lidocaine (Rx)

Brand and Other Names:Lidocaine CV, Lidopen
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Dosing & Uses

AdultPediatric

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

Endoracheal (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

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Interactions

Interaction Checker

and lidocaine

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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
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            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
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            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.

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            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%)

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            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

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.