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Drug overview for LIDOCAINE HCL (lidocaine hcl/pf):
Generic name: LIDOCAINE HCL/PF (LYE-doe-kane)
Drug class: Antiarrhythmic - Class IB (Systemic)
Therapeutic class: Cardiovascular Therapy Agents
Lidocaine hydochloride is an intermediate-acting local anesthetic of the Lidocaine hydrochloride is an amide-type local anesthetic that is also used amide type. as a class Ib antiarrhythmic agent.
Lidocaine hydrochloride is used for infiltration anesthesia and for nerve block techniques including peripheral, sympathetic, epidural (including caudal), and spinal block anesthesia. Lidocaine has been administered intraperitoneally+ for anesthesia of the peritoneum and pelvic viscera.
Generic name: LIDOCAINE HCL/PF (LYE-doe-kane)
Drug class: Antiarrhythmic - Class IB (Systemic)
Therapeutic class: Cardiovascular Therapy Agents
Lidocaine hydochloride is an intermediate-acting local anesthetic of the Lidocaine hydrochloride is an amide-type local anesthetic that is also used amide type. as a class Ib antiarrhythmic agent.
Lidocaine hydrochloride is used for infiltration anesthesia and for nerve block techniques including peripheral, sympathetic, epidural (including caudal), and spinal block anesthesia. Lidocaine has been administered intraperitoneally+ for anesthesia of the peritoneum and pelvic viscera.
DRUG IMAGES
LIDOCAINE HCL 2% JELLY URO-JET
LIDOCAINE HCL 2% LUER-JET
The following indications for LIDOCAINE HCL (lidocaine hcl/pf) have been approved by the FDA:
Indications:
Administration of local anesthesia
Local anesthesia for endotracheal intubation
Local anesthesia for urethral pain
Mouth irritation
Suppression of the gag reflex
Urethritis
Ventricular arrhythmias
Professional Synonyms:
Gag reflex suppression
Local anesthesia for intratracheal intubation
Local anesthesia for intubation of trachea
Oral irritation
Urogenital canal inflammation
Ventricular arrhythmia
Indications:
Administration of local anesthesia
Local anesthesia for endotracheal intubation
Local anesthesia for urethral pain
Mouth irritation
Suppression of the gag reflex
Urethritis
Ventricular arrhythmias
Professional Synonyms:
Gag reflex suppression
Local anesthesia for intratracheal intubation
Local anesthesia for intubation of trachea
Oral irritation
Urogenital canal inflammation
Ventricular arrhythmia
The following dosing information is available for LIDOCAINE HCL (lidocaine hcl/pf):
Dosage of lidocaine hydrochloride varies with the anesthetic procedure, the degree of anesthesia required, and individual patient response. The usual dosages should generally be reduced in children, geriatric patients, debilitated or acutely ill patients, and patients with cardiac and/or hepatic disease. The smallest dose and lowest concentration required to produce the desired effect should be used.
Use of dilute solutions (i.e., 0.25-0.5%) and total dosages not to exceed 3 mg/kg are recommended for induction of IV regional anesthesia in children.
Single doses of lidocaine hydrochloride (for anesthesia other than spinal) should not exceed 4.5 mg/kg (or 300 mg) in healthy adults or 4.5 mg/kg in children younger than 10 years of age.
When administered with epinephrine, lidocaine hydrochloride doses should not exceed 7 mg/kg (or 500 mg) in healthy adults or 7 mg/kg in children younger than 10 years of age. For spinal anesthesia, up to 100 mg of the drug may be given. For continuous epidural or caudal anesthesia, the maximum dose should not be repeated at intervals of less than 1.5
hours. When continuous lumbar or caudal epidural anesthesia is used for nonobstetric procedures, additional drug may be administered if necessary to attain adequate anesthesia. For paracervical block for nonobstetric and obstetric analgesia (including abortion), the maximum recommended dosage (200 mg) should not be repeated at intervals of less than 1.5
hours. For IV regional anesthesia in adults using a 0.5% solution without epinephrine, the dose administered should not exceed 4 mg/kg.
Solutions of 1-2% lidocaine hydrochloride with or without epinephrine and containing no preservatives are used for epidural or caudal anesthesia. To prevent intravascular or subarachnoid injection of a large epidural dose of lidocaine, a test dose (e.g., 2-3 mL of a 1.5% solution) of anesthetic solution should be injected at least 5 minutes prior to administering the total dose. When clinical conditions permit, use of a test dose solution that contains epinephrine (e.g., 10-15 mcg) should be considered to detect inadvertent intravascular injection.
The test dose should be repeated if the patient is moved such that the epidural catheter may have been displaced. Rapid injection of a large, single dose through a catheter should be avoided; instead, the drug should be administered, when feasible, in fractional doses. In epidural anesthesia, 2-3 mL of the indicated solution is usually required for each dermatome to be anesthetized.
