Lidocaine Hydrochloride

Class: Class Ib Antiarrhythmics
Molecular Formula: C₂₅H₂₈N₆O₃S•½C₄H₄ O₄
CAS Number: 6108-05-0

Introduction

Antiarrhythmic agent; an amide-type local anesthetic, class IB agent.^a

Uses for Lidocaine Hydrochloride

Ventricular Arrhythmias

Alternative to other antiarrhythmic drugs (e.g., amiodarone, procainamide, sotalol) for the acute treatment of hemodynamically compromising ventricular ectopy (e.g., VPCs) that occurs following myocardial ischemia or infarction or during cardiac manipulative procedures such as cardiac surgery or cardiac catheterization.^{121 123 128}

Prophylactic use to reduce primary VF following AMI is not recommended.^{121 123 128}

Alternative antiarrhythmic agent to amiodarone in the treatment of cardiac arrest secondary to VF or pulseless VT resistant to CPR, cardioversion (e.g., after 2 to 3 shocks) and a vasopressor (epinephrine, vasopressin).^{121 123 128}

Alternative to other antiarrhythmic agents or synchronized electrical cardioversion in the treatment of hemodynamically stable monomorphic VT in patients with preserved ventricular function;^{123 128} however, other agents are preferred.¹²⁸

Alternative antiarrhythmic agent in the treatment of hemodynamically stable polymorphic VT in patients with normal baseline QT interval and preserved ventricular function (when ischemia is treated and electrolyte imbalance is corrected) or with prolonged baseline QT interval that suggests torsades de pointes;^{123 128} efficacy not established in torsades de pointes.¹²⁸

Drug-induced cardiovascular emergencies or altered vital signs: May consider use in tachycardia, impaired conduction/ventricular arrhythmias, hypertensive emergencies, or acute coronary syndrome associated with stimulants (e.g., amphetamine, methamphetamine, cocaine, phencyclidine, ephedrine), tricyclic antidepressant, cardiac glycoside, or class I antiarrhythmic (e.g., procainamide, disopyramide, propafenone, flecainide) toxicity; do not use in lidocaine overdose.¹²⁸ Safety and efficacy not established in drug-induced polymorphic VT.¹²⁸ Efficacy not established in torsades de pointes.¹²⁸

Status Epilepticus

Treatment of status epilepticus†, as a last resort.^a

Lidocaine Hydrochloride Dosage and Administration

General

Ventricular Arrhythmias

• 
  

  Solutions containing epinephrine must not be used to treat arrhythmias.^a

  
  


• 
  

  Adjust dosage carefully according to individual requirements and response;^b constant ECG monitoring is recommended.^b

  
  


• 
  

  Discontinue therapy for VF or VT (at least temporarily) after 6–24 hours to reassess ongoing need for antiarrhythmic drugs.¹²¹ Terminate infusion as soon as the basic cardiac rhythm appears to be stable or at the earliest sign of toxicity.^a Immediately stop infusion if signs of excessive cardiac depression occur (e.g., prolongation of PR interval and QRS complex, appearance or aggravation of arrhythmias).^b

  
  


• 
  

  Infusions continued for >24 hours should be rarely necessary.^b

  
  

Administration

Administer IV.^a Has been administered IM (no longer commercially available in the US); IV infusion is preferred.^a

For ACLS during CPR, may be administered via endotracheal tube† or by intraosseous injection† when IV administration is not possible.^{124 128} Although endotracheal† administration is possible, IV or intraosseous† administration is preferred because of more predictable drug delivery and pharmacologic effect.¹²⁸

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer as a bolus IV injection for initial treatment of ventricular arrhythmias.^a Maintenance IV infusions may be required to maintain normal sinus rhythm if oral antiarrhythmic therapy is not feasible.^a

Administer via a peripheral vein (antecubital or external jugular in adults and the largest most accessible vein that does not interrupt resuscitation in pediatric patients) during CPR when a vein has not been cannulated prior to the arrest, since central venous access requires interruption of chest compressions, is technically more difficult, and is associated with an increased risk of complications.^{123 124 128}

