Dosing & Uses
Dosage Forms & Strengths
infusion solution in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
- 800mg/100mL
injectable solution
- 10mg/mL
- 20mg/mL
Ventricular Arrhythmias or Pulseless Ventricular Tachycardia (after defibrillation, attempts, CPR, and vasopressor administration)
1-1.5 mg/kg slow IV bolus over 2-3 minutes
May repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total if refractory VF or pulseless VT
Continuous infusion: 1-4 mg/min IV after return of perfusion
Administer 0.5 mg/kg bolus and reassess infusion if arrhythmia reappears during constant infusion
If IV not feasible may use IO/ET
Endotracheal (loading dose): 2-3.75 mg/kg (2 to 2.5 recommended IV dose); dilute in 5-10 mL 0.9% saline or sterile water
Monitor: ECG
Hemodynamically Stable Monomorphic Ventricular Tachycardia
1-1.5 mg/kg; repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total; follow with 1-4 mg/min continuous infusion
Other Indications & Uses
Acute management of ventricular arrhythmias (cardiac surgery, acute MI)
Off-label: Peds with premature ventricular beats during cardiac arrest
IM dose indicated when IV admin is not possible or when ECG monitoring is not available and danger of ventricular arrhythmia is great
Dosage Forms & Strengths
infusion solution in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
- 800mg/100mL
injectable solution
- 10mg/mL
- 20mg/mL
Ventricular Arrhythmias
Bolus: 0.5-1 mg/kg IV/IO/ET, not to exceed 100 mg; follow with continuous infusion; if delay between bolus and start of infusion is >15 minutes, administer a second bolus q5-10min to 5 mg/kg, THEN
Continuous infusion: 20-50 mcg/kg/min IV
Monitor ECG
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (5)
- bupivacaine liposome
lidocaine increases toxicity of bupivacaine liposome by Other (see comment). Contraindicated. Comment: Do not admix with other local nonbupivacaine-based local anesthetics; admixing results in a rapid increase in free (unencapsulated) bupivacaine; may administer after waiting at least 20 minutes following local administration of lidocaine.
- dofetilide
lidocaine increases effects of dofetilide by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- eliglustat
lidocaine increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.
- flibanserin
lidocaine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.
- lomitapide
lidocaine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.
Serious - Use Alternative (22)
- abametapir
abametapir will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.
- axitinib
lidocaine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .
- bosutinib
lidocaine increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cobimetinib
lidocaine will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).
- eliglustat
lidocaine increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .
- fentanyl
lidocaine will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
- fentanyl intranasal
lidocaine will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
- fentanyl transdermal
lidocaine will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
- fentanyl transmucosal
lidocaine will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
- fluvoxamine
fluvoxamine and lidocaine both increase serotonin levels. Avoid or Use Alternate Drug.
- fosamprenavir
fosamprenavir increases levels of lidocaine by unspecified interaction mechanism. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.
- ivabradine
lidocaine will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.
- ivosidenib
ivosidenib will decrease the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.
- lonafarnib
lidocaine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.
- mefloquine
mefloquine increases toxicity of lidocaine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- naloxegol
lidocaine will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay
- olaparib
lidocaine will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.
- pefloxacin
pefloxacin will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.
- phenytoin
phenytoin decreases levels of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- pimozide
lidocaine, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.
- pomalidomide
lidocaine increases levels of pomalidomide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.
Monitor Closely (76)
- amiodarone
amiodarone increases levels of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Higher doses of amiodarone (ie, 600 mg BID) were shown to significantly increase lidocaine levels.
- amobarbital
amobarbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- armodafinil
armodafinil will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- atogepant
lidocaine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- avapritinib
lidocaine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- bosutinib
bosutinib increases levels of lidocaine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- brexpiprazole
lidocaine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
lidocaine will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor. - butabarbital
butabarbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- butalbital
butalbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- cabozantinib
lidocaine will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cannabidiol
cannabidiol, lidocaine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.
