Lidocaine

Brands

DEA Class;  Rx

Common Brand Names; Lidocaine CV, Lidopen

Antidysrhythmics, Ib

Amide Local Anesthetics
Anti-arrhythmics, Class I-B
Miscellaneous Topical Agents for Local Pain
Ophthalmological Local Anaesthetics
Other Agents for Local Oral Treatment
Topical Anti-hemorrhoidals
Topical Local Anesthetics
Topical Neuropathic Pain agents

 

lidocaine anesthetic (Rx)

Brand and Other Names: Xylocaine, Zingo

  • Classes: Local Anesthetics, Dental; 

  • Local Anesthetics, Parenteral

lidocaine topical (Rx, OTC)

Brand and Other Names: Xylocaine Jelly, Xylocaine Topical Solution, AneCream, AneCream5, Derma Numb, Epic, Hawaiian Tropic Gel, Lidocoll, LidoRx, LidoStat, LMX4, Premjact, Promescent, Regenecare HA, Solarcaine Aloe Extra Burn Relief, Topicaine, Xolido
  • Classes: Anesthetics, Topical; 
  • Local Anesthetics, Amides

lidocaine transdermal (Rx, OTC)

Brand and Other Names: Lidoderm, Ztlido, Lidocare Patch
  • Classes: Anesthetics, Topical; 
  • Local Anesthetics, Amides

lidocaine ophthalmic (Rx)

Brand and Other Names: Akten
  • Classes: Anesthetics, Ophthalmic

lidocaine rectal (OTC)

Brand and Other Names: RectiCare, LMX5, Topicaine 5, Dr. Numb, H-Releve Hemorrhoidal
  • Classes: Anesthetics, Topical; 
  • Local Anesthetics, Amides

Amide local anesthetic and type IB antiarrhythmic
Used IV for acute, life-threatening ventricular arrhythmias; topically and locally for anesthesia
Continuous ECG monitoring necessary when given IV

Indicated for the treatment of perfusing ventricular arrhythmias including ventricular fibrillation (VF) and ventricular tachycardia (VT) that may result during acute myocardial infarction or cardiac manipulation (e.g., cardiac surgery).

Indicated as an anesthetic lubricant for oral or nasal endotracheal intubation

Indicated for temporary relief of pain and itching caused by minor skin irritations (eg, sunburn, minor burns, minor cuts, scrapes, insect bites, minor skin irritations)

Indicated for temporary pain relief in adults and adolescents aged ≥12 yr

Indicated for ocular surface anesthesia during ophthalmologic procedures

Indicated for pain, itching, and burning associated with hemorrhoids and other anorectal disorders

For topical anesthesia of skin and mucous membranes or stomatitis.
For the treatment of pain associated with postherpetic neuralgia.
For ophthalmic anesthesia.
 
For local anesthesia including peripheral nerve block anesthesia.
For epidural anesthesia.
For caudal anesthesia.
For spinal anesthesia.
For the treatment of ventricular arrhythmias during cardiopulmonary resuscitation (CPR).
For the attenuation of increased intracranial pressure during rapid-sequence intubation or endotracheal tube suctioning.
For short-term prophylaxis of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT).
 

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

lidocaine

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

lidocaine anesthetic (Rx)

  • 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

lidocaine topical (Rx, OTC)

  • Cardiovascular (with excessive systemic absorption): CV depressant effect characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest
  • Allergic: Cutaneous lesions, urticaria, edema, or anaphylactoid reactions

lidocaine transdermal (Rx, OTC)

  • Allergic and anaphylactoid reactions (rare) may be characterized by angioedema, bronchospasm, dermatitis, dyspnea, hypersensitivity, laryngospasm, pruritus, shock, and urticaria
  • Application site reactions may occur (eg, blisters, bruising, burning sensation, depigmentation, dermatitis, discoloration, edema, erythema, exfoliation, irritation, papules, petechia, pruritus, vesicles, or abnormal sensation

lidocaine ophthalmic (Rx)

  • Conjunctival hyperemia
  • Corneal epithelial changes
  • Headache
  • Burning upon instillation

lidocaine rectal (OTC)

Application site reactions

  • Abnormal sensation

  • Pallor or blanching when the application time is very prolonged (>2 hr)

  • Alterations in temperature sensations

  • Edema

  • Itching

  • Rash

Systemic reactions

  • Unlikely due to the small dose absorbed; may occur with repeated doses or application to large surface area (see Cautions)