Administer via a central venous catheter (if already in place at the time of arrest) because of more rapid onset of drug activity (in adults),^{123 128} more secure access to circulation, and avoidance of tissue infiltration.^{124 128}

Avoid central venous line placement in candidates for pharmacologic reperfusion (e.g., with thrombolytic therapy) and/or fibrinolytic therapy.^{123 128}

Injections containing preservatives should not be given IV.^a

Do not introduce additives into solutions of lidocaine in 5% dextrose, since dosage is titrated to response.^b

Do not add to blood transfusion assemblies.^a

Do not use commercially available solutions of lidocaine in 5% dextrose in series connections with other plastic containers; such use could result in air embolism.^a

Dilution

Lidocaine hydrochloride injections containing 40, 100, or 200 mg/mL are for the preparation of IV infusion solutions and must be diluted prior to administration. Massive overdosage resulting in cardiac arrest, seizures, and/or death may occur if administered by direct IV administration without prior dilution.^a

Prepare IV infusions by adding 1 g of lidocaine hydrochloride (25 mL of 4% or 5 mL of 20% lidocaine hydrochloride injection) to 1 L of 5% dextrose injection to provide a solution containing 1 mg/mL.^a

Alternatively, use commercially available 0.4 or 0.8% solutions in 5% dextrose.^a

If fluid restriction is desirable, up to 8 mg/mL may be used.^b

Rate of Administration

Administer IV bolus dose at a rate of 25–50 mg/minute (0.35–0.7 mg/kg per minute).^{100 121 123 128}

Administer maintenance infusions at a rate of 20–50 mcg/kg per minute in adults or 10–50 mcg/kg per minute in pediatric patients.^{a b}

For other populations, see Special Populations under Dosage and Administration.

Intraosseous Administration

For intraosseous injection, place a cannula in a noncollapsible marrow venous plexus using a rigid needle, preferably a specially designed intraosseous or Jamshidi-type bone marrow needle; a styleted needle is preferred to prevent obstruction of the needle with cortical bone.¹²⁴

Insert intraosseous needle into the anterior tibial bone marrow; alternatively, the distal femur, medial malleolus, or anterior superior iliac spine can be used.¹²⁴ In older children and adults, intraosseous cannulas may be inserted into the distal radius or ulna in addition to the proximal tibia.¹²⁴

Endotracheal Administration

For administration via endotracheal tube, dilute dose in 5–10 mL of 0.9% sodium chloride or sterile water (for adults)^{123 128} or flush with a minimum of 5 mL of 0.9% sodium chloride followed by 5 assisted manual ventilations (for pediatric patients).^{124 128} Dilution in sterile water may increase absorption of lidocaine;^{123 128} however, sterile water may have a more negative effect on arterial oxygen pressure (PaO₂).¹²³

Dosage

Available as lidocaine hydrochloride; dosage is expressed in terms of the salt.^a

Pediatric Patients

Ventricular Arrhythmias

IV

Initially, 0.5–1 mg/kg as a rapid IV injection (i.e., bolus); dose may be repeated according to patient response, up to a maximum total dose of 3–5 mg/kg.^a Maintenance infusion of 10–50 mcg/kg per minute.^a

For ACLS, 1 mg/kg initially, up to maximum initial dose of 100 mg.^{106 124 128 129} If VT or VF is not corrected following defibrillation (or cardioversion) and initial lidocaine dose, give 20–50 mcg/kg per minute as an IV infusion.^{124 128} If the time between initial IV bolus dose and onset of IV infusion exceeds 15 minutes, give an additional IV bolus of 0.5–1 mg/kg.^{106 124}

Intraosseous

Initially, 1 mg/kg, up to maximum initial dose of 100 mg.^{106 124 128 129} If VT or VF is not corrected following defibrillation (or cardioversion) and initial lidocaine dose, give infusion of 20–50 mcg/kg per minute.^{124 128}

Endotracheal

Optimal dose not established.¹²⁸

Initially, 2–3 mg/kg;^{106 124 128 130} however, 2–2.5 times the recommended IV dosage may be recommended.^{124 128}