- carbamazepine
carbamazepine will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- cigarette smoking
cigarette smoking will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- cimetidine
cimetidine will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Lidocaine plasma levels may be elevated, increasing the risk of toxicity. Monitor cardiac function and symptoms of toxicity.
- cobicistat
cobicistat will increase the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with antiarrhythmics.
- darunavir
darunavir increases levels of lidocaine by decreasing metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with antiarrhythmics.
- disopyramide
disopyramide, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of arrhythmia, heart failure in predisposed pts.
- duvelisib
duvelisib will increase the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- eliglustat
eliglustat increases levels of lidocaine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, lidocaine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- erythromycin base
erythromycin base will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- fexinidazole
fexinidazole will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- finerenone
lidocaine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- fostamatinib
fostamatinib will increase the level or effect of lidocaine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of lidocaine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- hawthorn
hawthorn increases effects of lidocaine by pharmacodynamic synergism. Use Caution/Monitor.
- hyaluronidase
hyaluronidase, lidocaine. Other (see comment). Use Caution/Monitor. Comment: Hyaluronidase hastens the onset of local analgesia and reduces swelling, but increases systemic absorption of anesthetic. This decreases the duration of action and increases incidence of systemic reaction.
- isavuconazonium sulfate
lidocaine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoniazid
isoniazid will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- ivacaftor
ivacaftor increases levels of lidocaine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
ivacaftor increases effects of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - lemborexant
lidocaine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
- letermovir
letermovir increases levels of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lomitapide
lomitapide increases levels of lidocaine by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.
- mefloquine
lidocaine will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- mexiletine
mexiletine will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- midazolam intranasal
lidocaine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
- modafinil
modafinil will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- nadolol
nadolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
nadolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol). - nevirapine
nevirapine will decrease the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nirmatrelvir
nirmatrelvir will increase the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution warranted. Monitor lidocaine therapeutic concentrations if available.
- nirmatrelvir/ritonavir
nirmatrelvir/ritonavir will increase the level or effect of lidocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution warranted. Monitor lidocaine therapeutic concentrations if available.
- oliceridine
lidocaine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of lidocaine by decreasing metabolism. Modify Therapy/Monitor Closely. Caution is warranted and therapeutic concentration monitoring (if available) is recommended for antiarrhythmics when coadministered with Viekira Pak
- palbociclib
lidocaine will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- peginterferon alfa 2a
peginterferon alfa 2a will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- pentobarbital
pentobarbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- phenobarbital
phenobarbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- pindolol
pindolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
pindolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol). - pipemidic acid
pipemidic acid will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- ponatinib
ponatinib increases levels of lidocaine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- primidone
primidone will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- procainamide
lidocaine, procainamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Either suppresses myocardial conduction by increasing electrical stimulation threshold of the ventricle and His-Purkinje fibers.
- propranolol
propranolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
propranolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol). - rifampin
rifampin will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- rucaparib
rucaparib will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.
- ruxolitinib
lidocaine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ruxolitinib topical
lidocaine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- secobarbital
secobarbital will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- sevelamer
sevelamer decreases levels of lidocaine by increasing elimination. Use Caution/Monitor.
- smoking
smoking will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- sonidegib
lidocaine will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.
- stiripentol
stiripentol, lidocaine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.
- suvorexant
lidocaine will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors
- tamsulosin
lidocaine increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.
lidocaine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - tazemetostat
lidocaine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- timolol
timolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).
timolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol). - tinidazole
lidocaine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tobacco use
tobacco use will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- tofacitinib
lidocaine increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.
