Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 0.4%
- 0.5%
- 0.8%
- 1%
- 1.5%
- 2%
- 4%
- 5%
Infiltration Anesthesia
Percutaneous: 1-60 mL of 0.5-1% solution (5-300 mg total dose)
IV regional: 10-60 mL of 0.5% solution (50-300 mg total dose)
Peripheral Nerve Blocks
Brachial: 15-20 mL of 1.5% solution (225-300 mg total dose)
Dental: 1-5 mL of 2% solution (20-100 mg total dose)
Intercostal: 3 mL of 1% solution (30 mg total dose)
Paravertebral: 3-5 mL of 1% solution (30-50 mg total dose)
Pudendeal (each side): 10 mL of 1% solution (100 mg total dose)
Paracervical obstetrical analgesia (each side): 10 mL of 1% solution (100 mg total dose)
Sympathetic Nerve Blocks
Cervical (stellate ganglion): 5 mL of 1% solution (50 mg total dose)
Lumbar: 5-10 mL of 1% solution (50-100 mg total dose)
Central Neural Blocks/Epidural
General: 2-3 mL/dermatome for anesthesia
Thoracic: 20-30 mL of 1% solution (200-300 mg total dose)
Lumbar analgesia: 25-30 mL of 1% solution (250-300 mg total dose)
Lumbar anesthesia: 15-20 mL of 1.5% solution (225-300 mg), or 10-15 mL of 2% solution (200-300 mg total dose)
Dosing Considerations
Use preservative-free preparations for spinal or epidural anesthesia
May be buffered 9:1 with sodium bicarbonate, to reduce pain on injection (e.g. remove 2 mL of 1% lidocaine from 20 mL vial, and add 2 mL of sodium bicarbonate solution to vial)
Maximum dose: 4.5 mg/kg, up to 300 mg lidocaine without epinephrine; or 7 mg/kg, up to 500 mg lidocaine with epinephrine
Adverse Effects
Frequency Not Defined
Arrhythmias
Bradycardia
Cardiovascular collapse
Edema
Hypotension
Heart block
Apprehension
Agitation
Coma
Confusion
Drowsiness
Dizziness
Disorientation
Euphoria
Lightheadedness
Nervousness
Paresthesia
Psychosis
Sensations of heat, cold, or numbness
Slurred speech
Seizures
Tinnitus
Tremulousness
Unconsciousness
Visual disturbances including blurred or double vision
Skin lesions
Urticaria
Anaphylactoid reactions
Difficulty swallowing
Nausea
Vomiting
Muscle twitching/ tremors
Dyspnea
Respiratory depression/arrest
Administration Effects
- pain IM injection site
- IM injection increases serum creatine kinase
Warnings
Contraindications
Hypersensitivity to drug or amide type anesthetic
Cautions
Some formulations may contain sulfites
History of malignant hyperthermia
DO NOT use solutions containing epinephrine in distal areas of body (eg, digit, nose, ear) because of vasoconstrictive effects; addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Significant systemic absorption reported when administered to mucosal surfaces and open wounds
Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)
Use with caution in hepatic impairment (ability to metabolize diminishes)
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Excreted in breast milk; use caution
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
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction
Pharmacokinetics
Half-life: 7-30 min (initial); 1.5-2 hr (terminal)
Vd: 0.7-2.7 L/kg (patch)
Peak plasma concentration: 1-5 mcg/mL
Protein Bound: 60-80%
Metabolism: Liver
Metabolites: Monoethylglycinexylidide (MEGX), glycinexylidide (GX)
Excretion: Urine (primarily)
Administration
IV Incompatibilities
Additive: amphotericin B, dacarbazine, methohexital, phenytoin
Syringe: cefazolin
Y-site: amphotericin B cholesteryl SO4, thiopental
IV Preparation
Standard diluent: 2 g/250 mL D5W
IV Administration
Use microdrip (60 drops/mL) or infusion pump to administer an accurate dose
Local thrombophlebitis may occur in pts receiving prolonged IV infusions
Add 1 g of drug (using 25mLl of 4% or 5 mL of 20 % inj) to 1 L of D5W inj to provide a solution containing 1 mg/mL
Storage
Injection is stable at room temperature
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| lidocaine HCl topical - | 3 % cream |  | |
| lidocaine HCl topical - | 3 % cream |  | |
| lidocaine HCl topical - | 3 % cream |  | |
| lidocaine HCl topical - | 3 % cream |  | |
| Astero topical - | 4 % gel |  | |
| Astero topical - | 4 % gel |  | |
| Lidocaine Viscous mucous membrane - | 2 % solution |  | |
| Lidocaine Viscous mucous membrane - | 2 % solution |  | |
| Lidocaine Viscous mucous membrane - | 2 % solution |  | |
| Lidocaine Viscous mucous membrane - | 2 % solution |  | |
| Gold Bond Medicated Pain-Itch topical - | 4 % cream |  | |
| Xylocaine injection - | 20 mg/mL (2 %) vial |  | |
| Xylocaine injection - | 20 mg/mL (2 %) vial |  | |
| Xylocaine injection - | 10 mg/mL (1 %) vial |  | |
| Xylocaine injection - | 10 mg/mL (1 %) vial |  | |
| Xylocaine injection - | 20 mg/mL (2 %) vial |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % cream |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % liquid |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % liquid |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % cream |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % cream |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % cream |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % cream |  | |
| Aspercreme (lidocaine HCl) topical - | 4 % liquid |  | |
| LidoRx topical - | 3 % gel |  | |
| LidoRx topical - | 3 % gel |  | |
| Glydo mucous membrane - | 2 % gel |  | |
| Glydo mucous membrane - | 2 % gel |  | |
| LidoDose topical - | 3 % swab |  | |
| LidoDose topical - | 3 % swab |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 20 mg/mL (2 %) vial |  | |
| lidocaine HCl injection - | 20 mg/mL (2 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 20 mg/mL (2 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 20 mg/mL (2 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 10 mg/mL (1 %) vial |  | |
| lidocaine HCl injection - | 5 mg/mL (0.5 %) vial |  | |
| lidocaine HCl injection - | 5 mg/mL (0.5 %) vial |  | |
| lidocaine HCl injection - | 20 mg/mL (2 %) vial |  | |
| lidocaine HCl mucous membrane - | 4 % (40 mg/mL) solution |  | |
| lidocaine HCl mucous membrane - | 2 % gel |  | |
| lidocaine HCl mucous membrane - | 2 % gel |  | |
| lidocaine HCl mucous membrane - | 2 % gel |  | |
| lidocaine HCl mucous membrane - | 4 % (40 mg/mL) solution |  | |
| lidocaine HCl mucous membrane - | 4 % (40 mg/mL) solution |  | |
| lidocaine HCl mucous membrane - | 4 % (40 mg/mL) solution |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
lidocaine HCl 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. 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.
Information last revised November 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.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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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.
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