Dosing & Uses
Dosage Forms & Strengths
Percutaneous: 1-60 mL of 0.5-1% solution (5-300 mg total dose)
IV regional: 10-60 mL of 0.5% solution (50-300 mg total dose)
Peripheral Nerve Blocks
Brachial: 15-20 mL of 1.5% solution (225-300 mg total dose)
Dental: 1-5 mL of 2% solution (20-100 mg total dose)
Intercostal: 3 mL of 1% solution (30 mg total dose)
Paravertebral: 3-5 mL of 1% solution (30-50 mg total dose)
Pudendeal (each side): 10 mL of 1% solution (100 mg total dose)
Paracervical obstetrical analgesia (each side): 10 mL of 1% solution (100 mg total dose)
Sympathetic Nerve Blocks
Cervical (stellate ganglion): 5 mL of 1% solution (50 mg total dose)
Lumbar: 5-10 mL of 1% solution (50-100 mg total dose)
Central Neural Blocks/Epidural
General: 2-3 mL/dermatome for anesthesia
Thoracic: 20-30 mL of 1% solution (200-300 mg total dose)
Lumbar analgesia: 25-30 mL of 1% solution (250-300 mg total dose)
Lumbar anesthesia: 15-20 mL of 1.5% solution (225-300 mg), or 10-15 mL of 2% solution (200-300 mg total dose)
Use preservative-free preparations for spinal or epidural anesthesia
May be buffered 9:1 with sodium bicarbonate, to reduce pain on injection (e.g. remove 2 mL of 1% lidocaine from 20 mL vial, and add 2 mL of sodium bicarbonate solution to vial)
Frequency Not Defined
Sensations of heat, cold, or numbness
Visual disturbances including blurred or double vision
Muscle twitching/ tremors
- pain IM injection site
- IM injection increases serum creatine kinase
Hypersensitivity to drug or amide type anesthetic
Some formulations may contain sulfites
History of malignant hyperthermia
DO NOT use solutions containing epinephrine in distal areas of body (eg, digit, nose, ear) because of vasoconstrictive effects; addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Significant systemic absorption reported when administered to mucosal surfaces and open wounds
Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)
Use with caution in hepatic impairment (ability to metabolize diminishes)
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Excreted in breast milk; use caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction
Half-life: 7-30 min (initial); 1.5-2 hr (terminal)
Vd: 0.7-2.7 L/kg (patch)
Peak plasma concentration: 1-5 mcg/mL
Protein Bound: 60-80%
Metabolites: Monoethylglycinexylidide (MEGX), glycinexylidide (GX)
Excretion: Urine (primarily)
Additive: amphotericin B, dacarbazine, methohexital, phenytoin
Y-site: amphotericin B cholesteryl SO4, thiopental
Standard diluent: 2 g/250 mL D5W
Use microdrip (60 drops/mL) or infusion pump to administer an accurate dose
Local thrombophlebitis may occur in pts receiving prolonged IV infusions
Add 1 g of drug (using 25mLl of 4% or 5 mL of 20 % inj) to 1 L of D5W inj to provide a solution containing 1 mg/mL
Injection is stable at room temperature
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.