- verapamil
verapamil will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
- zileuton
zileuton will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
Minor (27)
- alfentanil
lidocaine increases toxicity of alfentanil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- belladonna and opium
lidocaine increases toxicity of belladonna and opium by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- buprenorphine
lidocaine increases toxicity of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- buprenorphine buccal
lidocaine increases toxicity of buprenorphine buccal by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- butorphanol
lidocaine increases toxicity of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- codeine
lidocaine increases toxicity of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- dextromoramide
lidocaine increases toxicity of dextromoramide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- diamorphine
lidocaine increases toxicity of diamorphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- difenoxin hcl
lidocaine increases toxicity of difenoxin hcl by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- diphenoxylate hcl
lidocaine increases toxicity of diphenoxylate hcl by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- dipipanone
lidocaine increases toxicity of dipipanone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- hydromorphone
lidocaine increases toxicity of hydromorphone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- levorphanol
lidocaine increases toxicity of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- lily of the valley
lidocaine, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- meperidine
lidocaine increases toxicity of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- methadone
lidocaine increases toxicity of methadone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- morphine
lidocaine increases toxicity of morphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- nalbuphine
lidocaine increases toxicity of nalbuphine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- omeprazole
omeprazole will decrease the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.
- opium tincture
lidocaine increases toxicity of opium tincture by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- oxycodone
lidocaine increases toxicity of oxycodone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- oxymorphone
lidocaine increases toxicity of oxymorphone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- papaveretum
lidocaine increases toxicity of papaveretum by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- pentazocine
lidocaine increases toxicity of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- sufentanil
lidocaine increases toxicity of sufentanil by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- tapentadol
lidocaine increases toxicity of tapentadol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
- tramadol
lidocaine increases toxicity of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of increased CNS depression.
Adverse Effects
Frequency Not Defined
Common
- Cardiovascular: Hypotension
- Dermatologic: Edema, erythema at injection site, petechiae, skin irritation
- Gastrointestinal: Constipation, Nausea, vomiting
- Neurologic: Confusion, dizziness, headache, paresthesia, somnolence, tremor
- Other: Irritation symptom, Topical products; ie, erythema, edema
Serious
- Cardiovascular: Cardiac arrest, cardiac dysrhythmia
- Hematologic: Methemoglobinemia
- Neurologic: Seizure
- Anaphylactoid reactions
- Malignant hyperthermia
Warnings
Contraindications
Hypersensitivity to lidocaine or amide-type local anesthetic
Adams-Stokes syndrome, SA/AV/intraventricular heart block in the absence of artificial pacemaker
CHF, cardiogenic shock, 2nd and 3rd degree heart block (if no pacemaker is present), Wolff-Parkinson-White Syndrome
Cautions
Constant monitoring with an EKG is essential to the proper administration of lidocaine IV; discontinue immediately with signs of excessive depression of cardiac conductivity (eg, PR interval prolongation, QRS interval widening, arrhythmia exacerbation)
If malignant hyperthermia develops, discontinue administration immediately and institute therapeutic countermeasures as clinically indicated
Lidocaine hydrochloride should not be added to blood transfusion assemblies because of possibilities of pseudoagglutination or hemolysis
Not recommended as prophylaxis in acute MI (controversial)
Liver disease, CHF, bradycardia, Wolff-Parkinson-White syndrome, marked hypoxia, severe respiratory depression, hypovolemia, incomplete heart block
Use extreme caution in patients with severe hepatic impairment; may increase risk of lidocaine toxicity
Risk of lidocaine toxicity may increase in patients with pseudocholinesterase deficiency
Good for automatic and re-entrant arrhythmias, not PSVTs
Drug interaction overview
- Monitor toxicity when lidocaine is used with caution in patients with digitalis toxicity accompanied by supraventricular arrhythmia and/or atrioventricular block (see Contraindications)
- When lidocaine is administered with other antiarrhythmic drugs such as amiodarone, phenytoin, procainamide, propranolol or quinidine, the cardiac effects may be additive or antagonistic and toxic effects may be additive
