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Lidocaine Side Effects

Not all side effects for lidocaine may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to lidocaine: intradermal powder

In addition to its needed effects, some unwanted effects may be caused by lidocaine. In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking lidocaine, check with your doctor or nurse immediately:

More common
  • Flushing, redness of the skin
  • small red or purple spots on the skin
  • swelling at the site of application
  • unusually warm skin
Less common
  • Bruising, burning, pain, or bleeding at the site of application
  • itching skin

If any of the following symptoms of overdose occur while taking lidocaine, get emergency help immediately:

Symptoms of overdose
  • Change in consciousness
  • fainting
  • fast, pounding, or irregular heartbeat or pulse
  • loss of consciousness
  • no blood pressure or pulse
  • no breathing
  • stopping of the heart
  • unconsciousness

Some of the side effects that can occur with lidocaine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common
  • Nausea
  • vomiting

For Healthcare Professionals

Applies to lidocaine: compounding powder, injectable solution, intravenous solution

General

The overall incidence of adverse side effects of lidocaine in a study of 750 patients was 6.3%. Adverse drug reactions were more common in patients with acute myocardial infarction, congestive heart failure, and liver disease. In another large study of 285 patients with suspected or documented acute myocardial infarction who received prophylactic intravenous lidocaine, more adverse events occurred in patients who received drug versus patients who received placebo. The most adverse events were recorded within the first hour of therapy in patients who eventually proved not to have myocardial infarction. Adverse events were not necessarily correlated with high lidocaine levels.[Ref]

Adverse side effects of lidocaine may be more likely and more severe in patients with liver disease.[Ref]

Cardiovascular

An 84-year-old man with ischemic congestive heart failure, nonsustained ventricular tachycardia, and incomplete left bundle branch block developed sinus bradycardia, then asystole within five minutes after beginning a lidocaine 100 mg bolus and 2 mg per min infusion. Atropine was initially unsuccessful, but normal sinus rhythm resumed after approximately 20 seconds. Serum electrolytes were within normal limits at the time; arterial pO2 was not reported. A follow-up 24-hour ambulatory ECG failed to demonstrate evidence of AV heart block or bradyarrhythmias.[Ref]

Cardiovascular side effects occur in 2% of patients. Serious cardiovascular problems include hypotension, bradycardia which may lead to cardiac arrest, and cardiopulmonary arrest. Rare cases of asystole have been reported after lidocaine administration with and without other antiarrhythmic agents. Less commonly, negative inotropic activity, sinus node depression, torsades de pointes, and AV or His-Purkinje block have been reported.[Ref]

Nervous system

Lidocaine toxicity often presents as nervous system side effects. Yawning, restlessness, excitement, agitation, dizziness, blurred vision or double vision, muscle twitching, confusion, tinnitus, drowsiness, vertigo, paresthesias, seizures, respiratory depression and arrest, Lightheadedness, apprehension, euphoria, sensation of heat, cold or numbness, twitching, tremors, convulsions, and unconsciousness have been reported. Rare cases of seizures following topical or subcutaneous administration of lidocaine have been reported. Transient neurologic symptoms have been reported following intrathecal lidocaine.[Ref]

Toxicity is usually associated with serum lidocaine concentrations of 9 to 10 mcg per mL, but may occur with concentrations as low as 5 mcg/mL. Central nervous system toxicity has been observed in patients with hepatic cirrhosis who were receiving lidocaine at infusion rates as low as 2.2 to 2.5 mg per min.

