lidocaine injection (Xylocaine)

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GENERIC NAME: lidocaine injection

BRAND NAMES: Xylocaine

DRUG CLASS AND MECHANISM: Lidocaine is an antiarrhythmic agent (affects heart rhythm) as well as a local anesthetic (amide type). It is similar to bupivacaine and procaine. Lidocaine, like other local anesthetics causes a loss of sensation by reducing the flow of sodium in and out nerves to decrease the initiation and transfer of nerve signals. Compared to procaine, lidocaine has a more rapid onset, longer duration of action, and more potent activity. Lidocaine works as an antiarrhythmic by also decreasing conduction of electrical signals in damaged (ischemic) heart tissue. Lidocaine was approved by the FDA in November 1948.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Injection Solution with or without preservatives: 0.4%, 0.5%, 0.8%, 1%, 1.5%, 2%, 4%, 5% in 2, 5, 10, 20, 30, 50, 250, 500 mL.

STORAGE: Lidocaine should be stored at room temperature, between 15 C to 30 C (59 F to 86 F).

PRESCRIBED FOR: Lidocaine is prescribed for local or regional anesthesia (loss of sensation) during surgical procedures as well as for control of ventricular arrhythmias associated with heart attack or cardiac surgery.

DOSING: The initial dose for anesthesia in adults depends on the procedure, necessary depth of anesthesia, blood flow to the region, desired duration of anesthesia, and condition of the patient. For anesthesia, the maximum dose is 4.5 mg/kg and should not exceed 300 mg per dose. For control of arrhythmias (abnormal heart rhythm), an initial intravenous or intraosseous (injected into bone) dose is 1 to 1.5 mg/kg. If providing dose by endotrachial tube the initial dose is 2 to 3.75 mg/kg. Lidocaine is rapidly metabolized. Any conditions that later liver functions may alter the half live of lidocaine.

DRUG INTERACTIONS: Dronedarone increases blood levels of lidocaine and its side effects by reducing its breakdown in the liver. Lidocaine increases the effect of bupivicaine liposomal because it increases the availability of bupivicaine. The two drugs should not be mixed. Carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), phenobarbital, and rifampin may reduce blood levels of lidocaine by increasing its breakdown in the liver. Erythromycin, amprenavir (Agenerase), omeprazole (Prilosec), and ciprofloxacin (Cirpo, Cirpo XR, Proquin XR) may increase levels of lidocaine by reducing its breakdown in the liver.

PREGNANCY: There are no adequate studies of use in pregnant women. Available evidence does not suggest harm to the fetus. Lidocaine crosses the placenta and does enter the fetal blood stream so close monitoring of the heart is recommended.

NURSING MOTHERS: Lidocaine is excreted in breast milk so it should be used cautiously by nursing mothers. The amount absorbed by the infant is not expected to be significant.

SIDE EFFECTS: Side effects vary by dose and site of administration. The most common adverse reactions include low heart rate, low blood pressure, backache, dizziness, lightheadedness, and numbness. Additional side effects include shivering, tingling, sedation, blurry vision, confusion, nervousness, and euphoria. Rare, but serious side effects include cardiac arrest, methemoglobinemia, breakdown of cartilage, seizure, and loss of consciousness.

REFERENCE: FDA Prescribing Information.


Medically Reviewed by a Doctor on 7/18/2014



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