Xylocaine HCl Side Effects

Generic Name: lidocaine

Note: This page contains side effects data for the generic drug lidocaine. It is possible that some of the dosage forms included below may not apply to the brand name Xylocaine HCl.

It is possible that some side effects of Xylocaine HCl may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to lidocaine: intradermal powder

As well as its needed effects, lidocaine (the active ingredient contained in Xylocaine HCl) may cause unwanted side effects that 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 lidocaine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common
  • Nausea
  • vomiting

For Healthcare Professionals

Applies to lidocaine: compounding powder, injectable solution

General

The overall incidence of adverse side effects of lidocaine (the active ingredient contained in Xylocaine HCl) 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.

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

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 (the active ingredient contained in Xylocaine HCl) 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.

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.

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 (the active ingredient contained in Xylocaine HCl) have been reported. Transient neurologic symptoms have been reported following intrathecal lidocaine.

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.

Gastrointestinal

Nausea and vomiting are common gastrointestinal symptoms of lidocaine (the active ingredient contained in Xylocaine HCl) toxicity.

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 (the active ingredient contained in Xylocaine HCl)

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.

Psychiatric

Psychiatric reactions have been associated with lidocaine (the active ingredient contained in Xylocaine HCl) 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.

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.

Hematologic

Hematologic abnormalities associated with lidocaine (the active ingredient contained in Xylocaine HCl) 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.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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