In caudal block for production of obstetric analgesia or in epidural thoracic block, 20-30 mL of a 1% solution (200-300 mg) of the drug may be used. For surgical anesthesia with caudal block, 15-20 mL of a 1.5% solution (225-300 mg) is given.
For epidural lumbar analgesia, the dose is 25-30 mL (250-300 mg) of a 1% solution, and for epidural lumbar anesthesia, the recommended dose is 15-20 mL of a 1.5% solution (225-300 mg) or 10-15 mL of a 2% solution (200-300 mg).
A solution of 5% lidocaine hydrochloride with 7.5% dextrose is used for spinal anesthesia in adults and adolescents 16 years of age or older. For obstetric low spinal or saddle-block anesthesia in a normal vaginal delivery, the dose is approximately 1 mL (50 mg).
For cesarean section or deliveries which require intrauterine manipulations, 1.5 mL of the 5% solution (75 mg) may be given. For surgical anesthesia, 1.5-2
mL of the 5% solution (75-100 mg) may be administered.
The following doses of lidocaine hydrochloride have been suggested for various nerve blocks: brachial nerve block, 15-20 mL of a 1.5% solution (225-300 mg); dental nerve block, 1-5 mL of a 2% solution (20-100 mg); intercostal nerve block, 3 mL of a 1% solution (30 mg); paravertebral nerve block, 3-5 mL of a 1% solution (30-50 mg); pudendal nerve block (each side), 10 mL of a 1% solution (100 mg); and paracervical nerve block (each side) for obstetric analgesia, 10 mL of a 1% solution (100 mg). For sympathetic nerve blocks, the following doses may be used: cervical (stellate ganglion) nerve block, 5 mL of a 1% solution (50 mg), and lumbar nerve block, 5-10 mL of a 1% solution (50-100 mg).
For percutaneous infiltration anesthesia, the dose of lidocaine hydrochloride is 1-60 mL of a 0.5 or 1% solution (5-300 mg). For IV regional anesthesia, 10-60 mL of a 0.5%
solution (50-300 mg) may be employed.
For retrobulbar injection, 3-5 mL of a 4% sterile solution (120-200 mg) or 1.7-3 mg/kg is suggested; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve.
For transtracheal injection, 2-3 mL of a 4% solution (80-120 mg) is administered rapidly. When both transtracheal injection and topical application (oropharyngeal spray) of a 4% solution are needed to achieve complete analgesia, the combined total dose of lidocaine hydrochloride administered by injection and by oropharyngeal spray should not exceed 5 mL of a 4% solution (200 mg) or 3 mg/kg.
Lidocaine hydrochloride with or without epinephrine is used for various dental procedures by infiltration injection or nerve block. In oral infiltration and/or mandibular block, initial doses of 1-5 mL of 2% lidocaine hydrochloride (20-100 mg) with epinephrine 1:100,000 are usually effective. If greater hemostasis is required, epinephrine 1:50,000 may be used.
In children younger than 10 years of age, 0.9-1 mL of 2% lidocaine hydrochloride (18-20 mg) is adequate for a procedure involving 1 tooth (local infiltration), 2-3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).
Dosage of lidocaine hydrochloride must be carefully adjusted according to individual requirements and response.
For the initial treatment of ventricular arrhythmias, lidocaine hydrochloride usually is administered as a rapid (i.e., bolus) IV injection. The manufacturer states that the usual adult dose of lidocaine hydrochloride is 50-100 mg administered at a rate of approximately 25-50 mg/minute by direct IV injection. If the desired response is not achieved, a second dose may be administered 5 minutes after completion of the first injection.
The manufacturer states that no more than 200-300 mg should be administered during a 1-hour period. Patients with congestive heart failure or cardiogenic shock may require smaller loading doses.
For the treatment of hemodynamically stable monomorphic ventricular tachycardia, the American Heart Association (AHA) recommends an initial adult dose of 1-1.5 mg/kg IV; additional doses of 0.5-0.75
mg/kg may be administered every 5-10 minutes as necessary, up to a maximum total dose of 3 mg/kg.
For the treatment of shock-resistant ventricular fibrillation or pulseless ventricular tachycardia during cardiac resuscitation, the initial adult loading dose of lidocaine hydrochloride is 1-1.5 mg/kg by IV or IO+ injection, followed by 0.5-0.75
mg/kg repeated at 5- to 10-minute intervals as necessary, up to a maximum total dose of 3 mg/kg.
If IV or IO+ access cannot be established during cardiac arrest, lidocaine may be administered via the endotracheal+ route. Although the optimum endotracheal dose of lidocaine hydrochloride remains to be established, some experts state that typical doses should be 2-2.5 times those administered IV, and generally should be diluted in 5-10 mL of 0.9%
sodium chloride or sterile water.
A maintenance infusion of lidocaine hydrochloride may be required to maintain normal sinus rhythm if oral antiarrhythmic therapy is not feasible. Following initial administration with direct IV injections, an IV infusion of lidocaine hydrochloride may be initiated at a rate of 1-4 mg/minute (14-57 mcg/kg per minute). Some clinicians recommend maintaining the infusion rate below 30 mcg/kg per minute in patients with congestive heart failure.
