A-Z Drug Facts > Lidocaine Hydrochloride

Lidocaine Hydrochloride

Pronouncation: (LIE-doe-cane HIGH-droe-KLOR-ide)
Class: Antiarrhythmic agent, Local anesthetic, Topical

Trade Names:
Anestocaine
- Injection 1%
- Injection 2%

Trade Names:
Anestacon
- Gel 2%

Trade Names:
Burn-o-Jel
- Gel 0.5%

Trade Names:
Burnomycin
- Spray 0.5%

Trade Names:
Corta-Cap Needle Ease
- Spray 35%

Trade Names:
ELA-max
- Cream 4%

Trade Names:
Lida Mantle
- Cream 3%
- Lotion 3%

Trade Names:
Lidocaine Hydrochloride
- Injection, IV 20%

Trade Names:
Lidocaine Hydrochloride Viscous
- Solution 2%

Trade Names:
Lidoderm
- Patch, extended-release 5%

Trade Names:
LMX 4
- Cream 4%
- Cream 5%

Trade Names:
Premjact
- Spray 9.6%

Trade Names:
Senatec
- Lotion 3%

Trade Names:
Stud 100
- Spray 9.6%

Trade Names:
Topicaine
- Gel 4%
- Gel 5%

Trade Names:
Xylocaine
- Gel 2%
- Injection 0.5%
- Injection 1%
- Injection 2%
- Ointment 5%
- Solution 2%
- Solution 4%

Trade Names:
Xylocaine Hydrochloride IV for Cardiac Arrhythmias
- Injection for direct IV administration 2%

Trade Names:
Xylocaine-MPF
- Injection 0.5%
- Injection 1%
- Injection 1.5%
- Injection 2%
- Injection 4%

Trade Names:
Zilactin-L
- Liquid 2.5%

Lidodan Endotracheal (Canada)
Lidodan Ointment (Canada)
Lidodan Viscous (Canada)
Xylocaine CO2 (Canada)
Xylocaine Endotracheal (Canada)
Xylocaine 4% Sterile Solution (Canada)
Xylocaine Spinal 5% (Canada)
Xylocard (Canada)

Pharmacology

Attenuates phase 4 diastolic depolarization, decreases automaticity, decreases action potential duration, and raises ventricular fibrillation threshold; inhibits conduction of nerve impulses from sensory nerves.

Indications and Usage

Acute management of ventricular arrhythmias; topical anesthesia in local skin disorders; local anesthesia of accessible mucous membranes.

Unlabeled Uses

Intraosseous or endotracheal administration to children with cardiac arrest.

Contraindications

Hypersensitivity to amide local anesthetics; Stokes-Adams syndrome; Wolff-Parkinson-White syndrome; severe degrees of sinoatrial, AV or intraventricular block in absence of pacemaker; ophthalmic use.

Dosage and Administration

Adults

IM 300 mg. May be repeated after 60 to 90 min. IV bolus 50 to 100 mg at rate of 25 to 50 mg/min; may repeat, but do not exceed 200 to 300 mg/h. Continuous infusion 1 to 4 mg/min. Patch Apply patch and allow to remain in place until the desired anesthetic effect is produced for up to 15 min. Use the lowest dosage for effectiveness.

Children

IV bolus/intratracheal 1 mg/kg/dose every 5 to 10 min (max dose, 5 mg/kg). Maintenance dose is 20 to 50 mcg/kg/min. Topical Apply as needed to affected area; use lowest dose possible when applying to mucous membranes.

General Advice

IM

• Use IM route for emergency situations (eg, no IV access, no ECG monitoring) only. Only use 10% solution for injection. Deltoid muscle is preferred IM site. Switch to IV route as soon as possible.

IV

• When giving by IV route, use only 1% to 2% solutions of drug. Use only lidocaine specifically labeled for IV use (without preservatives or epinephrine). Do not administer with other agents.
• For continuous infusion, use prediluted solution or add 1 g of lidocaine to 500 mL of D5W to prepare 0.2% solution. Rate of administration should not exceed 1 to 4 mg/min. Adjust rate according to cardiac response.
• Use diluted solutions within 24 h.

Patch

• Gently dry the area of application with cotton gauze. Remove the clear protective liner and apply the patch.

Storage/Stability

Store all forms of drug at room temperature.

Drug Interactions

Beta-adrenergic blockers

Increased lidocaine levels.

Cimetidine

Decreased lidocaine Cl.

Class I antiarrhythmic agents (eg, tocainide, mexiletine)

Toxic effects are additive and potentially synergistic.

Procainamide

Additive neurological and cardiac effects.

Succinylcholine

Prolongation of neuromuscular blockade.

Incompatibility

Amphotericin B, parenteral cephalosporins, doxycycline, epinephrine, isoproterenol, methohexital, nitroprusside, norepinephrine, phenytoin, sodium bicarbonate, sulfadiazine.

Laboratory Test Interactions

IM administration may increase CPK levels.

Adverse Reactions

Cardiovascular

Hypotension; bradycardia; CV collapse; cardiac arrest.

CNS

Dizziness; lightheadedness; nervousness; drowsiness; apprehension; confusion; mood changes; hallucinations; tremors.

EENT

Visual disturbances; diplopia; tinnitus.

GI

Nausea; vomiting.

Respiratory

Respiratory depression or arrest.

Miscellaneous

Hypersensitivity reactions. Local reactions, including soreness at IM injection site; venous thrombosis or phlebitis; extravasation; burning, stinging, sloughing, tenderness (with topical application). Difficulty in speaking, breathing, and swallowing; numbness of lips or tongue, and other paresthesias, including heat and cold.

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established. If used, reduce dose. IM autoinjector device not recommended in children less than 50 kg.

Hypersensitivity

May occur.

Renal Function

Use caution with repeated doses or prolonged use.

Hepatic Function

Use caution with repeated doses or prolonged use.

Cardiac effects

Use with caution and in lower doses in patients with CHF, reduced cardiac output, digitalis toxicity, and in the elderly.

IV use

May result in excessive depression of cardiac conductivity.

Malignant hyperthermia

Has been reported with administration of amide local anesthetics.

Methemoglobinemia

Do not use in patients with congenital or idiopathic methemoglobinemia or in infants younger than 12 mo of age who are receiving methemoglobin-inducing drugs.

Oral use

May impair swallowing and enhance danger of aspiration; avoid food for 1 h if used in mouth or throat.

Topical use

Systemic effects can occur following topical use; use lowest possible dose to avoid serious toxicity, shock, or heart block.

Overdosage

Symptoms

Confusion, drowsiness, unconsciousness, tremors, convulsions, hypotension, bradycardia, CV collapse, cardiac arrest, tinnitus, diplopia.

Patient Information

• Explain that adverse reactions related to the CNS (eg, drowsiness, confusion, paresthesias, convulsions, respiratory arrest) can occur and are related to CNS toxicity.
• Emphasize importance of not allowing topical solution to come in contact with eyes or broken skin.
• Advise patient not to chew gum or eat food until 60 min after oral anesthetic has been administered.
• Advise patient that drug may cause dizziness or drowsiness and to avoid getting out of bed or walking without assistance.

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