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Lidocaine Injection

Last Updated: March 14, 2018
Status: Current

Lidocaine Injection

Products Affected - Description
  • Xylocaine injection, Fresenius Kabi
    0.5%, 50 mL vial, 25 count (NDC 63323-0484-57)
    1%, 20 mL vial, 25 count (NDC 63323-0485-27)
    1%, 50 mL vial, 25 count (NDC 63323-0485-57)
    2%, 20 mL vial, 25 count (NDC 63323-0486-27)
    2%, 50 mL vial, 25 count (NDC 63323-0486-57)
     
    Xylocaine-MPF injection, Fresenius Kabi
    0.5%, 50 mL vial, 25 count (NDC 63323-0491-57)
    1%, 2 mL vial, 25 count (NDC 63323-0492-27)
    1%, 5 mL vial, 25 count (NDC 63323-0492-57)
    1%, 10 mL sterile-pack vial, 5 count (NDC 63323-0492-97)
    1%, 30 mL sterile-pack vial, 5 count (NDC 63323-0492-31)
    1.5%, 20 mL ampule, 5 count (NDC 63323-0493-91)
    2%, 2 mL vial, 25 count (NDC 63323-0495-27)
    2%, 5 mL vial, 25 count (NDC 63323-0495-07)
     
    Lidocaine Hydrochloride injection, AuroMedics
    1%, 2 mL ampule, 10 count (NDC 55150-0158-72)
    1%, 2 mL vial, 10 count (NDC 55150-0161-02)
    1%, 5 mL ampule, 10 count (NDC 55150-0159-74)
    1%, 5 mL vial, 10 count (NDC 55150-0162-05)
    1%, 30 mL vial, 1 count (NDC 55150-0163-30)
    2%, 2 mL ampule, 10 count (NDC 55150-0160-72)
    2%, 5 mL vial, 10 count (NDC 55150-0165-05)
     
    Lidocaine Hydrochloride injection, Fresenius Kabi
    1%, 10 mL vial, 25 count (NDC 63323-0201-10)
    2%, 5 mL Tear-top preservative-free vial, 25 count (NDC 63323-0208-05)
     
    Lidocaine Hydrochloride injection, Pfizer
    0.5%, 50 mL SD Tear Top preservative-free vial, 25 count (NDC 00409-4278-01)
    1%, 2 mL preservative-free glass ampule, 50 count (NDC 00409-4713-32)
    1%, 5 mL emergency Ansyr syringe, 10 count (NDC 00409-9137-05)
    1%, 5 mL LifeShield syringe, 10 count (NDC 00409-4904-34)
    1%, 5 mL preservative-free glass ampule, 50 count (NDC 00409-4713-02)
    1%, 20 mL vial, 25 count (NDC 00409-4276-01)
    1%, 30 mL preservative-free vial, 25 count (NDC 00409-4279-02)
    1%, 50 mL vial, 25 count (NDC 00409-4276-02)
    2%, 2 mL preservative-free glass ampule, 25 count, NDC 00409-4282-01)
    2%, 5 mL emergency Ansyr syringe, 10 count (NDC 00409-1323-05)
    2%, 5 mL LifeShield syringe, 10 count (NDC 00409-4903-34)
    2%, 5 mL preservative-free vial, 10 count (NDC 00409-2066-05)
    2%, 10 mL preservative-free glass ampule, 25 count (NDC 00409-4282-02)
    2%, 20 mL vial, 25 count (NDC 00409-4277-01)
    2%, 50 mL vial, 25 count, NDC 00409-4277-02)
    4%, 5 mL preservative-free glass ampule, 25 count (NDC 00409-4283-01)
     
    Lidocaine Hydrochloride injection, West-Ward
    1%, 5 mL preservative-free vial, 25 count (NDC 00143-9595-25)
    1%, 50 mL vial, 10 count (NDC 00143-9577-10)
    2%, 5 mL preservative-free vial, 25 count (NDC 00143-9594-25)
    2%, 50 mL vial, 10 count (NDC 00143-9575-10)
Reason for the Shortage
    • Amphastar had lidocaine 2% emergency syringes on shortage due to increase demand for the product.
    • AuroMedics introduced lidocaine injection in February 2014.
    • Fresenius Kabi had generic lidocaine presentations on shortage due to a supply interruption of raw ingredients.
    • Pfizer has lidocaine presentations on shortage due to manufacturing delays.
       