- Coadministration of propranolol or cimetidine with lidocaine has been reported to reduce the clearance of lidocaine from the plasma and may result in toxic accumulation of drug
Pregnancy & Lactation
Pregnancy Category: B
Pregnancy
Reproduction studies have been performed in rats at doses up to five times maximum human dose and have revealed no significant findings; however, no adequate and well-controlled studies in pregnant women available; physicians should carefully consider potential risks and benefits for each specific patient before prescribing lidocaine hydrochloride; may cross the placental barrier
Lactation
Present in human milk; published studies have reported a range of lidocaine milk: plasma ratios between 0.4-1.1; limited data available on lidocaine’s effects on breastfed child have not revealed consistent pattern of associated adverse events; development and health benefits of breastfeeding should be considered along with mother’s clinical need for lidocaine and potential adverse effects on breastfed infant from lidocaine or from underlying maternal condition
Pregnancy Categories
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.Pharmacology
Mechanism of Action
Class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity
Absorption
Bioavailability: 35% (PO)
Onset: IV: 45-90 sec
Duration: 10-20 min
Distribution
Protein Bound: 60-80%
Vd: 1.7 L/kg
Metabolism
Liver by de-ethylation to form active metabolites
Metabolites (active): monoethylglycinexylidide (MEGX) and glycinexylidide (GX) (active met)
Elimination
Half-Life: 2.5-8 hr (parent drug), MEGX 2 hr and GX 10 hr (metabolites); half-life prolonged with CHF or liver disease
Clearance: less if CHF, shock, digoxin toxicity, geriatric
Excretion: Urine (90%)
Administration
IV Incompatibilities
Additive: methohexital, phenytoin
Syringe: ampicillin(?), cefazolin, ceftriaxone(?), Na bicarb(?)
Y-site: ampho B cholesteryl sulfate, thiopental
Not spec: diazepam, epinephrine
IV Compatibilities
Solution: compatible w/ most common solvents
Additive (partial list): aminophylline, amiodarone, CaCl2, Ca gluconate, cimetidine, ciprofloxacin, digoxin, diphenhydramine, dobutamine, dopamine, erythromycin, fentanyl(?), flumazenil, furosemide, heparin, hydrocortisone, hydroxyzine, nitroglycerin, pentobarbital, KCl, prochlorperazine, Na bicarb, verapamil, vit B/C
Syringe: caffeine citrate, clonidine/fentanyl, glycopyrrolate, heparin, hydroxyzine, ketamine/morphine sulfate, metoclopramide, milrinone, nalbuphine, Na bicarb(?)
Y-site (partial list): amiodarone, cefazolin, ciprofloxacin, diltiazem, dobutamine, dopamine, heparin, inamrinone, labetalol, linezolid, meperidine, morphine sulfate, nitroglycerin, KCl, propofol, vit B/C, warfarin
Not spec: carbenicillin, tetracycline
IV Preparation
Add 1-2 g of lidocaine hydrochloride to 1 L of D5W making 1-2 mg/mL solution; use (using 5-10 mL of 20% inj soln); may also use 400 mg/100 mL in D5W or 800 mg/100 mL in D5W
8 mg/mL concentrations have been recommended for fluid-restricted pts
IV Administration
IV injection or infusion
Do not administer 40 mg/ mL, 100 mg/mL, 200 mg/mL IV unless dilute first
Storage
Store intact vials & premixed infusion solutions at room temp
Protect from excess heat or freezing
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Lidoderm topical - | 5 % transdermal system |  | |
| AneCream5 topical - | 5 % cream |  | |
| AneCream5 topical - | 5 % cream |  | |
| RectiCare topical - | 5 % cream |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 4 % cream |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 4 % cream |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % cream |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 4 % transdermal system |  | |
| lidocaine topical - | 4 % transdermal system |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 4 % cream |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % ointment |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 5 % transdermal system |  | |
| lidocaine topical - | 4 % cream |  | |
| lidocaine topical - | 4 % cream |  | |
| Aspercreme (lidocaine) topical - | 4 % transdermal system |  | |
| Aspercreme (lidocaine) topical - | 4 % transdermal system |  | |
| Aspercreme (lidocaine) topical - | 4 % transdermal system |  | |
| Aspercreme (lidocaine) topical - | 4 % aerosol |  | |
| LMX 4 topical - | 4 % kit |  | |
| LMX 4 topical - | 4 % cream |  | |
| LMX 4 topical - | 4 % cream |  | |
| LMX 5 topical - | 5 % cream |  | |
| LMX 5 topical - | 5 % cream |  | |
| Anecream topical - | 4 % cream |  | |
| Anecream topical - | 4 % cream |  | |
| Anecream topical - | 4 % cream |  | |
| Anecream topical - | 4 % cream |  | |
| Lido King topical - | 4 % transdermal system |  | |
| ZTlido topical - | 1.8 % transdermal system |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
lidocaine topical
LIDOCAINE PATCH - TOPICAL
(LYE-doe-kane)
COMMON BRAND NAME(S): Lidoderm
USES: This product is used to help reduce itching and pain from certain skin conditions (such as scrapes, minor skin irritations, insect bites). It may also be used to help relieve nerve pain after shingles (infection with herpes zoster virus). Lidocaine belongs to a class of drugs known as local anesthetics. It works by causing a temporary loss of feeling in the area where you apply the patch.