In patients with liver disease, dosing must be carefully individualized.
Major differences in lidocaine pharmacokinetics may exist for different types of liver disease (e.g., cirrhosis, hepatitis) and no consistent correlation has been established between clearance of the drug and severity of liver disease (as determined by liver function tests). No dosing modification appears to be necessary in patients with renal failure.
When arrhythmias reappear during a constant infusion of lidocaine hydrochloride, a small bolus dose (e.g., 0.5 mg/kg) may be given to rapidly increase plasma concentrations of the drug; the infusion rate is maintained or increased simultaneously. If the infusion rate alone is increased, a plateau or peak concentration of lidocaine may not be reached for 3-4 half-lives (5-8 hours).
The infusion should be terminated as soon as the patient's basic cardiac rhythm appears to be stable or at the earliest sign of toxicity. If signs of excessive cardiac depression, such as prolongation of the PR interval and QRS complex or the appearance or aggravation of arrhythmias occur, the infusion should be stopped immediately. The manufacturers state that it should rarely be necessary to continue the infusion for longer than 24 hours.
Clinical studies have reported continuation of lidocaine infusions for several days; however, there are data which indicate that the half-life of lidocaine may be increased to 3 hours or longer following infusions lasting longer than 24 hours, and dosage may need to be reduced accordingly (e.g., by 50%) to avoid accumulation of the drug and potential toxicity. If maintenance therapy is necessary, therapy should be changed to an oral antiarrhythmic agent.
Controlled clinical studies to establish pediatric dosing schedules of lidocaine hydrochloride have not been performed. Some clinicians have suggested that infants and children may be given an initial rapid IV injection (i.e., bolus) of 0.5-1 mg/kg; this dose may be repeated according to the response of the patient, but the total dose should not exceed 3-5 mg/kg.
A maintenance IV infusion of 10-50 mcg/kg per minute may be given via an infusion pump.
For the treatment of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia during pediatric resuscitation, the recommended dosage of lidocaine hydrochloride is an initial rapid IV or IO+ injection (i.e., bolus) of 1 mg/kg, followed by a maintenance infusion of 20-50 mcg/kg per minute. A repeat IV injection should be given if there is more than a 15-minute delay from the time of the initial rapid IV injection dose to the onset of the infusion.
If IV or IO+ access cannot be established, lidocaine may be administered via the endotracheal+ route. Although the optimum endotracheal dose of lidocaine hydrochloride remains to be established, some experts state that typical doses should be 2-2.5 times those administered IV.
If cardiopulmonary resuscitation (CPR) is in progress, chest compressions should be interrupted briefly to administer lidocaine. Following administration, the endotracheal tube should be flushed with 5 mL of 0.9% sodium chloride injection and followed by 5 consecutive positive-pressure ventilations.
Use of dilute solutions (i.e., 0.25-0.5%) and total dosages not to exceed 3 mg/kg are recommended for induction of IV regional anesthesia in children.
Single doses of lidocaine hydrochloride (for anesthesia other than spinal) should not exceed 4.5 mg/kg (or 300 mg) in healthy adults or 4.5 mg/kg in children younger than 10 years of age.
When administered with epinephrine, lidocaine hydrochloride doses should not exceed 7 mg/kg (or 500 mg) in healthy adults or 7 mg/kg in children younger than 10 years of age. For spinal anesthesia, up to 100 mg of the drug may be given. For continuous epidural or caudal anesthesia, the maximum dose should not be repeated at intervals of less than 1.5
hours. When continuous lumbar or caudal epidural anesthesia is used for nonobstetric procedures, additional drug may be administered if necessary to attain adequate anesthesia. For paracervical block for nonobstetric and obstetric analgesia (including abortion), the maximum recommended dosage (200 mg) should not be repeated at intervals of less than 1.5
hours. For IV regional anesthesia in adults using a 0.5% solution without epinephrine, the dose administered should not exceed 4 mg/kg.
Solutions of 1-2% lidocaine hydrochloride with or without epinephrine and containing no preservatives are used for epidural or caudal anesthesia. To prevent intravascular or subarachnoid injection of a large epidural dose of lidocaine, a test dose (e.g., 2-3 mL of a 1.5% solution) of anesthetic solution should be injected at least 5 minutes prior to administering the total dose. When clinical conditions permit, use of a test dose solution that contains epinephrine (e.g., 10-15 mcg) should be considered to detect inadvertent intravascular injection.
The test dose should be repeated if the patient is moved such that the epidural catheter may have been displaced. Rapid injection of a large, single dose through a catheter should be avoided; instead, the drug should be administered, when feasible, in fractional doses. In epidural anesthesia, 2-3 mL of the indicated solution is usually required for each dermatome to be anesthetized.
