Lidocaine HCL

A to Z Drug Facts

(LIE-doe-cane HIGH-droe-KLOR-ide)

Anestacon, Burn-o-Jel, Dentipatch, DermaFlex, Dilocaine, DuoTrach Kit, ELA-Max, Lidocaine HCl for Cardiac Arrhythmias, Lidocaine HCl in 5% Dextrose, Lidoject-1, Lidoject-2, LidoPen Auto-Injector, Nervocaine, Nulicaine, Numby Stuff, Octocaine, Solarcaine Aloe Extra Burn Relief, Xylocaine, Xylocaine 10% Oral, Xylocaine Viscous, Xylocaine HCl, Xylocaine HCl IV for Cardiac Arrhythmias, Xylocaine MPF, Zilactin-L,  Lidodan Ointment, PMS-Lidocaine Viscous, Xylocaine Endotracheal, Xylocaine 4% Sterile Solution, Xylocaine Jelly 2%, Xylocaine Ointment/Dental Ointment 5%, Xylocaine Parenteral without Epinephrine, Xylocaine Topical 4%, Xylocaine Viscous 2%, Xylocard

Class: Antiarrhythmic/local anesthetic

 Action Attenuates phase 4 diastolic depolarization, decreases automaticity, decreases action potential duration and raises ventricular fibrillation threshold; inhibits conduction of nerve impulses from sensory nerves.

 Indications Acute management of ventricular arrhythmias; topical anesthesia in local skin disorders; local anesthesia of accessible mucous membranes. Unlabeled use(s): Intraosseous or endotracheal administration to pediatric patients with cardiac arrest.

 Contraindications Hypersensitivity to amide local anesthetics; Stokes-Adams syndrome; Wolff-Parkinson-White syndrome; severe degrees of sinoatrial, atrioventricular (AV) or intraventricular block in absence of pacemaker; ophthalmic use.

 Route/Dosage

ADULTS: IM 300 mg. May be repeated after 60 to 90 min. IV Bolus 50 to 100 mg at rate of 25 to 50 mg/min; may repeat, but do not exceed 200 to 300 mg/hr. Continuous infusion: 1 to 4 mg/min. Patch Apply patch and allow to remain in place until the desired anesthetic effect is produced for £ 15 minutes. The lowest dosage for effectiveness should be used. CHILDREN: IV bolus/intratracheal 1 mg/kg/dose q 5 to 10 min (maximum dose: 5 mg/kg). Maintenance: 20 to 50 mcg/kg/min. Topical Apply as needed to affected area; use lowest dose possible when applying to mucous membranes.

 Interactions

Beta-adrenergic blockers: Increased lidocaine levels. Cimetidine: Decreased lidocaine clearance. Class I antiarrhythmic agents (eg, tocainide, mexiletine): Toxic effects are additive and potentially synergistic. Procainamide: Additive neurological and cardiac effects. Succinylcholine: Prolongation of neuromuscular blockade. INCOMPATABILITIES: Amphotericin B, parenteral cephalosporins, doxycycline, epinephrine, isoproterenol, methohexital, nitroprusside, norepinephrine, phenytoin, sodium bicarbonate, sulfadiazine.

 Lab Test Interferences IM administration may increase CPK levels.

