Lidocaine

Indications
 Intravenous
Pulseless ventricular fibrillation or ventricular tachycardia
Adult: As hydrochloride: 1-1.5 mg/kg repeated as necessary. Max total: 3 mg/kg. For ventricular arrhythmias in more stable patients: Usual loading dose: 50-100 mg as an IV inj at 25-50 mg/minute, may repeat once or twice up to a max of 200-300 mg in 1 hr, followed by 1-4 mg/minute via continuous IV infusion. May need to reduce dose if the infusion is longer than 24 hr.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Parenteral
Sympathetic nerve block
Adult: As hydrochloride: 50 mg (5 ml) of a 1% solution for cervical block or 50-100 mg (5-10 ml) of a 1% solution for lumbar block.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Epidural
Epidural anaesthesia
Adult: As hydrochloride: 2-3 ml solution administered for each dermatome to be anaesthesized. Recommended doses are: lumbar epidural 250-300 mg (25-30 ml of a 1% solution) for analgesia and 225-300 mg (15-20 ml of a 1.5% solution) or 200-300 mg (10-15 ml of a 2% solution) for anaesthesia; for thoracic epidural: 200-300 mg of a 1% solution. For obstetric caudal analgesia, up to 300 mg (30 ml of a 0.5% or 1% solution); for surgical caudal analgesia: 225-300 mg (15-20 ml of a 1.5% solution). For continuous epidural anaesthesia, not to repeat max doses more frequently than 1.5 hrly.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Intraspinal
Spinal anaesthesia
Adult: As hyperbaric solution of 1.5% or 5% lidocaine in 7.5% glucose solution. Normal vaginal delivery: 50 mg (1 ml) of a 5% solution or 9-15 mg (0.6-1 ml) of a 1.5% solution. Caesarian operation: Up to 75 mg (1.5 ml) of a 5% solution. Other surgical procedures: 75-100 mg (1.5-2 ml).
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Intravenous
Intravenous regional anaesthesia
Adult: 50-300 mg (10-60 ml) of a 0.5% solution without adrenaline; max dose: 4 mg/kg.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Urethral
Surface anaesthesia
Adult: As 2% gel: Female: 60-100 mg inserted into the urethra several minutes before examination. Male: 100-200 mg before catheterisation and 600 mg before sounding or cystoscopy.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Intramuscular
Emergency treatment of ventricular arrhythmias
Adult: As hydrochloride: 300 mg injected into the deltoid muscle, repeat after 60-90 minutes if necessary.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Parenteral
Percutaneous infiltration anaesthesia
Adult: As hydrochloride: 5-300 mg (1-60 ml of a 0.5% solution or 0.5-30 ml of a 1% solution).
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Parenteral
Peripheral nerve block
Adult: As hydrochloride: For brachial plexus block: 225-300 mg (15-20 ml) of a 1.5% solution; for intercostal nerve block: 30 mg (3 ml) of a 1% solution; for paracervical block: 100 mg (10 ml) of a 1% solution on each side, repeated not more frequently than every 90 minutes; for paravertebral block: 30-50 mg (3-5 ml) of a 1% solution; for pudendal block: 100 mg (10 ml) as a 1% solution on each side; for retrobulbar block: 120-200 mg (3-5 ml) of a 4% solution.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Injection
Pupil dilatation during phacoemulsification cataract surgery
Adult: As a 1% ophthalmic preservative-free solution (often used in combination with phenylephrine and cyclopentolate). To be injected into the anterior chamber of the eye at the beginning of the procedure.
Mouth/Throat
Surface anaesthesia
Adult: For pain: 300 mg (15 ml) of 2% solution rinsed and ejected for mouth and throat pain; or gargled and swallowed if necessary for pharyngeal pain. Not to be used more frequently than every 3 hr. Max (topical oral solution): 2.4 g/day. Before bronchoscopy, bronchography, laryngoscopy, oesophagoscopy, endotracheal intubation, and biopsy in the mouth and throat: 40-300 mg (1-7.5 ml) of 4% solution. For dentistry and otorhinolaryngology procedures: 10-50 mg of 10% solution sprayed to mucous membrane. For laryngotracheal anaesthesia: 160 mg of 4% solution sprayed or instilled as a single dose into the lumen of the larynx and trachea.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Ophthalmic
Surface anaesthesia
Adult: As hydrochloride 4 % with fluorescein: 1 or more drops as required.
Child: As hydrochloride 4 % with fluorescein : As directed by physician.
Topical/Cutaneous
Surface anaesthesia
Adult: As eutectic mixture containing lidocaine base 2.5% and prilocaine base 2.5%: Apply cream to skin under an occlusive dressing before procedure. Use without an occlusive dressing for genital warts.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Rectal
Haemorrhoids
Adult: Apply topically to clean, dry area or using applicator, insert rectally, up to 6 times/day.
Child: ≥12 yr: Apply topically to clean, dry area or using applicator, insert rectally, up to 6 times/day.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.
Rectal
Perianal pain and itching
Adult: Apply topically to clean, dry area or using applicator, insert rectally, up to 6 times/day.
Child: ≥12 yr: Apply topically to clean, dry area or using applicator, insert rectally, up to 6 times/day.
Hepatic impairment: Reduce dose by 50% in acute hepatitis and decompensated cirrhosis.