In caudal block for production of obstetric analgesia or in epidural thoracic block, 20-30 mL of a 1% solution (200-300 mg) of the drug may be used. For surgical anesthesia with caudal block, 15-20 mL of a 1.5% solution (225-300 mg) is given.
For epidural lumbar analgesia, the dose is 25-30 mL (250-300 mg) of a 1% solution, and for epidural lumbar anesthesia, the recommended dose is 15-20 mL of a 1.5% solution (225-300 mg) or 10-15 mL of a 2% solution (200-300 mg).
A solution of 5% lidocaine hydrochloride with 7.5% dextrose is used for spinal anesthesia in adults and adolescents 16 years of age or older. For obstetric low spinal or saddle-block anesthesia in a normal vaginal delivery, the dose is approximately 1 mL (50 mg).
For cesarean section or deliveries which require intrauterine manipulations, 1.5 mL of the 5% solution (75 mg) may be given. For surgical anesthesia, 1.5-2
mL of the 5% solution (75-100 mg) may be administered.
The following doses of lidocaine hydrochloride have been suggested for various nerve blocks: brachial nerve block, 15-20 mL of a 1.5% solution (225-300 mg); dental nerve block, 1-5 mL of a 2% solution (20-100 mg); intercostal nerve block, 3 mL of a 1% solution (30 mg); paravertebral nerve block, 3-5 mL of a 1% solution (30-50 mg); pudendal nerve block (each side), 10 mL of a 1% solution (100 mg); and paracervical nerve block (each side) for obstetric analgesia, 10 mL of a 1% solution (100 mg). For sympathetic nerve blocks, the following doses may be used: cervical (stellate ganglion) nerve block, 5 mL of a 1% solution (50 mg), and lumbar nerve block, 5-10 mL of a 1% solution (50-100 mg).
For percutaneous infiltration anesthesia, the dose of lidocaine hydrochloride is 1-60 mL of a 0.5 or 1% solution (5-300 mg). For IV regional anesthesia, 10-60 mL of a 0.5%
solution (50-300 mg) may be employed.
For retrobulbar injection, 3-5 mL of a 4% sterile solution (120-200 mg) or 1.7-3 mg/kg is suggested; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve.
For transtracheal injection, 2-3 mL of a 4% solution (80-120 mg) is administered rapidly. When both transtracheal injection and topical application (oropharyngeal spray) of a 4% solution are needed to achieve complete analgesia, the combined total dose of lidocaine hydrochloride administered by injection and by oropharyngeal spray should not exceed 5 mL of a 4% solution (200 mg) or 3 mg/kg.
Lidocaine hydrochloride with or without epinephrine is used for various dental procedures by infiltration injection or nerve block. In oral infiltration and/or mandibular block, initial doses of 1-5 mL of 2% lidocaine hydrochloride (20-100 mg) with epinephrine 1:100,000 are usually effective. If greater hemostasis is required, epinephrine 1:50,000 may be used.
In children younger than 10 years of age, 0.9-1 mL of 2% lidocaine hydrochloride (18-20 mg) is adequate for a procedure involving 1 tooth (local infiltration), 2-3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).
Dosage of lidocaine hydrochloride must be carefully adjusted according to individual requirements and response.
For the initial treatment of ventricular arrhythmias, lidocaine hydrochloride usually is administered as a rapid (i.e., bolus) IV injection. The manufacturer states that the usual adult dose of lidocaine hydrochloride is 50-100 mg administered at a rate of approximately 25-50 mg/minute by direct IV injection. If the desired response is not achieved, a second dose may be administered 5 minutes after completion of the first injection.
The manufacturer states that no more than 200-300 mg should be administered during a 1-hour period. Patients with congestive heart failure or cardiogenic shock may require smaller loading doses.
For the treatment of hemodynamically stable monomorphic ventricular tachycardia, the American Heart Association (AHA) recommends an initial adult dose of 1-1.5 mg/kg IV; additional doses of 0.5-0.75
mg/kg may be administered every 5-10 minutes as necessary, up to a maximum total dose of 3 mg/kg.
For the treatment of shock-resistant ventricular fibrillation or pulseless ventricular tachycardia during cardiac resuscitation, the initial adult loading dose of lidocaine hydrochloride is 1-1.5 mg/kg by IV or IO+ injection, followed by 0.5-0.75
mg/kg repeated at 5- to 10-minute intervals as necessary, up to a maximum total dose of 3 mg/kg.
If IV or IO+ access cannot be established during cardiac arrest, lidocaine may be administered via the endotracheal+ route. Although the optimum endotracheal dose of lidocaine hydrochloride remains to be established, some experts state that typical doses should be 2-2.5 times those administered IV, and generally should be diluted in 5-10 mL of 0.9%
sodium chloride or sterile water.
A maintenance infusion of lidocaine hydrochloride may be required to maintain normal sinus rhythm if oral antiarrhythmic therapy is not feasible. Following initial administration with direct IV injections, an IV infusion of lidocaine hydrochloride may be initiated at a rate of 1-4 mg/minute (14-57 mcg/kg per minute). Some clinicians recommend maintaining the infusion rate below 30 mcg/kg per minute in patients with congestive heart failure.
