Formulary
Lidocaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Lidocaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 7 min read
Lidocaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Lidocaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation [**
- **Adult** (By Intravenous Injection): for cardiopulmonary resuscitation as an alternative to amiodarone] 100 mg for 1 dose, then 50 mg for 1 dose, dose to be given if required. Consult Resuscitation Council (UK) guidelines for further details.
**Pain relief (in anal fissures, haemorrhoids, pruritus ani, pruritus vulvae, herpes zoster, or herpes labialis),Lubricant in cystoscopy,Lubricant in proctoscopy**
- **Adult** (To The Skin Using Ointment): Apply 1-2 mL as required, avoid long-term use.
**Sore nipples from breast-feeding**
- **Adult** (To The Skin Using Ointment): Apply using gauze and wash off immediately before next feed.
**Anaesthesia before venous cannulation or venepuncture**
- **Child** (To The Skin): 1-17 years Apply 1-2.5 g, apply thick layer to small area (2.5 cm 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 5 hours, remove cream with gauze and perform procedure after approximately 5 minutes.
- **Adult** (To The Skin): Apply 1-2.5 g, apply thick layer to small area (2.5 cm 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 5 hours, remove cream with gauze and perform procedure after approximately 5 minutes.
**Postherpetic neuralgia**
- **Adult** (To The Skin): Apply once daily for up to 12 hours, followed by a 12-hour plaster-free period; discontinue if no response after 4 weeks, to be applied to intact, dry, non-hairy, non-irritated skin, up to 3 plasters may be used to cover large areas; plasters may be cut.
**During delivery in obstetrics**
- **Adult** (To The Skin): Up to 20 doses.
**Ventricular arrhythmias, Pulseless ventricular tachycardia, Ventricular fibrillation for lidocaine hydrochloride**
- **Neonate** (Initially by intravenous injection, or by intraosseous injection): Initially 0.5-1 mg/kg, followed immediately by (by intravenous infusion) 0.6-3 mg/kg/hour, alternatively (by intravenous injection or by intraosseous injection) 0.5-1 mg/kg repeated at intervals of not less than 5 minutes if infusion is not immediately available following initial injection, until infusion can be initiated; maximum 3 mg/kg per course.
- **Child 1 month-11 years** (Initially by intravenous injection, or by intraosseous injection): Initially 0.5-1 mg/kg, followed immediately by (by intravenous infusion) 0.6-3 mg/kg/hour, alternatively (by intravenous injection or by intraosseous injection) 0.5-1 mg/kg repeated at intervals of not less than 5 minutes if infusion is not immediately available following initial injection, until infusion can be initiated; maximum 3 mg/kg per course.
- **Child 12-17 years** (Initially by intravenous injection, or by intraosseous injection): Initially 50-100 mg, followed by (by intravenous infusion) 120 mg, dose to be given over 30 minutes, then (by intravenous infusion) 240 mg, dose to be given over 2 hours, then (by intravenous infusion) 60 mg/hour, reduce dose further if infusion is continued beyond 24 hours, if infusion not immediately available following initial injection, the initial injection dose may be repeated at intervals of not less than 5 minutes (to a maximum 300 mg dose in 1 hour) until infusion can be initiated.
**Infiltration anaesthesia for lidocaine hydrochloride**
- **Neonate** (By local infiltration): Up to 3 mg/kg, dose to be given according to patient's weight and nature of procedure, dose may be repeated not more often than every 4 hours, 3 mg/kg equivalent to 0.3 mL/kg of 1% solution.
- **Child 1 month-11 years** (By local infiltration): Up to 3 mg/kg, dose to be given according to patient's weight and nature of procedure, dose may be repeated not more often than every 4 hours, 3 mg/kg equivalent to 0.3 mL/kg of 1% solution.
- **Child 12-17 years** (By local infiltration): (max. per dose 200 mg), dose to be given according to child's weight and nature of procedure, dose may be repeated not more often than every 4 hours.
**Intravenous regional anaesthesia and nerve block for lidocaine hydrochloride**
- **Child** (By regional administration): Seek expert advice.
**Dental anaesthesia for lidocaine hydrochloride**
- **Child** (By regional administration): Seek expert advice.
**Dental practice for lidocaine hydrochloride**
- **Child** (By buccal administration using ointment): Rub gently into dry gum.
**Pain relief (in anal fissures, haemorrhoids, pruritus ani, pruritus vulvae, herpes zoster, or herpes labialis), Lubricant in cystoscopy, Lubricant in proctoscopy for lidocaine hydrochloride**
- **Child** (To the skin using ointment): Apply 1-2 mL as required, avoid long-term use.
