Dangerous Drug: Lidocaine Hydrochloride(lye’ doe kane)
Lidocaine HCl in 5% Dextrose Lidocaine HCl Without Preservatives
Antiarrhythmic preparations: Xylocaine HCl IV for Cardiac Arrhythmias
Local anesthetic preparations: Octocaine, Xylocaine HCl (injectable)
Topical for mucous membranes: Anestacon, Burn-O-Jel, Xylocaine, Zilactin-L
Topical Dermatologic: Numby Stuff, Regenecare, Solarcaine, Xylocaine
Transdermal: Lidoderm
PREGNANCY CATEGORY B
Drug Classes
Antiarrhythmic
Local anesthetic
Therapeutic Actions
Type 1b antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.
Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.
Indications
As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit)
As alternative to amiodarone to treat ventricular fibrillation or tachycardia with cardiac arrest
As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes
As local analgesia for pain associated with post-herpetic neuralgia
Contraindications and Cautions
Contraindicated with allergy to lidocaine or amide-type local anesthetics, heart failure, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Stokes-Adams syndrome, Wolff-Parkinson-White syndrome.
Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.
Available Forms
Direct injection—10, 20 mg/mL; IV injection (admixture)—5, 10, 15, 20, 40, 100 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%; topical ointment—5%; topical cream—0.5%, 3%, 4%; topical gel—0.5%, 2%, 2.5%, 4%, 5%; topical spray—0.5%, 10%; topical solution—2%, 4%; transdermal system—5%; topical lotion—3%
Dosages
Adults
IM
IV bolus
Arrhythmia: Use only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 25–50 mg/min. Give second bolus dose after 5 min if needed. Do not exceed 200–300 mg in 1 hr.
IV, continuous infusion
Arrhythmia: Give 1–4 mg/min (or 20–50 mcg/kg/min). Titrate the dose down as soon as the cardiac rhythm stabilizes. Use lower doses in patients with heart failure, liver disease, and in patients older than 70 yr.
Topical, intratissue, epidural
Local anesthesia: Preparations containing preservatives should not be used for spinal or epidural anesthesia. Drug concentration and diluent should be appropriate to particular local anesthetic use: 5% solution with glucose is used for spinal anesthesia, 1.5% solution with dextrose for low spinal or “saddle block” anesthesia. Dosage varies with the area to be anesthetized and the reason for the anesthesia; use the lowest dose possible to achieve results.
Topical analgesia
Transdermal: Apply up to 3 patches to area of pain for up to 12 hr within 24 hr.
Cream, ointment, gel, solution, oral patch, spray: Apply as directed 1–3 times per day.
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