  • CNS excitation and/or depression

  • Light-headedness, nervousness, apprehension, euphoria, confusion

  • Dizziness

  • Drowsiness

  • Tinnitus

  • Blurred or double vision

  • Vomiting

  • Sensations of heat, cold or numbness

  • Twitching, tremors, convulsions

  • Unconsciousness, respiratory depression, and arrest

  • Cardiovascular manifestations (eg, bradycardia, hypotension, and cardiovascular collapse leading to arrest)

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

Pregnancy Category: B

Present in human milk; published studies have reported a range of lidocaine milk: plasma ratios between 0.4-1.1

NOTE: The dose of local anesthetics differs with the anesthetic procedure; the area to be anesthetized; the vascularity of the tissues; the number of neuronal segments to be blocked; the intensity of the block; the degree of muscle relaxation required; the duration of anesthesia desired; individual tolerance; and the physical condition of the patient.

Adults

100 mg/dose IV load (may repeat to a Max total load of 300 mg over a 1 hour period) for perfusing ventricular arrhythmias or 1.5 mg/kg/dose IV load (may repeat to a Max total load of 3 mg/kg) for ventricular arrhythmias during CPR; 4 mg/minute (50 mcg/kg/minute) IV continuous infusion for ventricular arrhythmias; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Geriatric

100 mg/dose IV load (may repeat to a Max total load of 300 mg over a 1 hour period) for perfusing ventricular arrhythmias or 1.5 mg/kg/dose IV load (may repeat to a Max total load of 3 mg/kg) for ventricular arrhythmias during CPR; 4 mg/minute (50 mcg/kg/minute) IV continuous infusion for ventricular arrhythmias; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Adolescents

1 mg/kg (Max: 100 mg) IV loading dose, up to 3 mg/kg (Max: 300 mg) IV total loading dose, and 50 mcg/kg/minute IV continuous infusion for ventricular arrhythmias; 2 mg/kg IV loading dose and 6 mg/kg/hour IV continuous infusion for status epilepticus; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Children

1 mg/kg (Max: 100 mg) IV loading dose, up to 3 mg/kg (Max: 300 mg) IV total loading dose, and 50 mcg/kg/minute IV continuous infusion for ventricular arrhythmias; 2 mg/kg IV loading dose and 6 mg/kg/hour IV continuous infusion for status epilepticus; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Infants

1 mg/kg IV loading dose, up to 3 mg/kg IV total loading dose, and 50 mcg/kg/minute IV continuous infusion for ventricular arrhythmias; 2 mg/kg IV loading dose and 6 mg/kg/hour IV continuous infusion for status epilepticus; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Neonates

1 mg/kg IV loading dose, up to 3 mg/kg IV total loading dose, and 50 mcg/kg/minute IV continuous infusion for ventricular arrhythmias; 2 mg/kg IV loading dose and 6 mg/kg/hour IV continuous infusion for status epilepticus; maximum dosage for use as a topical or local anesthetic is dependent on the indication, route, and formulation used.

Lidocaine hydrochloride

infusion solution in D5W

  • 100mg/100mL
  • 200mg/100mL
  • 400mg/100mL
  • 800mg/100mL

injectable solution

  • 10mg/mL
  • 20mg/mL

injectable solution

  • 0.4%
  • 0.5%
  • 0.8%
  • 1%
  • 1.5%
  • 2%
  • 4%
  • 5%

topical jelly

  • 2% (Xylocaine Jelly)

topical gel

  • 0.5% (Solarcaine Aloe Extra Burn Relief)
  • 0.8% (Hawaiian Tropic Gel)
  • 3% (LidoRx)
  • 4% (Topicaine)

topical cream

  • 2% (Xolido)
  • 4% (AneCream, LidoStat, LMX4, Xolido)
  • 5% (AneCream5)

topical ointment

  • 5%

topical lotion

  • 3%

topical spray

  • 2% (Regenecare HA)
  • 4% (Derma Numb, Lidocoll)
  • 10mg/spray (Epic, Premjact, Promescent)

topical solution, mouth/throat

  • 2%
  • 4% (Xylocaine Solution)

transdermal patch

  • 5%; 700mg/patch (Lidoderm; Rx)
  • 1.8%; 36mg/patch (ZTlido; Rx)
  • 4% (Lidocare Patch; OTC)

ophthalmic gel

  • 3.5%

anorectal cream

  • 4% (H-Releve Hemorrhoidal)
  • 5% (RectiCare, LMX5, Dr. Numb)

anorectal gel

  • 5% (Topicaine 5)
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