 Adverse Reactions

CV: Hypotension; bradycardia; cardiovascular collapse; cardiac arrest. CNS: Dizziness; lightheadedness; nervousness; drowsiness; apprehension; confusion; mood changes; hallucinations; tremors. EENT: Visual disturbances; diplopia; tinnitus. GI: Nausea; vomiting. RESP: Respiratory depression or arrest. OTHER: Hypersensitivity reactions. Local reactions, including soreness at IM injection site; venous thrombosis or phlebitis; extravasation; burning, stinging, sloughing, tenderness (with topical application). Difficulty in speaking, breathing and swallowing; numbness of lips or tongue and other paresthesias, including heat and cold.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. If used, reduce dose. IM autoinjector device not recommended in children < 50 kg. Cardiac effects: Use with caution and in lower doses in patients with CHF, reduced cardiac output, digitalis toxicity and in elderly. Hypersensitivity reactions: May occur. IV use: IV use: May result in excessive depression of cardiac conductivity. Malignant hyperthermia: Has been reported with administration of amide local anesthetics. Methemoglobinemia: Do not use in patients with congenital oridiopathic methemoglobinemia or in infants < 12 months of age who are receiving methemoglobin-inducing drugs. Oral use: May impair swallowing and enhance danger of aspiration; avoid food for 1 hr if used in mouth or throat. Renal or hepatic impairment: Use caution with repeated doses or prolonged use in patients with renal or hepatic impairment. Topical use: Systemic effects can occur following topical use; use lowest possible dose to avoid serious toxicity, shock or heart block.

 Administration/Storage

IM

• Use IM route for emergency situations (eg, no IV access, no ECG monitoring) only. Use 10% solution, only, for injection. Deltoid muscle is preferred IM site. Switch to IV route as soon as possible.

IV

• When giving by IV route, use only 1 to 2% solutions of drug. Use only lidocaine specifically labeled for IV use (without preservatives or epinephrine). Do not administer with other agents.
• To initiate IV therapy, start IV of 5% Dextrose in Water at “keep vein open (KVO)” rate. Bolus loading dose of 50 to 100 mg may be given undiluted at rate of 25 to 50 mg/min. IV push is indicated for resuscitation situations.
• For continuous infusion, use prediluted solution or add 1 g of lidocaine to 500 mL of 5% Dextrose in Water to prepare 0.2% solution. Rate of administration should not exceed 1 to 4 mg/min. Adjust rate according to cardiac response.
• Use diluted solutions within 24 hr.
• When giving by topical route, apply thinly and to smallest area possible. Do not apply to abraded or otherwise injured areas of skin.
• Store all forms of drug at room temperature.
• For IV infusion, use microdropper and infusion pump or controller.

Patch

• Gently dry the area of application with cotton gauze. Remove the clear protective liner and apply the patch.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note renal, cardiac or hepatic impairment and hypersensitivity to amide-type local anesthetics.
• Obtain baseline BP and ECG before administration.
• Monitor BP, ECG and respirations during IV administration. Continuous ECG monitoring is essential for proper administration. Have resuscitative equipment and medication immediately available.
• Monitor serum levels of drug if given via IV for more than 24 hr. Therapeutic serum levels range from 1.5 to 6 mcg/mL; toxic levels are > 6 to 10 mcg/mL.
• If serious adverse reactions occur, notify physician, but continue 5% dextrose IV. Continue to monitor patient closely.
• Keep bolus dose of 100 mcg of lidocaine available at all times.
• For topical use, apply thinly and to smallest area possible. Do not apply to abraded or otherwise injured areas of skin.
• Assess for systemic toxicity, which can result if excessive amounts of topical drug are absorbed. Risk of toxicity is greatest when large surface area, mucous membranes, and/or abraded or otherwise injured skin is involved.
• If topical preparation is used during labor and delivery, monitor vital signs and level of consciousness of newborn and mother.
• Monitor activity and position of patient postanesthesia, until senses of pain, pressure, and temperature return.
• Monitor I&O and voiding.
• When topical drug is applied to pharynx, maintain npo status until gag reflex returns. If tongue and oral mucosa are numb, do not permit patient to eat food or chew gum until sensation returns.

 Patient/Family Education

• Explain that adverse reactions related to central nervous system (eg, drowsiness, confusion, paresthesias, convulsions, respiratory arrest) can occur and are related to CNS toxicity.
• Emphasize importance of not allowing topical solution to come in contact with eyes or broken skin.
• Advise patient not to chew gum or eat food until 60 min after oral anesthetic has been administered.
• Advise patient that drug may cause dizziness or drowsiness and to avoid getting out of bed or walking without assistance.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
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