In patients with liver disease, dosing must be carefully individualized.
Major differences in lidocaine pharmacokinetics may exist for different types of liver disease (e.g., cirrhosis, hepatitis) and no consistent correlation has been established between clearance of the drug and severity of liver disease (as determined by liver function tests). No dosing modification appears to be necessary in patients with renal failure.
When arrhythmias reappear during a constant infusion of lidocaine hydrochloride, a small bolus dose (e.g., 0.5 mg/kg) may be given to rapidly increase plasma concentrations of the drug; the infusion rate is maintained or increased simultaneously. If the infusion rate alone is increased, a plateau or peak concentration of lidocaine may not be reached for 3-4 half-lives (5-8 hours).
The infusion should be terminated as soon as the patient's basic cardiac rhythm appears to be stable or at the earliest sign of toxicity. If signs of excessive cardiac depression, such as prolongation of the PR interval and QRS complex or the appearance or aggravation of arrhythmias occur, the infusion should be stopped immediately. The manufacturers state that it should rarely be necessary to continue the infusion for longer than 24 hours.
Clinical studies have reported continuation of lidocaine infusions for several days; however, there are data which indicate that the half-life of lidocaine may be increased to 3 hours or longer following infusions lasting longer than 24 hours, and dosage may need to be reduced accordingly (e.g., by 50%) to avoid accumulation of the drug and potential toxicity. If maintenance therapy is necessary, therapy should be changed to an oral antiarrhythmic agent.
Controlled clinical studies to establish pediatric dosing schedules of lidocaine hydrochloride have not been performed. Some clinicians have suggested that infants and children may be given an initial rapid IV injection (i.e., bolus) of 0.5-1 mg/kg; this dose may be repeated according to the response of the patient, but the total dose should not exceed 3-5 mg/kg.
A maintenance IV infusion of 10-50 mcg/kg per minute may be given via an infusion pump.
For the treatment of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia during pediatric resuscitation, the recommended dosage of lidocaine hydrochloride is an initial rapid IV or IO+ injection (i.e., bolus) of 1 mg/kg, followed by a maintenance infusion of 20-50 mcg/kg per minute. A repeat IV injection should be given if there is more than a 15-minute delay from the time of the initial rapid IV injection dose to the onset of the infusion.
If IV or IO+ access cannot be established, lidocaine may be administered via the endotracheal+ route. Although the optimum endotracheal dose of lidocaine hydrochloride remains to be established, some experts state that typical doses should be 2-2.5 times those administered IV.
If cardiopulmonary resuscitation (CPR) is in progress, chest compressions should be interrupted briefly to administer lidocaine. Following administration, the endotracheal tube should be flushed with 5 mL of 0.9% sodium chloride injection and followed by 5 consecutive positive-pressure ventilations.
Lidocaine hydrochloride may be administered by infiltration or by epidural (including caudal) block, peripheral or sympathetic nerve block, and subarachnoid block. The manufacturers state that only the preservative-free, epinephrine-free 0.5% lidocaine injection should be used for IV regional anesthesia.
Local anesthetics, including lidocaine hydrochloride, have been administered by continuous intra-articular infusion+ (e.g., for control of postoperative pain); however, such use has been associated with chondrolysis. Lidocaine hydrochloride solutions containing preservatives shouldnot be used for spinal or epidural (including caudal) block. Partially used bottles of solutions that do not contain preservatives should be discarded.
Aspiration for blood should be performed prior to injection of lidocaine hydrochloride to avoid inadvertent intravascular administration; however, a negative aspiration does not ensure protection against inadvertent intravascular injection. Local anesthetics should only be administered by clinicians who are experienced in the diagnosis and management of dose-related toxicities and other acute emergencies associated with these agents. Resuscitative equipment, oxygen, drugs, and personnel required for treatment of adverse reactions should be immediately available when lidocaine is administered.
Proper positioning of the patient is extremely important in spinal anesthesia. For specific procedures and techniques of administration, specialized references should be consulted.
Local anesthetics, including lidocaine hydrochloride, have been administered by continuous intra-articular infusion+ (e.g., for control of postoperative pain); however, such use has been associated with chondrolysis. Lidocaine hydrochloride solutions containing preservatives shouldnot be used for spinal or epidural (including caudal) block. Partially used bottles of solutions that do not contain preservatives should be discarded.
Aspiration for blood should be performed prior to injection of lidocaine hydrochloride to avoid inadvertent intravascular administration; however, a negative aspiration does not ensure protection against inadvertent intravascular injection. Local anesthetics should only be administered by clinicians who are experienced in the diagnosis and management of dose-related toxicities and other acute emergencies associated with these agents. Resuscitative equipment, oxygen, drugs, and personnel required for treatment of adverse reactions should be immediately available when lidocaine is administered.