Transient neurologic symptoms (TNS), characterized as a symptom complex of acute onset low back pain with transient radiating pain into the buttocks and lower extremities, have been associated with the use of intrathecal hyperbaric lidocaine. TNS typically occurs within 24 hours after spinal anesthesia and resolves within 1 week without lasting sequelae. TNS has been reported in up to 40% of patients receiving intrathecal lidocaine; however, in at least two studies involving obstetric patients undergoing cesarean section or postpartum tubal ligation, the incidence of TNS did not exceed 3% following use of hyperbaric lidocaine 5%. Some practitioners consider TNS a minor manifestation of the cauda equine syndrome. It is thought that patient position may be a contributing factor to the development of TNS.[Ref]

Gastrointestinal

Nausea and vomiting are common gastrointestinal symptoms of lidocaine toxicity.[Ref]

Hypersensitivity

A previously healthy 27-year-old woman, pre-Cesarean section, with a history of possible hypersensitivity to bupivacaine developed tongue tingling, faintness, and nausea associated with hypotension 25 minutes after receiving bupivacaine as local anesthesia for an epidural catheter. She became progressively erythematous, pruritic, and edematous. The patient responded well to fluids, oxygen, a sympathomimetic, antihistamines, and corticosteroids. The neonate, born after emergency Cesarean section, was limp, cyanotic, edematous, and required mechanical ventilation secondary to pulmonary edema. Follow-up investigations in the mother revealed moderately raised total plasma IgE levels and positive intradermal wheal formation to 2% lidocaine.[Ref]

Hypersensitivity reactions are rare. Anaphylaxis, adult respiratory distress syndrome (ARDS), and cardiovascular collapse have been associated with the use of lidocaine, and have occasionally resulted in death. Cases of angioneurotic edema, anaphylaxis, bronchospasm, and urticaria following local anesthesia with lidocaine have been reported. Contact dermatitis associated with lidocaine has been described in chemical and health care workers. Patients with a history of an allergic reaction to local amide-type anesthetics may react to lidocaine. Delayed-type hypersensitivity reactions to lidocaine have also been reported.[Ref]

Psychiatric

Psychiatric reactions have been associated with lidocaine toxicity. Several case reports of acute psychosis associated with lidocaine infusions have been reported. It is not clear from the case reports whether these reactions were associated with therapeutic or toxic serum levels of lidocaine.[Ref]

Several cases of acute and reversible psychoses have been reported in several patients, most of whom were in their sixth decade of life or older and who were receiving intravenous lidocaine.[Ref]

Hematologic

Hematologic abnormalities associated with lidocaine have been limited to rare reports of significant increases in methemoglobin levels during lidocaine infusions. These increases are usually not clinically significant, however, at least one case of acute topical benzocaine-induced methemoglobinemia of 29% has been reported.[Ref]

References

1. Morganroth J, Panidis IP, Harley S, et al "Efficacy and safety of intravenous tocainide compared with intravenous lidocaine for acute ventricular arrhythmias immediately after cardiac surgery." Am J Cardiol 54 (1984): 1253-8

2. Bryant CA, Hoffman JR, Nichter LS "Pitfalls and perils of intravenous lidocaine." West J Med 139 (1983): 528-30

3. Routledge PA, Shand DG, Barchowsky A, et al "Relationship between a1-acid glycoprotein and lidocaine disposition in myocardial infarction." Clin Pharmacol Ther 30 (1981): 154-7

4. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2

5. Nattel S, Arenal A "Antiarrhythmic prophylaxis after acute myocardial infarction. Is lidocaine still useful?" Drugs 45 (1993): 9-14

6. Pfeifer HJ, Greenblatt DJ, Koch-Weser J "Clinical use and toxicity of intravenous lidocaine." Am Heart J 92 (1976): 168-73

7. Ronnevik PK, Gundersen T, Abrahamsen AM "Tolerability and antiarrhythmic efficacy of disopyramide compared to lignocaine in selected patients with suspected acute myocardial infarction." Eur Heart J 8 (1987): 19-24

8. Applebaum D, Halperin E "Asystole following a conventional therapeutic dose of lidocaine." Am J Emerg Med 4 (1986): 143-5

9. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76

10. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90

11. Rademaker AW, Kellen J, Tam YK, Wyse DG "Character of adverse effects of prophylactic lidocaine in the coronary care unit." Clin Pharmacol Ther 40 (1986): 71-80

