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

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

Next:

Interactions

Interaction Checker

and lidocaine

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            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.

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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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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            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 % ointment
            lidocaine topical
            -
            5 % ointment
            lidocaine topical
            -
            5 % cream
            lidocaine topical
            -
            5 % ointment
            lidocaine topical
            -
            5 % ointment
            lidocaine topical
            -
            5 % ointment
            lidocaine topical
            -
            5 % ointment
            lidocaine topical
            -
            4 % cream
            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
            -
            5 % transdermal system
            lidocaine topical
            -
            5 % ointment
            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
            -
            4 % cream
            lidocaine topical
            -
            5 % ointment
            Lidoderm topical
            -
            5 % transdermal system
            RectiCare topical
            -
            5 % cream
            AneCream5 topical
            -
            5 % cream
            AneCream5 topical
            -
            5 % cream
            ZTlido topical
            -
            1.8 % transdermal system
            Aspercreme (lidocaine) topical
            -
            4 % transdermal system
            Aspercreme (lidocaine) topical
            -
            4 % transdermal system
            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
            LMX 4 topical
            -
            4 % kit
            LMX 4 topical
            -
            4 % cream
            LMX 4 topical
            -
            4 % cream

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            lidocaine topical

            LIDOCAINE - TOPICAL

            (LYE-doe-kane)

            COMMON BRAND NAME(S): Lidamantle, Xylocaine

            USES: This medication is used on the skin to stop itching and pain from certain skin conditions (such as scrapes, minor burns, eczema, insect bites) and to treat minor discomfort and itching caused by hemorrhoids and certain other problems of the genital/anal area (such as anal fissures, itching around the vagina/rectum). Some forms of this medication are also used to decrease discomfort or pain during certain medical procedures/exams (such as sigmoidoscopy, cystoscopy). Lidocaine is a local anesthetic that works by causing temporary numbness/loss of feeling in the skin and mucous membranes.

            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.Before use on the skin, clean and dry the affected area as directed. Apply a thin layer of medication to the affected area of skin, usually 2 to 3 times a day or as directed.If you are using the spray, shake the canister well before using. While holding the canister 3-5 inches (8-13 centimeters) from the affected area, spray until wet. If the affected area is on the face, spray the medication onto your hand and apply to the face. Do not spray near your eyes, nose, or mouth.If you are using the foam, shake the canister well before using. Spray the foam onto your hand and apply to the affected area.Do not use on large areas of the body, cover the area with waterproof bandages or plastic, or apply heat unless directed to do so by your doctor. These may increase the risk of serious side effects.Wash hands immediately after use unless you are treating an area on the hands. Avoid getting the product in eyes, nose, or ears. If the medication gets in these areas, rinse the area immediately with clean water.The dosage is based on your medical condition and response to treatment. Do not use more of this product, use it more often, or keep using it longer than directed. If there is an infection or sore in the area to be treated, do not use this medication without consulting your doctor first.If your condition lasts or gets worse, or if you think you may have a serious medical problem, get medical help right away.

            SIDE EFFECTS: Temporary redness, stinging, and a little bit of swelling may occur at the application site. If these effects last or get worse, tell your doctor right away.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.Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, seizures, pale/bluish/gray skin, unusual tiredness, shortness of breath, fast/slow/irregular 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: new/worsening rash, new or worsening 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 any 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 amide type anesthetics (such as bupivacaine, prilocaine); 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: broken skin/infection in the area where lidocaine is to be used, heart disease, liver disease, a certain blood disorder (methemoglobinemia).If you are going to have an MRI test, tell testing personnel that you are using this product. Some brands of this medication may contain metals that can cause serious burns during an MRI and should not be used before MRI imaging. Ask your doctor or pharmacist for questions about your particular brand.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Caution is advised when using this drug in children because they may be more sensitive to the side effects of the drug.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, but is unlikely to harm a nursing infant. 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 medicine may be harmful if inhaled or swallowed. If someone has overdosed and has 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: drowsiness, irregular heartbeat, seizures.

            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 away from light and moisture. Do not freeze. Keep all medications away from children and pets.Do not store the gel or the foam or spray canisters near high heat (more than 120 degrees F/49 degrees C), and do not store or use it near open flame. Because the foam or spray canisters are under pressure, do not puncture or burn the container.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. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised May 2022. Copyright(c) 2022 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.

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            Formulary

            FormularyPatient Discounts

            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.

            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.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each 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.