Proper positioning of the patient is extremely important in spinal anesthesia. For specific procedures and techniques of administration, specialized references should be consulted.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for LIDOCAINE HCL (lidocaine hcl/pf):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Disopyramide/Class IB, II, and IV Antiarrhythmics SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Disopyramide has been shown to prolong the QTc interval. Concurrent use with other agents that affect the heart rate and rhythm may result in unpredictable effect on heart rhythm.(1-2) CLINICAL EFFECTS: The concurrent use of disopyramide with other agents that affect the heart rate and rhythm may result in in potentially life-threatening cardiac arrhythmias, including torsades de pointes.(1-2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of disopyramide states that concurrent use of disopyramide with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias who are demonstrably unresponsive to single-agent antiarrhythmic therapy.(3) The Australian manufacturer of disopyramide states that the concurrent use of other antiarrhythmics, such as Class I, II, III, or IV is contraindicated.(1) The US manufacturer of verapamil states that disopyramide should not be administered within 48 hours before or 24 hours after verapamil.(2) The Australian manufacturer of celiprolol states that the concurrent use of antiarrhythmics such as disopyramide is contraindicated during treatment with celiprolol (exception: intensive care).(4) If concurrent therapy is deemed medically necessary, obtain serum calcium, magnesium, and potassium levels and monitor ECG at baseline and at regular intervals. Correct any electrolyte abnormalities. Instruct patients to report any irregular heartbeat, dizziness, or fainting. DISCUSSION: Because combinations of antiarrhythmics are not well researched and concurrent use may result in unpredictable effects, the Australian manufacturer of disopyramide states that the concurrent use of other antiarrhythmics, such as Class I, II, III, or IV is contraindicated.(1) |
DISOPYRAMIDE PHOSPHATE, NORPACE, NORPACE CR |
There are 1 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Long-acting Bupivacaine/Local Anesthetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1) CLINICAL EFFECTS: Concurrent or use of local anesthetics with 96 hours of use of long-acting bupivacaine may result in neurologic and cardiovascular toxicity. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also result in methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1) PREDISPOSING FACTORS: Use of additional agents that are associated with methemoglobinemia may further increase the risk of methemoglobinemia.(1) Patients who are at increased risk of developing methemoglobinemia include those with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.(1) PATIENT MANAGEMENT: Avoid the use of other local anesthetics within 96 hours following the administration of long-acting bupivacaine. In patients for whom use is required, monitor for neurologic and cardiovascular effects. Also monitor for methemoglobinemia with use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine.(1,2) Non-liposomal bupivacaine may be administered in the same syringe as bupivacaine liposomal or injected immediately before bupivacaine liposomal as long as the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1) DISCUSSION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposome bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally. Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1) |
BUPIVACAINE LIPOSOME, EXPAREL, XARACOLL, ZYNRELEF |
There are 7 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Lidocaine/Cimetidine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Cimetidine reduces the hepatic clearance of lidocaine. Changes in hepatic blood flow may contribute. CLINICAL EFFECTS: Increased serum lidocaine levels with enhanced therapeutic and toxic response. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Patients receiving this combination should be monitored for signs of lidocaine toxicity. The dosage of lidocaine should be adjusted based on serum lidocaine levels and patient response. Since other H-2 antagonists (e.g., ranitidine, famotidine) do not appear to interact, substituting cimetidine with one of these agents may be desirable. However, if a patient is already receiving this combination and is not experiencing adverse effects, substitution is probably not necessary. DISCUSSION: This interaction is likely to occur. |
CIMETIDINE |
| Lidocaine/Beta-Blockers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Decreased cardiac output and hepatic blood flow due to beta-blockers may result in reduced elimination of lidocaine. Inhibition of hepatic microsomal enzymes may also contribute to decreased lidocaine clearance. CLINICAL EFFECTS: Lidocaine toxicity is more likely to occur when these drugs are used in combination. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The lidocaine dose may need to be adjusted when a beta-blocker is added or discontinued. Clinical signs of lidocaine toxicity and lidocaine plasma levels should be monitored. DISCUSSION: The effect seems to be more pronounced in the lipid soluble beta-blockers (eg. propranolol, metoprolol). |