12. Collinsworth KA, Kalman SM, Harrison DC "The clinical pharmacology of lidocaine as an antiarrhythmic drug." Circulation 50 (1974): 1217-30

13. Hilleman DE, Mohiuddin SM, Destache CJ "Lidocaine-induced second-degree mobitz type II heart block." Drug Intell Clin Pharm 19 (1985): 669-73

14. Tagliente TM, Jayagopal S "Transient left bundle branch block following lidocaine." Anesth Analg 69 (1989): 545-7

15. Rothman MT "Prolonged QT interval, atrioventricular block, and torsade de pointes after antiarrhythmic therapy." Br Med J 280 (1980): 922-3

16. Keidar S, Grenadier E, Palant A "Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration." Am Heart J 104 (1982): 1384-5

17. Demczuk RJ "Significant sinus bradycardia following intravenous lidocaine injection." Anesthesiology 60 (1984): 69-70

18. Nikolic G "Lidocaine bradycardia." Heart Lung 13 (1984): 290-1

19. Grothe DR, Sunderland T, Vitiello B, et al "Supersensitivity to subcutaneous lidocaine ." Clin Pharm 9 (1990): 338

20. Burkart F "Value and risk of class i and III antiarrhythmic drugs." Pacing Clin Electrophysiol 17 (1994): 467-72

21. Grenadier E, Alpan G, Keidar S, Palant A "Respiratory and cardiac arrest after the administration of lidocaine into the central venous system." Eur Heart J 2 (1981): 235-7

22. Luntley JB, Van Hasselt G "Topical lignocaine: toxic lignocaine ." Anaesthesia 45 (1990): 61-2

23. Gianelly R, von der Groeben JO, Spivack AP, Harrison DC "Effect of lidocaine on ventricular arrhythmias in patients with coronary heart disease." N Engl J Med 277 (1967): 1215-9

24. Aouad MT, Siddik SS, Jalbout MI, Baraka AS "Does pregnancy protect against intrathecal lidocaine-induced transient neurologic symptoms?." Anesth Analg 92 (2001): 401-4

25. Aaron H "Lidocaine (xylocaine) as an anti-arrhythmic agent." Med Lett Drugs Ther 13 (1971): 1-4

26. Wu FL, Razzaghi A, Souney PF "Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia." Pharmacotherapy 13 (1993): 72-8

27. Ryan CA, Robertson M, Coe JY "Seizures due to lidocaine toxicity in a child during cardiac catheterization." Pediatr Cardiol 14 (1993): 116-8

28. Selden R "Systemic use of lidocaine." N Engl J Med 278 (1968): 626

29. Fortuna A, Fortuna AO "Convulsion during lignocaine infiltration." Anaesth Intensive Care 21 (1993): 483

30. Sundaram MB "Seizures after intraurethral instillation of lidocaine." Can Med Assoc J 137 (1987): 219-20

31. Schneider M, Ettlin T, Kaufmann M, Schumacher P, Urwyler A, Hampl K, von Hochstetter A "Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine." Anesth Analg 76 (1993): 1154-7

32. Crampton RS, Oriscello RG "Petit and grand mal convulsions during lidocaine hydrochloride treatment of ventricular tachycardia." JAMA 204 (1968): 109-12

33. Johnson ME "Potential neurotoxicity of spinal anesthesia with lidocaine." Mayo Clin Proc 75 (2000): 921-32

34. Crabb IJ, Allan L "Opisthotonus and hysteria." Anaesthesia 48 (1993): 445-6

35. Schneider MC, Birnbach DJ "Lidocaine neurotoxicity in the obstetric patient: Is the water safe?." Anesth Analg 92 (2001): 287-90

36. Philip J, Sharma SK, Gottumukkala VNR, Perez BJ, Slaymaker EA, Wiley J "Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients." Anesth Analg 92 (2001): 405-9

37. Pelter MA, Vollmer TA, Blum RL "Seizure-like reaction associated with subcutaneous lidocaine injection ." Clin Pharm 8 (1989): 767-8