HOW TO USE: If you are using the over-the-counter product to self-treat, read and follow all directions on the product package before using this medication. If you have any questions, consult your pharmacist. If your doctor has prescribed this medication, use it as directed.This product should only be applied to normal intact skin. Do not apply to skin that is broken or irritated. The dosage is based on your medical condition and response to treatment.Remove the protective liner and apply the patch to the skin area that is most painful. Apply the prescribed number of patches as directed by your doctor, usually once a day. Depending on your product, the patch may be left on the skin for up to 8 or 12 hours. Follow the instructions carefully. Do not apply more than 3 patches once a day or leave any patch on for longer than the stated time period. If a smaller patch is needed, it may be cut with scissors before the liner is removed. It is best to avoid getting the patch wet since it may not stick to the skin. Some brands may be wet in water for a short time (such as showering for10 minutes). Pat dry gently if you get the patch wet.Wash your hands well after each application. Avoid getting this medication in your eyes or mucous membranes (such as nose, mouth). If contact with the eyes accidentally occurs, wash your eyes right away with water and protect them until normal feeling returns.If your condition does not get better, or if it gets worse, or if you think you may have a serious medical problem, get medical help right away.Used patches still contain some medication. However, do not reuse them. Fold the used patch with the sticky sides together and discard it out of the reach of children and pets to prevent accidental swallowing or application.
SIDE EFFECTS: Redness, swelling, blisters, or changes in skin color at the site of application may occur. These effects usually disappear within a few minutes or hours. If any of these effects last or get worse, tell your doctor or pharmacist promptly.If irritation or a burning feeling occurs, remove the patch(es) and do not reapply until the irritation is gone.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: blurred vision, mental/mood changes (such as nervousness, confusion), drowsiness, dizziness, unusually slow heartbeat.Get medical help right away if you have any very serious side effects, including: pale/bluish/gray skin, unusual tiredness, shortness of breath, fast heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using lidocaine, tell your doctor or pharmacist if you are allergic to it; or to other local anesthetics; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, a certain blood disorder (methemoglobinemia).While wearing your patch, avoid exposing it to direct heat sources such as heating pads, electric blankets, heat lamps, saunas, hot tubs, heated waterbeds, or prolonged direct sunlight. Heat may cause more drug to be released into your body, increasing the chance of side effects.If you are going to have an MRI test, tell testing personnel that you are using this patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: This medication patch may be harmful if chewed or swallowed. If someone has overdosed, remove the patch if possible. For serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, seizures, slowed breathing, slow/fast/irregular heartbeat.
NOTES: Keep all regular medical and lab appointments.
MISSED DOSE: If you are using this product on a regular schedule and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature. Keep the patch sealed in its protective envelope until ready to use. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed (See How to Use section).
Information last revised October 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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.