BYSTOLIC, HEMANGEOL, INDERAL LA, INDERAL XL, INNOPRAN XL, KAPSPARGO SPRINKLE, LOPRESSOR, METOPROLOL SUCCINATE, METOPROLOL TARTRATE, METOPROLOL-HYDROCHLOROTHIAZIDE, NADOLOL, NEBIVOLOL HCL, PROPRANOLOL HCL, PROPRANOLOL HCL ER, TOPROL XL |
| Succinylcholine/Lidocaine; Procaine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Since both succinylcholine and procaine are metabolized by plasma pseudocholinesterase, competitive inhibition of succinylcholine metabolism by procaine is believed to be responsible. The mechanism between succinylcholine and lidocaine is not well understood. CLINICAL EFFECTS: The neuromuscular blocking activity of succinylcholine may be increased, producing profound sedation, respiratory depression, coma, and/or death. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If it is necessary to administer these drugs concurrently, do so with extreme caution. Monitor neuromuscular function and adjust the dose of the neuromuscular blocking agent accordingly. If concurrent use is necessary, monitor patients for unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. DISCUSSION: Available data indicate that intravenous administration of high doses of procaine prolonged the neuromuscular activity of succinylcholine. |
ANECTINE, QUELICIN, SUCCINYLCHOLINE CHLORIDE, SUCCINYLCHOLINE CHLORIDE-NACL |
| Lidocaine/Fluvoxamine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Fluvoxamine may inhibit the metabolism of lidocaine by CYP1A2.(1,2) CLINICAL EFFECTS: Concurrent or recent use of fluvoxamine may result in increased effects of lidocaine.(1,2) PREDISPOSING FACTORS: This interaction may be more severe in patients taking strong CYP3A4 inhibitors.(1,2) The interaction may be less clinically significant in patients with severe liver impairment.(3) PATIENT MANAGEMENT: Patients receiving this combination should be monitored for signs of lidocaine toxicity. The dosage of lidocaine should be adjusted based on serum lidocaine levels and patient response. DISCUSSION: In a study in 8 subjects, pretreatment with fluvoxamine (100 mg daily) for 6 days increased the peak concentration (Cmax) and area-under-curve (AUC) of oral lidocaine (1 mg/kg) by 220% and 305%, respectively. Pretreatment with fluvoxamine (100 mg daily) and erythromycin (1500 mg daily) for 6 days increased lidocaine Cmax and AUC by 250% and 360%, respectively.(1) In a study in 9 subjects, pretreatment with fluvoxamine (100 mg daily) for 6 days decreased the clearance of intravenous lidocaine by 41%. Pretreatment with fluvoxamine (100 mg daily) and erythromycin (1500 mg daily) for 6 days decreased the clearance of intravenous lidocaine by 53%.(2) In a study in 10 healths subjects, 10 patients with mild (Child grade A) liver impairment, and 10 patients with severe (Child grade C) liver impairment, fluvoxamine decreased lidocaine clearance by 60% in healthy subjects and by 44% in patients with mild liver impairment. However, there was no significant effect in patients with severe liver impairment.(3) |
FLUVOXAMINE MALEATE, FLUVOXAMINE MALEATE ER |
| Lacosamide/Sodium Channel Blockers; Potassium Channel Blockers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Lacosamide may enhance the slow inactivation of voltage-gated sodium channels and may cause dose-dependent bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1) CLINICAL EFFECTS: Concurrent use of lacosamide and agents that affect cardiac conduction (sodium channel blockers and potassium channel blockers) may increase the risk of bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction, including sodium channel blockers and potassium channel blockers.(1) If concurrent use is needed, obtain an ECG before lacosamide therapy and after lacosamide dose is titrated to steady-state.(1) Patients should be monitored closely when lacosamide is given intravenously.(1) DISCUSSION: In a clinical trial in patients with partial-onset seizures, asymptomatic first-degree atrioventricular (AV) block occurred in 4/944 (0.4%) of patient who received lacosamide compared to 0/364 (0%) with placebo.(1) In a clinical trial in patients with diabetic neuropathy, asymptomatic first-degree AV block occurred in 5/1023 (0.5%) of patients who received lacosamide compared to 0/291 (0%) with placebo.(1) Second-degree and complete AV block have been reported in patients with seizures.(1) One case of profound bradycardia was observed in a patient during a 15-minute infusion of 150 mg of lacosamide.(1) A case report of a 49 year old male with refractory complex partial and generalized seizures described the development of ventricular tachycardia four months after addition of lacosamide 400 mg/day to the existing regimen of carbamazepine, lamotrigine, clonazepam, and valproate. The patient's ECG showed first-degree AV block, posterior left fascicular block, and severe widening of the QRS complex, all of which resolved upon discontinuation of lacosamide.(2) |
LACOSAMIDE, MOTPOLY XR, VIMPAT |
