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 |
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Lidocaine
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Lidocaine Containing Brands
Lidocaine is used in following diseases
Drug - Drug Interactions of Lidocaine
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