**Neonatal seizures for lidocaine hydrochloride**
- **Neonate** (By intravenous infusion): Initially 2 mg/kg, dose to be given over 10 minutes, followed by 6 mg/kg/hour for 6 hours; reduced to 4 mg/kg/hour for 12 hours, then reduced to 2 mg/kg/hour for a further 12 hours, preterm neonates may require lower doses.
**Anaesthesia before venous cannulation or venepuncture for LMX 4**
- **Child 1-2 months** (To the skin): Apply up to 1 g, apply thick layer to small area (2.5 cm 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 60 minutes, remove cream with gauze and perform procedure after approximately 5 minutes.
- **Child 3-11 months** (To the skin): Apply up to 1 g, apply thick layer to small area (2.5 cm 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 4 hours, remove cream with gauze and perform procedure after approximately 5 minutes.
- **Child 1-17 years** (To the skin): Apply 1-2.5 g, apply thick layer to small area (2.5 cm 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 5 hours, remove cream with gauze and perform procedure after approximately 5 minutes.
**Bronchoscopy, Laryngoscopy, Oesophagoscopy, Endotracheal intubation for Xylocaine**
- **Child** (To mucous membranes): Up to 3 mg/kg.
Cautions
With intravenous use Acute porphyrias (consider infusion with glucose for its anti-porphyrinogenic effects); congestive cardiac failure (consider lower dose); post cardiac surgery (consider lower dose) With oral (topical) use Avoid anaesthesia of the pharynx before meals-risk of choking (in adults); can damage plastic cuffs of endotracheal tubes When used by regional administration Acute porphyrias (consider infusion with glucose for its anti-porphyrinogenic effects); children (consider dose reduction); congestive cardiac failure (consider lower dose); debilitated patients (consider dose reduction); elderly (consider dose reduction) (in adults); epilepsy; hypovolaemia; impaired cardiac conduction; impaired respiratory function; myasthenia gravis; post cardiac surgery (consider lower dose); shock
Contraindications
With intravenous use All grades of atrioventricular block; severe myocardial depression; sino-atrial disorders When used by regional administration Avoid injection into infected tissues; avoid injection into inflamed tissues; complete heart block; preparations containing preservatives should not be used for caudal, epidural, or spinal block, or for intravenous regional anaesthesia (Bier's block) With topical use Application to the middle ear (can cause ototoxicity); should not be applied to damaged skin Contra-indications, further information Administration site With topical use or when used by regional administration: Manufacturer advises local anaesthetics should not be injected into inflamed or infected tissues nor should they be applied to damaged skin. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.
Side effects
Frequency not known With parenteral use Anxiety; arrhythmias; atrioventricular block; cardiac arrest; circulatory collapse; confusion; dizziness; drowsiness; euphoric mood; headache; hypotension (may lead to cardiac arrest); loss of consciousness; methaemoglobinaemia; muscle twitching; myocardial contractility decreased; nausea; neurological effects; nystagmus; pain; psychosis; respiratory disorders; seizure; sensation abnormal; temperature sensation altered; tinnitus; tremor; vision blurred; vomiting Side-effects, further information Toxic effects The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. Methaemoglobinaemia Methylthioninium chloride is licensed for the acute symptomatic treatment of drug-induced methaemoglobinaemia.
Interactions
**Other interactions (7):**
- Lidocaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics, e.g.
- In patients taking erythromycin the toxicity of oral lidocaine may be markedly increased.
- In patients taking itraconazole, the toxicity of oral lidocaine may be markedly increased.
- Antiarrhythmic drugs class III (e.g.
- Drugs that reduce the clearance of lidocaine (e.g.
- Anbesol) at the recommended dose.
Pregnancy
Crosses the placenta but not known to be harmful in animal studies-use if benefit outweighs risk. When used as a local anaesthetic, large doses can cause fetal bradycardia; if given during delivery can also cause neonatal respiratory depression, hypotonia, or bradycardia after paracervical or epidural block.
Breast feeding
Present in milk but amount too small to be harmful.
Hepatic impairment
Manufacturer advises caution (risk of increased exposure). Dose adjustments With intravenous use: Manufacturer advises slower infusion rate.
Renal impairment
Possible accumulation of lidocaine and active metabolite; caution in severe impairment.
Medicinal forms
Solution,Solution,Ointment,Spray,Cream
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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