| Lidocaine/Selected Protease Inhibitors; Cobicistat SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Protease inhibitors(1-15) may inhibit the metabolism of lidocaine via CYP3A4. CLINICAL EFFECTS: Concurrent use of protease inhibitors(1-15) with antiarrhythmic doses of lidocaine may result in elevated levels and toxicity from lidocaine. PREDISPOSING FACTORS: Lidocaine clearance is significantly impaired in patients with moderate or severe hepatic impairment. PATIENT MANAGEMENT: The US manufacturers of atazanavir,(1) atazanavir-cobicistat,(2) darunavir,(4) darunavir-cobicistat,(5) fosamprenavir,(8) indinavir,(10) lopinavir-ritonavir,(11) nelfinavir,(12) nirmatrelvir/ritonavir,(13) ombitasvir-paritaprevir-ritonavir,(14) and tipranavir(15) recommend caution and therapeutic concentration monitoring when lidocaine is administered concurrently as an antiarrhythmic. Recommendations differ in other regions. The UK manufacturer of atazanavir-cobicistat(3) and the Canadian manufacturer of darunavir,(6) darunavir-cobicistat,(7) and fosamprenavir(9) state that concurrent use of lidocaine is contraindicated. DISCUSSION: The protease inhibitors are moderate to strong inhibitors of CYP3A4, one of the metabolic pathways for lidocaine elimination.(16-17) |
APTIVUS, ATAZANAVIR SULFATE, DARUNAVIR, EVOTAZ, FOSAMPRENAVIR CALCIUM, GENVOYA, KALETRA, LOPINAVIR-RITONAVIR, PAXLOVID, PREZCOBIX, PREZISTA, REYATAZ, STRIBILD, SYMTUZA, VIRACEPT |
| Lidocaine/Phenytoin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Concurrent administration of lidocaine and phenytoin may result in additive effects. Lidocaine is a Class Ib antiarrhythmic. Phenytoin has Class Ib antiarrhythmic properties. CLINICAL EFFECTS: Concurrent use of lidocaine and phenytoin may result in additive effects on the heart, including arrhythmias.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: When used for the treatment of neonatal seizures, lidocaine should not be given to patients who are currently or recently received phenytoin.(1) If concurrent use is needed, cardiac monitoring is required.(1) For pediatric and adult patients, concurrent use of lidocaine and phenytoin should be approached with caution and monitored closely. DISCUSSION: Concurrent administration of lidocaine and phenytoin may result in additive effects. Lidocaine is a Class Ib antiarrhythmic. Phenytoin has Class Ib antiarrhythmic properties. Studies in neonates have evaluated the use of lidocaine and phenytoin for treatment of neonatal seizures. Studies recommended avoiding lidocaine use in neonates who are currently or recently received phenytoin. |
CEREBYX, DILANTIN, DILANTIN-125, FOSPHENYTOIN SODIUM, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED |
The following contraindication information is available for LIDOCAINE HCL (lidocaine hcl/pf):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 6 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Adams-stokes syndrome |
| Large open wound |
| Methemoglobinemia |
| Severe heart block |
| Systemic lidocaine toxicity |
| Wolff-parkinson-white pattern |
There are 14 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Chronic heart failure |
| Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min |
| Glucose-6-phosphate dehydrogenase (g6Pd) deficiency |
| Heart block |
| Hemolytic anemia from pyruvate kinase and g6PD deficiencies |
| Hypokalemia |
| Hypovolemia |
| Hypoxia |
| Incomplete AV heart block |
| Myasthenia gravis |
| Respiratory depression |
| Sepsis |
| Shock |
| Sinus bradycardia |
There are 4 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Atrial fibrillation |
| Disease of liver |
| Respiratory depression |
| Seizure disorder |
The following adverse reaction information is available for LIDOCAINE HCL (lidocaine hcl/pf):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 24 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Bradycardia Dermatitis due to topical drug Hypotension |
| Rare/Very Rare |
|---|
|
Acute respiratory failure Anaphylaxis Angioedema Bradycardia Bronchospastic pulmonary disease Cardiac arrest Cardiac arrhythmia CNS toxicity Cyanosis Diplopia Dyspnea Edema Eyelid edema Headache disorder Hypotension Methemoglobinemia Nausea Paralysis Respiratory depression Seizure disorder Unconsciousness |
There are 34 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Blanching of skin Dizziness Drowsy Edema Erythema Injection site sequelae Muscle fasciculation Nervousness Paresthesia Pruritus of skin Sensation of cold Skin rash Stinging of skin Symptoms of anxiety Urticaria |
| Rare/Very Rare |
|---|
|
Accidental fall Acute cognitive impairment Apprehension Back pain Blurred vision Dizziness Drowsy Euphoria General weakness Muscle fasciculation Nervousness Oral hypoesthesia Sensation of cold Sensation of warmth Skin lesion Tinnitus Tremor Urticaria Vomiting |
The following precautions are available for LIDOCAINE HCL (lidocaine hcl/pf):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Safe use of lidocaine during pregnancy (prior to labor) has not been established. The drug should be used during pregnancy only when clearly needed.
Since lidocaine is distributed into milk, the drug should be used with caution in nursing women. Limited data suggest that the amount of drug that potentially would be ingested by a breast-fed infant is small.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for LIDOCAINE HCL (lidocaine hcl/pf):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for LIDOCAINE HCL (lidocaine hcl/pf)'s list of indications:
| Mouth irritation | |
| K13.79 | Other lesions of oral mucosa |
| Urethritis | |
| N34.1 | Nonspecific urethritis |
| N34.2 | Other urethritis |
| Ventricular arrhythmias | |
| I49.01 | Ventricular fibrillation |
| I49.02 | Ventricular flutter |
| I49.9 | Cardiac arrhythmia, unspecified |
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