Adults

Ventricular Arrhythmias

IV

Initial doses ranging from 0.5–0.75 mg/kg and up to 1–1.5 mg/kg (about 50–100 mg) administered as rapid IV injection may be used.^{100 128} If desired response is not achieved, 25–50 mg may be administered 5 minutes after completion of the first injection,¹⁰⁰ or 0.5–0.75 mg/kg as rapid IV injection may be repeated at 5- to 10-minute intervals as necessary, up to a total of 3 doses (or up to 3 mg/kg).^{121 123 128}

Cardiac arrest secondary to VF or pulseless VT: 1–1.5 mg/kg as initial loading dose,^{121 123 128} then 0.5–0.75 mg/kg as rapid IV injection repeated at 5- to 10-minute intervals as necessary, up to a total of 3 doses (or up to 3 mg/kg).^{121 123 128}

Maintenance infusion of 30–50 mcg/kg per minute (1–4 mg/minute in an average 70-kg adult).¹²⁸

If arrhythmias recur during maintenance infusion, administer 0.5 mg/kg as a bolus dose while maintaining or increasing infusion rate simultaneously up to a maximum rate of 4 mg/minute.¹²³

Intraosseous

Cardiac arrest secondary to VF or pulseless VT: 1–1.5 mg/kg as initial loading dose, then 0.5–0.75 mg/kg repeated at 5- to 10-minute intervals as necessary, up to a total of 3 doses (or up to 3 mg/kg).¹²⁸

Endotracheal

Optimal dose not established.¹²⁸

Usually, 2–2.5 times the recommended IV dosage.^{123 128}

Status Epilepticus†

IV

Initially, 1 mg/kg.^a After 2 minutes, administer 0.5 mg/kg if seizure is not terminated.^a Maintenance infusion of 30 mcg/kg per minute for prevention of seizure recurrence.^a

Prescribing Limits

Pediatric Patients

Ventricular Arrhythmias

IV

Maximum 3–5 mg/kg for initial treatment.^a

ACLS: 1 mg/kg initially up to maximum initial dose of 100 mg.^{128 129}

Intraosseous

ACLS: 1 mg/kg initially up to maximum initial dose of 100 mg.^{128 129}

Adults

Ventricular Arrhythmias

IV

Maximum 3 mg/kg as total dose for initial treatment.^{121 123 128}

Maximum total dose of 200–300 mg over a 1-hour period.¹⁰⁰

Maximum 4 mg/minute as maintenance infusion.^{123 128}

Special Populations

Hepatic Impairment

Careful and individualized dosing recommended.^{32 107 108 109 110 111 112 113 114 115 116}

Slower infusion rates (e.g., 50% of usual maintenance infusion) recommended.¹²³

Reduce infusion rate after 24 hours to 1–2 mg/minute; dosage reduction may be guided by plasma lidocaine concentrations.¹²¹

Renal Impairment

Dosage modification not required.^a

Geriatric Patients

Slower infusion rates (e.g., 50% of usual maintenance infusion) recommended in patients >70 years of age.¹²³

Decreased Cardiac Output

Smaller bolus doses may be required.^a

Slower infusion rates (e.g., 50% of usual maintenance infusion) recommended in patients with decreased cardiac output (e.g., hypotension or shock associated with AMI, poor peripheral perfusion states, CHF).¹²³

Maximum infusion rate of 20 mcg/kg per minute in patients with persistently poor cardiac output and hepatic or renal failure;¹²⁴ <30 mcg/kg per minute in patients with CHF.^a

Reduce infusion rate after 24 hours to 1–2 mg/minute; dosage reduction may be guided by plasma lidocaine concentrations.¹²¹

Patients Requiring Prolonged Therapy

Possible increased half-life following infusions lasting>24 hours; reduce dosage accordingly (e.g., by 50%) to avoid accumulation of the drug and potential toxicity.^a

Cautions for Lidocaine Hydrochloride

Contraindications

• 
  

  Adams-Stokes syndrome; severe degrees of SA, AV, or intraventricular heart block (unless a functioning pacemaker is present).^b Some manufacturers state that lidocaine is contraindicated in patients with Wolff-Parkinson-White syndrome.^b

  
  


