Dosing and uses of Lidocaine CV, Lidopen (lidocaine)
Adult dosage forms and strengths
infusion solution in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
- 800mg/100mL
injectable solution
- 10mg/mL
- 20mg/mL
Ventricular Arrhythmias
1-1.5 mg/kg slow IV bolus over 2-3 minutes
May repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg totaL
Continuous infusion: 1-4 mg/min IV
If IV not feasible may use IO/Et
Monitor: ECg
Regional Anesthesia (IV)
4 mg/kg
Paracervical Block
200 mg per 90 min in obstetric and nonobstetric patients
Other Indications & Uses
Acute management of ventricular arrhythmias (cardiac surgery, acute MI)
Off-label: Peds with premature ventricular beats during cardiac arrest
IM dose indicated when IV admin is not possible or when ECG monitoring is not available and danger of ventricular arrhythmia is great
Pediatric dosage forms and strengths
infusion solution in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
- 800mg/100mL
injectable solution
- 10mg/mL
- 20mg/mL
Ventricular Arrhythmias
Bolus: 0.5-1 mg/kg IV/IO/ET, not to exceed 100 mg; follow with continuous infusion; if delay between bolus and start of infusion is >15 minutes, administer a second bolus q5-10min to 5 mg/kg, THEn
Continuous infusion: 20-50 mcg/kg/min IV
Monitor ECg
Lidocaine CV, Lidopen (lidocaine) adverse (side) effects
Frequency not defined
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
Warnings
Contraindications
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
Cautions
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)
Lidocaine effects increased by beta-blockers & cimetidine
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
Good for automatic and re-entrant arrhythmias, not PSVTs
Pregnancy and lactation
Pregnancy category: B
Lactation: crosses into 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.
Pharmacology of Lidocaine CV, Lidopen (lidocaine)
Mechanism of action
Class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity
Absorption
Bioavailability: 35% (PO)
Onset: IV: 45-90 sec
Duration: 10-20 min
Distribution
Protein Bound: 60-80%
Vd: 1.7 L/kg
Metabolism
Liver by de-ethylation to form active metabolites
Metabolites (active): monoethylglycinexylidide (MEGX) and glycinexylidide (GX) (active met)
Elimination
Half-Life: 2.5-8 hr (parent drug), MEGX 2 hr and GX 10 hr (metabolites); half-life prolonged with CHF or liver disease
Clearance: less if CHF, shock, digoxin toxicity, geriatric
Excretion: Urine (90%)
Administration
IV Incompatibilities
Additive: methohexital, phenytoin
Syringe: ampicillin(?), cefazolin, ceftriaxone(?), Na bicarb(?)
Y-site: ampho B cholesteryl sulfate, thiopentaL
Not spec: diazepam, epinephrine
IV Compatibilities
Solution: compatible w/ most common solvents
Additive (partial list): aminophylline, amiodarone, CaCl2, Ca gluconate, cimetidine, ciprofloxacin, digoxin, diphenhydramine, dobutamine, dopamine, erythromycin, fentanyl(?), flumazenil, furosemide, heparin, hydrocortisone, hydroxyzine, nitroglycerin, pentobarbital, KCl, prochlorperazine, Na bicarb, verapamil, vit B/C
Syringe: caffeine citrate, clonidine/fentanyl, glycopyrrolate, heparin, hydroxyzine, ketamine/morphine sulfate, metoclopramide, milrinone, nalbuphine, Na bicarb(?)
Y-site (partial list): amiodarone, cefazolin, ciprofloxacin, diltiazem, dobutamine, dopamine, heparin, inamrinone, labetalol, linezolid, meperidine, morphine sulfate, nitroglycerin, KCl, propofol, vit B/C, warfarin
Not spec: carbenicillin, tetracycline
IV Preparation
Add 1-2 g of lidocaine hydrochloride to 1 L of D5W making 1-2 mg/mL solution; use (using 5-10 mL of 20% inj soln); may also use 400 mg/100 mL in D5W or 800 mg/100 mL in D5W
8 mg/mL concentrations have been recommended for fluid-restricted pts
IV Administration
IV injection or infusion
Do not administer 40 mg/ mL, 100 mg/mL, 200 mg/mL IV unless dilute first
Storage
Store intact vials & premixed infusion solutions at room temp
Protect from excess heat or freezing
