lidocaine injection (Xylocaine)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

Do I need a prescription for lidocaine injection?

Yes

Why is lidocaine injection prescribed to patients?

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.

What are the side effects of lidocaine injection?

Side effects vary by dose and site of administration. The most common adverse reactions include:

Additional side effects include:

  • shivering,
  • tingling,
  • sedation,
  • blurry vision,
  • confusion,
  • nervousness, and
  • euphoria.

Rare, but serious side effects include:

What is the dosage for lidocaine injection?

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.

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Which drugs or supplements interact with lidocaine injection?

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.

Is lidocaine injection safe to use during pregnancy or while breastfeeding?

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.

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.

What else should I know about lidocaine injection?

What preparations of lidocaine injection are available?

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.

How should I keep lidocaine injection stored?

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

How does lidocaine injection work?

Lidocaine 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.

When was lidocaine injection approved by the FDA?

Lidocaine was approved by the FDA in November 1948.

REFERENCE: FDA Prescribing Information.

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Summary

lidocaine injection (Xylocaine) is a medication that is an antiarrhythmic agent and a local anesthetic used for local or regional anesthesia during surgical procedures of ventricular arrhythmias associated with heart attack or cardiac surgery. Side effects, dosage, storage, drug interactions, and pregnancy safety information should be reviewed prior to administering this medication.

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Reviewed on 11/2/2016
References
REFERENCE: FDA Prescribing Information.

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