• 
  

  Known hypersensitivity to amide-type local anesthetics.^b

  
  

Warnings/Precautions

Warnings

Cardiac Monitoring

Constant ECG monitoring is necessary during IV administration.^b Discontinue infusion if signs of excessive cardiac depression occur (e.g., prolongation of PR interval and QRS complex, appearance or aggravation of arrhythmias).^b

Severe Reactions

Resuscitative equipment and drugs should be immediately available for the management of severe adverse cardiovascular, respiratory, or CNS effects.^b Discontinue therapy if severe reactions occur; institute emergency resuscitative procedures and other supportive measures as required.^{a b}

Severe reactions may be preceded by somnolence and paresthesia.^a

Sensitivity Reactions

Hypersensitivity

Possible hypersensitivity reactions (e.g., skin lesions, urticaria, edema, anaphylactoid reactions).^a

General Precautions

Prolonged Therapy

Possible increased half-life following infusions lasting >24 hours; reduce dosage accordingly (see Patients Requiring Prolonged Therapy under Dosage and Administration).^a

If maintenance therapy is necessary, an oral antiarrhythmic agent (e.g., procainamide) is recommended.^a

Nervous System Effects

Possible muscle twitching or tremors, seizures, unconsciousness, and coma;^{a b 128} may be associated with high doses or overdosage.^b

Possible drowsiness, disorientation, slurred speech, and altered consciousness.¹²⁸

Cardiovascular Effects

Possible hypotension, arrhythmias, heart block, cardiovascular collapse, and bradycardia,^{a b 128} which may lead to cardiac arrest in patients with high plasma lidocaine concentrations or myocardial conduction defects.^{a b}

Possible serious ventricular arrhythmias or heart block in patients with sinus bradycardia;^a potentially life-threatening adverse effects in patients with symptomatic bradycardia.¹²³

Possible increased sensitivity to cardiac depressant effects in patients with a diseased or abnormal sinus node.^a

Possible increased ventricular rate in patients with atrial fibrillation.^a

Possible increased coronary blood flow in patients with recent MI.^a

Possible myocardial and circulatory depression.¹²⁸

Cautious use recommended in patients with any form of heart block, CHF, marked hypoxia, severe respiratory depression, hypovolemia, or shock.^a

Respiratory Effects

Possible respiratory depression and arrest;^{a b} may be associated with high doses or overdosage.^b

Local Effects

Possible local thrombophlebitis in patients receiving prolonged IV infusions.^a

Tissue infiltration may lead to local ischemia, tissue injury, and ulceration.¹²⁸

Laboratory Test Interference

Possible increased serum CK (CPK) concentrations associated with IM injections.^a Isoenzyme separation is necessary when CK determinations are used in the diagnosis of AMI.^a

Specific Populations

Pregnancy

Category B.^b

Lactation

Distributed into milk.¹¹⁷ Use with caution.¹⁰⁰

Pediatric Use

Safety and efficacy not established in controlled clinical studies;¹⁰⁰ however, lidocaine has been used for treatment of ventricular arrhythmias in infants and children.^{123 128}

Use may be considered in children as an alternative antiarrhythmic agent, if amiodarone is unavailable, in the treatment of cardiac arrest secondary to VF or pulseless VT resistant to CPR, cardioversion, and epinephrine.^{124 128}

Hepatic Impairment

Use with caution.^a (See Pharmacokinetics and also see Hepatic Impairment under Dosage and Administration.)

Renal Impairment

Use with caution in severe renal impairment.^a (See Elimination: Special Populations, under Pharmacokinetics.)