Special Populations: Reduce dose in children, elderly and in debilitated patients.

Reconstitution: Standard diluent: 2 g/250 ml dextrose 5%.
Incompatibility: Y-site incompatibility: Amphotericin B cholesteryl sulfate complex, thiopental. Syringe incompatibility: Cefazolin. Admixture incompatibility: Phenytoin, amphotericin B, dacarbazine, methohexital.
Contraindications
 Hypovolaemia; heart block or other conduction disturbances.
Warnings / Precautions
 Hepatic or renal impairment; CHF and following cardiac surgery; bradycardia; respiratory depression; porphyria; elderly or debilitated patients; pregnancy.
Adverse Reactions
 Dizziness, paraesthesia, drowsiness, confusion, respiratory depression and convulsions.
Potentially Fatal: Hypotension and bradycardia leading to cardiac arrest; anaphylaxis.
Overdose Reactions
 Severe hypotension, asystole, bradycardia, apnoea, seizures, coma, cardiac arrest, respiratory arrest, and death.
Drug Interactions
 Additive cardiac effects with IV phenytoin. Effects antagonized by hypokalaemia caused by acetazolamide, loop diuretics and thiazides. Dose requirements may be increased with long-term use of phenytoin and other enzyme-inducers.
Potentially Fatal: Cimetidine and propranolol increase plasma concentration and toxicity. Increased risk of myocardial depression with beta blockers and other antiarrhythmics.
See Below for More lidocaine Drug Interactions
Lab Interactions
 IM admin of lidocaine increases creatine phosphokinase levels interfering with diagnosis of MI.
Food Interactions
 Decreased levels with St John's wort.
Mechanism of Actions
 Lidocaine is an amide type local anaesthetic. It stabilises the neuronal membrane and inhibits sodium ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces phase 4 depolarisation and automaticity. Duration of action potential and effective refractory period are also reduced.
Onset: 45-90 sec.
Duration: 10-20 min.
Absorption: Readily absorbed from the GI tract, mucous membranes, damaged skin, inj sites, including muscle; poor through intact skin.
Distribution: Crosses the placenta, blood-brain barrier and enters breast milk. Protein-binding: 66% (α1-acid glycoprotein).
Metabolism: 90% hepatic; converted to monoethylglycinexylidide and glycinexylidide. First-pass metabolism is extensive, bioavailability after oral dose is approx 35%.
Excretion: Via urine (<10% unchanged). Elimination half-life: biphasic; initial: 7-30 min; terminal: 1.5-2 hr (adults), 3.2 hr (infants, premature infants).
Storage Conditions
 Epidural: Stable at room temperature. Intramuscular: Stable at room temperature. Intraspinal: Stable at room temperature. Intravenous: Stable at room temperature. Mouth/Throat: Stable at room temperature. Ophthalmic: Store at 15-25°C. Protect from light. Discard after use. Parenteral: Stable at room temperature. Rectal: Stable at room temperature. Topical/Cutaneous: Stable at room temperature. Urethral: Stable at room temperature.
ATC Classification
 C01BB01 - lidocaine ; Belongs to class Ib antiarrhythmics.
C05AD01 - lidocaine ; Belongs to the class of local anesthetics. Used in the topical treatment of hemorrhoids and anal fissures.
D04AB01 - lidocaine ; Belongs to the class of topical anesthetics used in the treatment of pruritus.
N01BB02 - lidocaine ; Belongs to the class of amides. Used as local anesthetics.
R02AD02 - lidocaine ; Belongs to the class of local anesthetics used in throat preparations.
S01HA07 - lidocaine ; Belongs to the class of local ophthalmologic anesthetics.
S02DA01 - lidocaine ; Belongs to the class of analgesic and anesthetic agents used as otologicals.
Storage
 Epidural: Stable at room temperature. Intramuscular: Stable at room temperature. Intraspinal: Stable at room temperature. Intravenous: Stable at room temperature. Mouth/Throat: Stable at room temperature. Ophthalmic: Store at 15-25°C. Protect from light. Discard after use. Parenteral: Stable at room temperature. Rectal: Stable at room temperature. Topical/Cutaneous: Stable at room temperature. Urethral: Stable at room temperature.
Available As
  • Lidocaine 0.70% w/w
  • Lidocaine 1%
  • Lidocaine 10 mg
  • Lidocaine 100 mg
  • Lidocaine 15% w/w
  • Lidocaine 2%
  • Lidocaine 2% w/v
  • Lidocaine 2% w/w
  • Lidocaine 2.000% w/v
  • Lidocaine 2.5%
  • Lidocaine 2.5% w/w
  • Lidocaine 20 mg
  • Lidocaine 21.3 mg
  • Lidocaine 25 mg
  • Lidocaine 3%
  • Lidocaine 3% w/w
  • Lidocaine 4%
  • Lidocaine 5% w/w

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