Available Products
  • Xylocaine injection, Fresenius Kabi

2%, 10 mL vial, 25 count (NDC 63323-0486-17)
 
Xylocaine-MPF injection, Fresenius Kabi
1%, 30 mL vial, 25 count (NDC 63323-0492-37)
1.5%, 10 mL ampule, 5 count (NDC 63323-0493-97)
2%, 10 mL ampule, 5 count (NDC 63323-0496-97)
 
Lidocaine Hydrochloride injection, Amphastar
2%, 5 mL Luer-Jet Emergency syringe, 10 count (NDC 76329-3390-01)
 
Lidocaine Hydrochloride injection, AuroMedics
2%, 2 mL vial, 10 count (NDC 55150-0164-02)
 
Lidocaine Hydrochloride injection, Fresenius Kabi
1%, 2 mL vial, 25 count (NDC 63323-0201-02)
2%, 2 mL vial, 25 count (NDC 63323-0202-02)
 
Lidocaine Hydrochloride injection, Pfizer
0.5%, 50 mL SD Flip Top vial, 25 count (NDC 00409-4275-01)
1.5%, 20 mL preservative-free ampule, 25 count (NDC 00409-4776-01)

Estimated Resupply Dates

    • AuroMedics has 1% lidocaine 2 mL and 5 mL ampules and 2mL, 5 mL, and 30 mL vials on intermittent back order and the company is releasing product as it becomes available. AuroMedics has 2% lidocaine 2mL ampules and 5 mL vials on intermittent back order and the company is releasing product as it becomes available.
    • Fresenius Kabi has 0.5% Xylocaine and 0.5% Xylocaine-MPF 50 mL vials on back order and the company estimates a release date of mid-April 2018 for the 0.5% Xylocaine 50 mL vials and early-April 2018 for the 0.5% Xylocaine-MPF 50 mL vials. The 1% lidocaine 10 mL vials are on back order and the company estimates a release date of late-March 2018. The 1% Xylocaine 20 mL and 50 mL vials are on back order and the company estimates a release date of mid-March 2018. The 1% Xylocaine-MPF 2 mL vials and 5 mL vials are on back order and the company estimates a release date of late-March 2018 for the 2 mL vials and mid-March 2018 for the 5 mL vials. The 1% Xylocaine-MPF 10 mL vial and 30 mL vial sterile packs are on back order and the company cannot estimate a release date. The 1.5% Xylocaine-MPF 20 mL ampules are on back order and the company estimates a release date of late-March 2018. The 2% Xylocaine-MPF 2 mL and 5 mL vials are on back order and the company estimates a release date of mid-April 2018 for the 2 mL vials and mid- to late-March 2018 for the 5 mL vials. The 2% Xylocaine 20 mL and 50 mL vials are on back order and the company estimates a release date of late-March 2018 for the 20 mL vials and early-April 2018 for the 50 mL vials. The 2% lidocaine 5 mL preservative free vials are on back order and the company estimates a release date of late-March 2018.
    • Pfizer has 0.5% lidocaine 50 mL vials on back order and the company estimates a release date of March 2018. The 2 mL preservative-free ampules are on back order and the company estimates a release date of early-April 2018. The 1% lidocaine 5 mL preservative-free ampules are on back order and the company estimates a release date of June 2019. The 1% lidocaine 20 mL vials are on back order and the company estimates a release date of early-April 2018. The 1% lidocaine 30 mL preservative-free vials are on back order and the company estimates a release date of late-March 2018. The 1% lidocaine 50 mL vials are on back order and the company estimates a release date in June 2018. The 1% lidocaine 5 mL Ansyr syringes are on back order and the company estimates a release date of late-March 2018. The 2% lidocaine 2 mL preservative-free ampules are on back order and the company estimates a release date of September 2018. The 2% lidocaine 5 mL vials and 20 mL vials are on back order and the company estimates a release date of late-March 2018. The 2% lidocaine 50 mL vials are on back order and the company estimates a release date of early-May 2018. The 2% lidocaine 5 mL Lifeshield syringes and 5 mL Ansyr syringes are on back order and the company estimates a release date of early-April 2018. The 4% lidocaine 5 mL ampules are on back order and the company estimates a release date of early-April 2018.
    • West-Ward has 1% lidocaine 5 mL preservative-free vials and 2% lidocaine 5 mL preservative free vials on allocation. The 1% lidocaine 50 mL vials are on back order and the company estimates a release date of April to May 2018. The 2% lidocaine 50 mL vials are on back order and the company estimates a release date of late-March to early-April 2018.