Common Adverse Effects

Adverse CNS effects (e.g., drowsiness, dizziness, disorientation, confusion, lightheadedness, tremulousness, psychosis, nervousness, apprehension, agitation, euphoria, tinnitus, visual disturbances, paresthesia, difficulty swallowing, dyspnea, slurred speech, sensations of heat, cold, or numbness), nausea, vomiting.^b

Interactions for Lidocaine Hydrochloride

Antiarrhythmic Agents

Potential pharmacologic interaction (additive or antagonistic cardiac effects and additive toxicity) with concomitant administration of antiarrhythmic agents (e.g., phenytoin, procainamide, propranolol, quinidine).^a

Specific Drugs

Drug	Interaction	Comments
Cimetidine	Decreased lidocaine clearancea	Monitor serum lidocaine concentrations and observe closely for signs of lidocaine toxicitya
Phenytoin	Possible increased lidocaine metabolismb	Clinical importance unknownb
Propranolol	Decreased lidocaine clearancea	Monitor serum lidocaine concentrations and observe closely for signs of lidocaine toxicitya
Succinylcholine	Increased neuromuscular blocking effecta	Appears to be important only at lidocaine doses higher than those used clinicallya

Lidocaine Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Absorbed from the GI tract, but passes into hepatic circulation and only about 35% of an oral dose reaches the systemic circulation unchanged.^a Toxic effects appear at oral doses that fail to produce therapeutic plasma concentrations.^a

Following IM (deltoid) injection, peak plasma concentrations are achieved in 10 minutes.^a

Onset

Following direct IV (bolus) administration of 50–100 mg, onset of action is 45–90 seconds.^a

Duration

Following direct IV (bolus) administration of 50–100 mg, duration is 10–20 minutes.^a

Plasma Concentrations

Plasma lidocaine concentrations of 1–5 mcg/mL are required to suppress ventricular arrhythmias; concentrations exceeding 5 mcg/mL associated with toxicity.^a

Distribution

Extent

Widely distributed into body tissues.^a Readily crosses the blood-brain barrier.¹¹⁷ Crosses the placenta and is distributed into milk.¹¹⁷

Early, rapid decline in plasma concentrations is associated with distribution into highly perfused tissues (e.g., kidneys, lungs, liver, heart);^a slower elimination phase associated with metabolism and redistribution into skeletal muscle and adipose tissue.^a

Plasma Protein Binding

Binding is variable and concentration dependent;^{100 101 102 103 104 105} 60 –80% bound to plasma proteins at concentrations of 1–4 mcg/mL.^{100 101 102 103 104 105} Partially bound to α₁-acid glycoprotein.^{100 102 103 104 105}

Special Populations

Volume of distribution is decreased in patients with CHF and increased in patients with liver disease.^a

Elimination

Metabolism

Approximately 90% of a parenteral dose is metabolized rapidly in the liver by de-ethylation to the active metabolites monoethylglycinexylidide (MEGX) and glycinexylidide (GX).^a Rate of metabolism appears to be limited by hepatic blood flow.^a

Elimination Route

Excreted in urine principally as metabolites.^a

Half-life

Lidocaine has an initial half-life of 7–30 minutes and a terminal half-life of 1.5–2 hours.^a Elimination half-lives of MEGX and GX are 2 and 10 hours, respectively.^a

Special Populations

Rate of metabolism of lidocaine may be decreased and the half-life increased in patients with liver disease.^a Major differences may exist in pharmacokinetics for different types of liver disease (e.g., cirrhosis, hepatitis); no consistent correlation established between clearance and severity of liver disease (as determined by liver function tests).^{32 107 108 109 110 111 112 113 114 115 116}

GX may accumulate in patients with renal failure.^a

In patients with MI, the half-lives of lidocaine and its metabolites appear to be prolonged.^a

In patients with CHF, half-life of lidocaine may be prolonged.^a

In individuals receiving continuous IV infusions lasting >24 hours, half-life of lidocaine may be prolonged.^a

Stability

Storage

Parenteral

Injection

25°C; may be exposed briefly to temperatures up to 40°C.^a Do not freeze; protect from excessive heat.^a

Extemporaneously prepared solutions (1–4 mg/mL in 5% dextrose injection) appear to be stable at room temperature for at least 24 hours.^a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility^HID

Compatible
Amino acids 4.25%, dextrose 25%
Dextrose 5% in Ringer’s injection, lactated
Dextrose 5% in sodium chloride 0.45 or 0.9%
Dextrose 5% in water
Ringer’s injection, lactated
Sodium chloride 0.45 or 0.9%

