Brand Name
Alphacaine
(CAN), Anestacon, DermaFlex, Dilocaine, L-Caine, Lidoderm, Xylocaine, Xylocard
(CAN), Zingo
Class and
Category
Chemical
class: Aminoacetamide
Therapeutic
class: Class IB antiarrhythmic, local anesthetic
Pregnancy
category: B
Indications
and Dosages
To treat ventricular
tachycardia or ventricular fibrillation
I.V.
INFUSION AND INJECTION
Adults. Loading: 50 to 100
mg (or 1 to 1.5 mg/kg), given at 25 to 50 mg/min. If desired response isn’t
achieved after 5 to 10 min, second dose of 25 to 50 mg (or 0.5 to 0.75 mg/kg)
given every 5 to 10 min until maximum loading dose (300 mg in 1 hr) has been
given. Maintenance: 20 to 50 mcg/kg/min (1 to 4 mg/min) by continuous infusion.
Smaller bolus dose repeated 15 to 20 min after start of infusion if needed to
maintain therapeutic blood level. Maximum: 300 mg (or 3 mg/kg) over 1 hr.
Children. Loading: 1 mg/kg. Maintenance:
30 mcg/kg/min by continuous infusion. Maximum: 3 mg/kg.
DOSAGE
ADJUSTMENT
For elderly patients receiving
I.V. lidocaine to treat arrhythmias and for patients with acute hepatitis or decompensated
cirrhosis, loading dose and continuous infusion rate reduced by 50%.
I.M.
INJECTION
Adults. 300 mg,
repeated after 60 to 90 min, if needed.
To provide topical
anesthesia for skin or mucous membranes
FILM-FORMING
GEL, JELLY, OR OINTMENT
Adults. Thin layer
applied to skin or mucous membranes as needed before procedure.
TRANSDERMAL
PATCH
Adults. 1 to 3
patches applied over most painful area only once for up to 12 hr with-in a
24-hr period.
To provide topical
anesthesia before venous access procedures
POWDER
Children
ages 3 to 18. Compressed gas application of powder to selected skin site 1 to 3
minutes before procedure.
Route Onset Peak Duration
I.V. 45–90 sec Immediate 10–20 min
I.M. 5–15 min Unknown 60–90
min
Topical 2–5 min Unknown 0.5–1 hr
Mechanism
of Action
Combines with fast sodium
channels in myocardial cell membranes, which inhibits sodium influx into cells
and decreases ventricular depolarization, automaticity, and excitability during
diastole. Lidocaine also blocks nerve impulses by decreasing the permeability
of neuronal membranes to sodium, which produces local anesthesia.
Contraindications
Adams-Stokes syndrome;
hypersensitivity to lidocaine, amide anesthetics, or their components; severe
heart block (without artificial pacemaker);Wolff-Parkinson- White syndrome
Interactions
DRUGS
beta
blockers, cimetidine: Increased blood lidocaine level and risk of toxicity
MAO
inhibitors, tricyclic antidepressants: Risk of severe, prolonged
hypertension
mexiletine,
tocainide: Additive cardiac effects
neuromuscular
blockers: Possibly increased neuromuscular blockade
phenytoin,
procainamide: Increased cardiac depression
Adverse
Reactions
CNS: Anxiety,
confusion, difficulty speaking, dizziness, hallucinations, lethargy, paresthesia,
seizures
CV: Bradycardia,
cardiac arrest, hypotension, new or worsening arrhythmias
EENT: Blurred
vision, diplopia, tinnitus
GI: Nausea
MS: Muscle
weakness, myalgia
RESP: Respiratory
arrest or depression
Other: Hypersensitivity;
injection site burning, irritation, petechiae, redness, stinging, swelling, and
tenderness; worsened pain
Nursing
Considerations
•Observe for respiratory
depression after bolus injection and during I.V. infusion of lidocaine.
• Keep life-support
equipment and vasopressors nearby during I.V. use in case of respiratory
depression or other reactions.
• Carefully check prefilled
syringes before using. Use only syringes labeled “for cardiac arrhythmias” for
I.V. administration.
• As ordered, titrate I.V.
dose to minimum amount needed to prevent arrhythmias.
• During I.V.
administration, place patient on cardiac monitor, as ordered, and closely observe
her at all times.Monitor for worsening arrhythmias, widening QRS complex, and
prolonged PR interval—possible signs of drug toxicity.
• Check blood drug level,
as ordered. Therapeutic level is 2 to 5 mcg/ml.
• If signs of toxicity,
such as dizziness, occur, notify prescriber and expect to discontinue or slow
infusion.
• Give I.M. injection in
deltoid muscle only.
• Apply lidocaine jelly or
ointment to gauze or bandage before applying to skin.
•Monitor vital signs as
well as BUN and serum creatinine and electrolyte levels during and after
therapy.
PATIENT
TEACHING
• Inform patient who
receives lidocaine as an anesthetic that she’ll feel numbness.
• Advise patient to report
difficulty speaking, dizziness, injection site pain, nausea, numbness or
tingling, and vision changes.
• Caution patient to keep
lidocaine topical preparations and patches out of reach of children and pets.
• Tell patient to wash
hands thoroughly after handling lidocaine topical forms or patch and to avoid
getting drug in eyes.
• If patient uses patches,
tell her to store them in their sealed envelopes until needed and to apply
immediately after removing from the envelope. Tell patient to remove patch if
irritation or burning occurs at the site and not to reapply until irritation is
gone.
• Tell patient to fold used
patches so that the adhesive side sticks to itself and discard where children
or pets cannot get to them.