Alternative Agents & Management

  • Bupivacaine and lidocaine are amide-type local anesthetics commonly used in clinical practice. The following table compares their pharmacodynamic and pharmacokinetic properties. Key differences between the products are onset of action, duration of action, and dose. In general, bupivacaine is a longer-acting local anesthetic, while lidocaine has a more rapid onset, but shorter duration of action.1-2

 
Table 1. Table. Comparison of Bupivacaine and lidocaine for Local Anesthesia1-6 

Property

Bupivacaine

Lidocaine

Onset of action

Infiltration: 2-10 min
Epidural: 4-7 min
Spinal: 1-15 min

Not well-defined for anesthetic use as a single agent.
In general local analgesia 1 to 3 min
Spinal and Epidural rapid onset

Duration of action:
As a single agent

Infiltration: 2-8 h
Nerve block, minor: 3-6 h
Epidural: 3-9 h
Spinal: 1.5-3.5 h

Infiltration: 0.5-2 h
Nerve block, minor: 1-2 h
Epidural: 100 min
Spinal: 0.5-2 h

Duration of action: Combined with epinephrine*

Infiltration: 3-4 h
Nerve block, minor: 4-7 h

Infiltration: 2 h
Nerve block, minor: 2-3 h

Maximum dose

Single injections up to 175 mg without epinephrine or 225 mg with epinephrine; may repeat up to once every 3 hours.
Maximum dosage: 400 mg/24 hours.

Maximum: 4.5 mg/kg/dose not to exceed 300 mg without epinephrine or 7mg/kg/dose not to exceed 500 mg with epinephrine; do not repeat within 2 hours.
Maximum dose for spinal anesthesia is 100 mg.

Protein Binding

82%-96%

60%-80%

Volume of distribution

~2.5 L/kg

1.5 + 0.6 L/kg

Half-life, terminal

Adults: 1.5-5 h
Neonates: 8.1 h

Adults: 1.5-2 h
Premature infants: 3.2 h

Metabolism

Undergoes N-dealkylation in the liver.

Extensive hepatic metabolism (90%) with active metabolites.

Elimination

Excreted in urine as metabolites and 5% as unchanged drug.

Excreted in urine as metabolites (90%) and unchanged drug (< 10 %).

*Duration of effect is prolonged by use of local anesthetics in combination with epinephrine, although magnitude of effect is not well-defined for all routes.

References

    1. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders;2015:1028-1054.e4.
    2. Drasner K. Local anesthetics. In: Miller RD, Pardo MC, ed. Basics of Anesthesia. 6th ed. Philadelphia, PA: Elsevier Saunders;2011:130-142.
    3. Drugdex system. Micromedex 2.0 [database online]. http://www.micromedexsolutions.com. Updated March 13, 2018. Greenwood Village, CO: Truven Health Analytics; Accessed March 13, 2018.
    4. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc; 2018.
    5. Lidocaine hydrochloride and epinephrine injection, solution [package insert]. Lake Forest, IL: Hospira Inc; 2017.
    6. McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH, eds. AHFS DI (Lexi-Comp Online). Bethesda, MD: American Society of Health-System Pharmacists; 2018.

Updated

Updated March 14, 2018 by Leslie Jensen, PharmD, Drug Information Specialist. Created June 23, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. Copyright 2018, Drug Information Service, University of Utah, Salt Lake City, UT.

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