38. Carr TW "Severe allergic reaction to an intraurethral lignocaine preparation containing parabens preservatives." Br J Urol 66 (1990): 98

39. Duggan M, Burns D, Henry M, Mitchell T "Reaction to topical lignocaine in a patient with contact dermatitis." Contact Dermatitis 28 (1993): 190-1

40. Rooke NT, Milne B "Acute pulmonary edema after regional anesthesia with lidocaine and epinephrine in a patient with chronic renal failure." Anesth Analg 63 (1984): 363-4

41. Bircher AJ, Messmer SL, Surber C, Rufli T "Delayed-type hypersensitivity to subcutaneous lidocaine with tolerance to articaine: confirmation by in vivo and in vitro tests." Contact Dermatitis 34 (1996): 387-9

42. Promisloff RA, DuPont DC "Death from ARDS and cardiovascular collapse following lidocaine administration ." Chest 83 (1983): 585

43. Curley RK, Macfarlane AW, King CM "Contact sensitivity to the amide anesthetics lidocaine, prilocaine, and mepivacaine: case report and review of the literature." Arch Dermatol 122 (1986): 924-6

44. Ruffles SP, Gayres JG "Fatal bronchospasm after topical lignocaine before bronchoscopy." Br Med J 294 (1987): 1658-9

45. Chin TM, Fellner MJ "Allergic hypersensitivity to lidocaine hydrochloride." Int J Dermatol 19 (1980): 147-8

46. Woelke BJ, Tucker RA "ARDS after local lidocaine administration ." Chest 83 (1983): 933-4

47. Barer MR, McAllen MK "Hypersensitivity to local anaesthetics: a direct challenge test with lignocaine for definitive diagnosis." Br Med J 284 (1982): 1229-30

48. Bricker SR, Raitt DG "Angioneurotic oedema following etomidate/lignocaine ." Anaesthesia 42 (1987): 323-4

49. Kennedy KS, Cave RH "Anaphylactic reaction to lidocaine." Arch Otolaryngol Head Neck Surg 112 (1986): 671-3

50. Handfield-Jones SE, Cronin E "Contact sensitivity to lignocaine." Clin Exp Dermatol 18 (1993): 342-3

51. Klein CE, Gall H "Type IV allergy to amide-type local anesthetics." Contact Dermatitis 25 (1991): 45-8

52. Jackson D, Chen AH, Bennet CR "Identifying true lidocaine allergy." J Am Dent Assoc 125 (1994): 1362-6

53. Howard JJ, Mohsenifar Z, Simons SM "Adult respiratory distress syndrome following administration of lidocaine." Chest 81 (1982): 644-5

54. Whalen JD, Dufresne RG "Delayed-type hypersensitivity after subcutaneous administration of amide anesthetic." Arch Dermatol 132 (1996): 1256-7

55. Zimmerman J, Rachmilewitz D "Systemic anaphylactic reaction following lidocaine administration ." Gastrointest Endosc 31 (1985): 404-5

56. Thomas AD, Caunt JA "Anaphylactoid reaction following local anaesthesia for epidural block." Anaesthesia 48 (1993): 50-2

57. Mackley CL, Marks JG Jr, Anderson BE "Delayed-type hypersensitivity to lidocaine." Arch Dermatol 139 (2003): 343-6

58. Saravay SM, Marke J, Steinberg MD, Rabiner CJ ""Doom anxiety" and delirium in lidocaine toxicity." Am J Psychiatry 144 (1987): 159-63

59. Turner WM "Lidocaine and psychotic reactions ." Ann Intern Med 97 (1982): 149-50

60. Weiss LD, Generalovich T, Heller MB, et al "Methemoglobin levels following intravenous lidocaine administration." Ann Emerg Med 16 (1987): 323-5

61. O'Donohue WJ Jr, Moss LM, Angelillo VA "Acute methemoglobinemia induced by topical benzocaine and lidocaine." Arch Intern Med 140 (1980): 1508-9

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