213 214

  • Advise patients to avoid inadvertent trauma to the lips, tongue, cheek mucosae, or soft palate when these structures are anesthetized for dental procedures; postpone ingestion of food until normal function returns.213 Advise patient to consult dentist if anesthesia persists or if rash develops.213

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., cardiovascular or liver disease).211 213 214

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.211 213 214

  • Importance of informing patients of other important precautionary information. 211 213 214 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lidocaine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

0.5%*

Lidocaine Hydrochloride Injection

Xylocaine

APP Pharmaceuticals

Xylocaine-MPF

APP Pharmaceuticals

1%*

Lidocaine Hydrochloride Injection

Xylocaine

APP Pharmaceuticals

Xylocaine-MPF

APP Pharmaceuticals

1.5%*

Lidocaine Hydrochloride Injection

Xylocaine-MPF

APP Pharmaceuticals

2%*

Lidocaine Hydrochloride Injection

Xylocaine

APP Pharmaceuticals

Xylocaine Dental (available as dental cartridge)

Dentsply

Xylocaine-MPF

APP Pharmaceuticals

4%*

Lidocaine Hydrochloride Injection

Xylocaine-MPF Sterile Solution

APP Pharmaceuticals

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lidocaine Hydrochloride in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

5% Lidocaine Hydrochloride in 7.5% Dextrose*

Lidocaine Hydrochloride Injection in Dextrose

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lidocaine Hydrochloride Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

0.5% with Epinephrine 1:200,000*

Lidocaine Hydrochloride and Epinephrine Injection

Xylocaine with Epinephrine

APP Pharmaceuticals

1% with Epinephrine 1:100,000*

Lidocaine Hydrochloride and Epinephrine Injection

Xylocaine with Epinephrine

APP Pharmaceuticals

1% with Epinephrine 1:200,000

Xylocaine-MPF with Epinephrine

APP Pharmaceuticals

1.5% with Epinephrine 1:200,00*

Lidocaine Hydrochloride and Epinephrine Injection

Xylocaine-MPF with Epinephrine

APP Pharmaceuticals

2% with Epinephrine Hydrochloride 1:100,000 (of epinephrine)*

Lidocaine Hydrochloride and Epinephrine Injection

Xylocaine with Epinephrine

APP Pharmaceuticals

2% with Epinephrine Hydrochloride 1:200,000 (of epinephrine)*

Lidocaine Hydrochloride and Epinephrine Injection

Xylocaine-MPF with Epinephrine

APP Pharmaceuticals

2% with Epinephrine Bitartrate 1:50,000 (of epinephrine)*

Lidocaine Hydrochloride and Epinephrine Injection (available as dental cartridge)

Xylocaine Dental (available as dental cartridge)

Dentsply

2% with Epinephrine Bitartrate 1:100,000 (of epinephrine)*

Lidocaine Hydrochloride and Epinephrine Injection (available as dental cartridge)

Xylocaine Dental (available as dental cartridge)

Dentsply

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions February 1, 2011. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

a. AHFS drug information 2011. McEvoy GK, ed. Lidocaine Hydrochloride. Bethesda, MD: American Society of Health-System Pharmacists; 2011: e-pub ahead of print.

e. Food and Drug Administration. FDA Public Health Advisory: Life-threatening side effects with use of skin products containing numbing ingredients for cosmetic procedures. 2007 Feb 6, updated 2007 Feb 9. From FDA website.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1001-12.

101. Food and Drug Administration. FDA Public Health Advisory: Potential hazards of skin products containing numbing ingredients for relieving pain from mammography and other medical tests and conditions. 2009 Jan 16. From FDA website.

102. Food and Drug Administration. Topical Anesthetics. MedWatch alert. Rockville, MD; 2009 Jan 16. From FDA website.

103. Lambertz CK, Johnson CJ, Montgomery PG et al. Premedication to reduce discomfort during screening mammography. Radiology. 2008; 248:765-72. [PubMed 18647845]

200. Food and Drug Administration. Information for healthcare professionals: Chondrolysis reported with continuously infused local anesthetics (marketed as bupivacaine, chloroprocaine, lidocaine, mepivacaine, procaine, and ropivacaine). Rockville, MD; Updated 2010 Feb 16. From FDA website ().

201. Todd JF. Chondrolysis linked to intra-articular infusions. Medical Devices Alerts and Notices. Silver Spring, MD: Food and Drug Administration; 2010 June. From FDA website ().

202. Hansen BP, Beck CL, Beck EP et al. Postarthroscopic glenohumeral chondrolysis. Am J Sports Med. 2007; 35:1628-34. [PubMed 17609526]

203. Bailie DS, Ellenbecker TS. Severe chondrolysis after shoulder arthroscopy: a case series. J Shoulder Elbow Surg. 2009 Sep-Oct; 18:742-7.

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205. Anderson SL, Buchko JZ, Taillon MR et al. Chondrolysis of the glenohumeral joint after infusion of bupivacaine through an intra-articular pain pump catheter: a report of 18 cases. Arthroscopy. 2010; 26:451-61. [PubMed 20362823]

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