Drug Compatibility

Drugs that require low pH for stability (e.g., dopamine, epinephrine, norepinephrine, isoproterenol) may be adversely affected by the pH of lidocaine (5–7).^a Use such mixtures promptly after preparation or consider separate administration of the drugs.^a The manufacturers state that commercially available solutions of lidocaine hydrochloride in 5% dextrose should not be mixed with other drugs.^{a b}

Admixture CompatibilityHID

Compatible
Alteplase
Aminophylline
Amiodarone HCl
Atracurium besylate
Bretylium tosylate
Calcium chloride
Calcium gluconate
Chloramphenicol sodium succinate
Chlorothiazide sodium
Cimetidine HCl
Ciprofloxacin
Dexamethasone sodium phosphate
Digoxin
Diphenhydramine HCl
Dobutamine HCl
Dopamine HCl
Ephedrine sulfate
Erythromycin lactobionate
Flumazenil
Furosemide
Heparin sodium
Hydrocortisone sodium succinate
Hydroxyzine HCl
Mephentermine sulfate
Metaraminol bitartrate
Nafcillin sodium
Nitroglycerin
Penicillin G potassium
Pentobarbital sodium
Phenylephrine HCl
Potassium chloride
Procainamide HCl
Prochlorperazine edisylate
Propafenone HCl
Ranitidine HCl
Sodium bicarbonate
Sodium lactate
Theophylline
Verapamil HCl
Vitamin B complex with C
Incompatible
Methohexital sodium
Phenytoin sodium
Variable
Fentanyl citrate

Y-Site Injection CompatibilityHID

Compatible
Alteplase
Amiodarone HCl
Bivalirudin
Cefazolin sodium
Ciprofloxacin
Clarithromycin
Daptomycin
Dexmedetomidine HCl
Diltiazem HCl
Dobutamine HCl
Dobutamine HCl with dopamine HCl
Dobutamine HCl with nitroglycerin
Dobutamine HCl with sodium nitroprusside
Dopamine HCl
Dopamine HCl with dobutamine HCl
Dopamine HCl with nitroglycerin
Dopamine HCl with sodium nitroprusside
Enalaprilat
Etomidate
Famotidine
Fenoldopam mesylate
Haloperidol lactate
Heparin sodium
Heparin sodium with hydrocortisone sodium succinate
Hetastarch in lactated electrolyte injection (Hextend)
Inamrinone lactate
Labetalol HCl
Levofloxacin
Linezolid
Meperidine HCl
Morphine sulfate
Nicardipine HCl
Nitroglycerin
Nitroglycerin with dobutamine HCl
Nitroglycerin with dopamine HCl
Nitroglycerin with sodium nitroprusside
Potassium chloride
Propofol
Remifentanil HCl
Sodium nitroprusside
Sodium nitroprusside with dobutamine HCl
Sodium nitroprusside with dopamine HCl
Sodium nitroprusside with nitroglycerin
Streptokinase
Theophylline
Tirofiban HCl
Vasopressin
Vitamin B complex with C
Warfarin sodium
Incompatible
Amphotericin B cholesteryl sulfate complex
Lansoprazole
Thiopental sodium

ActionsActions

• 
  

  Membrane-stabilizing antiarrhythmic agent.^a Combines with fast sodium channels in their inactive state and inhibits recovery after repolarization in a time- and voltage-dependent manner.^a Exhibits rapid rates of attachment to and dissociation from transmembrane sodium channels.^a

  
  


• 
  

  Controls ventricular arrhythmias by suppressing automaticity in His-Purkinje system and by suppressing spontaneous depolarization of the ventricles during diastole.^{a b 128}

  
  


• 
  

  Little effect on AV node conduction and His-Purkinje conduction in normal heart at therapeutic concentrations.^a Affects conducting tissues of ventricles more than atria.^a Variable effect on the effective refractory period (ERP) of the AV node; ERP and action potential duration of the His-Purkinje system are shortened.^a

  
  


• 
  

  Cardiac actions appear to be similar to those of phenytoin.^a

  
  


• 
  

  CNS depressant.^a Produces sedative, analgesic, and anticonvulsant effects.^a Suppresses cough and gag reflexes.^a

  
  


