lidocaine anesthetic (Rx)

Brand and Other Names:Xylocaine, Zingo
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Dosing & Uses

AdultPediatric

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  

Dosage Forms & Strengths

injectable solution

  • 0.5%
  • 1%
  • 1.5%
  • 2%
  • 4%
  • 5%

Infiltration

Percutaneous: 4-4.5 mg/kg maximum  

IV regional: 3 mg/kg

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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
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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)

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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.

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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)

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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

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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
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2 % solution
Lidocaine Viscous mucous membrane
-
2 % solution
Lidocaine Viscous mucous membrane
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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
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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.

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Patient Handout

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Patient Education
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.

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Formulary

FormularyPatient Discounts

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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.