• 
  

  Produces little effect on autonomic tone; generally does not produce a substantial fall in BP, decreased myocardial contractility, or diminished cardiac output.^a Usually has little effect on heart rate.^a

  
  

Advice to Patients

• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and of concomitant illnesses.^a

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^b

  
  


• 
  

  Importance of advising patients of other important precautionary information.^b (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lidocaine Hydrochloride

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection, for direct IV injection	10 mg/mL*	Lidocaine Hydrochloride Injection for Cardiac Arrhythmias
		20 mg/mL*	Lidocaine Hydrochloride Injection for Cardiac Arrhythmias
	Injection, for preparation of IV infusion only	100 mg/mL (1 g)*	Lidocaine Hydrochloride Injection for Cardiac Arrhythmias
		200 mg/mL (1 or 2 g)*	Lidocaine Hydrochloride Injection for Cardiac Arrhythmias

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Lidocaine Hydrochloride in Dextrose

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection, for IV infusion	4 mg/mL (1 or 2 g) Lidocaine Hydrochloride in 5% Dextrose*	0.4% Lidocaine Hydrochloride and 5% Dextrose Injection (LifeCare and glass containers [Hospira], Viaflex [Baxter], Excel [Braun])
		8 mg/mL (2 or 4 g) Lidocaine Hydrochloride in 5% Dextrose*	0.8% Lidocaine Hydrochloride and 5% Dextrose Injection (LifeCare [Hospira], Viaflex [Baxter], Excel [Braun])

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions August 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

32. Thomson PD, Melmon KL, Richardson JA et al. Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans. Ann Intern Med. 1973; 78:499-508. [IDIS 31055] [PubMed 4694036]

52. Anon. Lignocaine for acute ventricular arrhythmias. Drug Ther Bull. 1969; 7:5-6. [PubMed 5763260]

100. Astra Pharmaceutical Products, Inc. Xylocaine (lidocaine hydrochloride) solution for ventricular arrhythmias prescribing information. Westborough, MA; 1997 Jun.

101. Tucker GT, Boyes RN, Bridenbaugh PO et al. Binding of anilide-type local anesthetics in human plasma. I. Relationships between binding, physiochemical properties and anesthetic activity. Anesthesiology. 1970; 33:287-303. [PubMed 5454949]

102. Routledge PA, Barchowsky A, Bjornsson TD et al. Lidocaine plasma protein binding. Clin Pharmacol Ther. 1980; 27:347-51. [IDIS 113908] [PubMed 7357791]

103. Routledge PA, Stargel WW, Wagner GS et al. Increased alpha-1-acid glycoprotein and lidocaine disposition in myocardial infarction. Ann Intern Med. 1980; 93:701-4. [IDIS 124049] [PubMed 7212479]

104. Routledge PA, Shand DG, Barchowsky A et al. Relationship between α₁-acid glycoprotein and lidocaine disposition in myocardial infarction. Clin Pharmacol Ther. 1981; 30:154-7. [IDIS 136577] [PubMed 7249498]

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106. Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). JAMA. 1986; 255:2905-84.

107. Forrest JAH, Finlayson NDC, Adjepon-Yamoah KK et al. Antipyrine, paracetamol, and lignocaine elimination in chronic liver disease. Br Med J. 1977; 1:1384-7. [PubMed 861646]

108. Williams RL, Blaschke TF, Meffin PJ et al. Influence of viral hepatitis on the disposition of two compounds with high hepatic clearance: lidocaine and indocyanine green. Clin Pharmacol Ther. 1976; 20:290-9. [PubMed 954351]

109. Selden R, Sasahara AA. Central nervous system toxicity induced by lidocaine: report of a case in a patient with liver disease. JAMA. 1967; 202:908-9. [PubMed 6072663]

110. Waller ES. Pharmacokinetic principles of lidocaine dosing in relation to disease state. J Clin Pharmacol. 1981; 21:181-94. [IDIS 158243] [PubMed 7240439]

111. Williams RL. Drug administration in hepatic disease. N Engl J Med. 1983; 309:1616-22. [IDIS 179500] [PubMed 6358891]

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