LIDOCAINE (XYLOCAINE)

Class
Description
Onset and Duration
Indications
Contraindications
Adverse Reactions
Drug Interactions
How Supplied
Dosage and Administration
Special Considerations

LIDOCAINE (XYLOCAINE)
Class

Antidysrhvthmic (class Ib)

LIDOCAINE (XYLOCAINE)
Description

Lidocaine decreases phase-4 diastolic depolarization and suppresses premature ventricular contractions. In addition, it is used to treat ventricular tachycardia and some cases of ventricular fibrillation. Lidocaine also raises the ventricular fibrillation threshold.

LIDOCAINE (XYLOCAINE)
Onset & Duration

Onset:

30-90 sec

Duration:

2-4 hr

LIDOCAINE (XYLOCAINE)
Indications

Acute ventricular dysrhythmias

LIDOCAINE (XYLOCAINE)
Contraindications

Hypersensitivity
Stokes-Adams syndrome
Second- or third-degree heart block in the absence of an artificial pacemaker

LIDOCAINE (XYLOCAINE)
Adverse Reactions

Lightheadedness
Confusion
Blurred vision
Hypotension
Cardiovascular collapse
Bradycardia
CNS depression (altered level of consciousness, irritability, muscle twitching, seizures) with high doses

LIDOCAINE (XYLOCAINE)
Drug Interactions

Metabolic clearance of lidocaine may be decreased in patients taking beta-adrenergic blockers or in patients with liver dysfunction. Apnea induced witll succinylcholine may be prolonged with large doses of lidocaine. Cardiac depression may occur if lidocaine is given concomitantly with IV phenytoin. Additive neurological effects may occur with procainamide.

LIDOCAINE (XYLOCAINE)
How Supplied

Prefilled syringes:

100 mg in 5 ml of solution

1 and 2 g additive syringes

Ampules:

100 mg in 5 ml of solution

1- and 2g vials in 30 ml of solution

5 ml containing 100 mg/ml

LIDOCAINE (XYLOCAINE)
Dosage and Administration

Ventricular fibrillation or pulseless ventricular tachycardia

Adult:

15 mg/kg Repeat once in 3-5 min (maximum dose 3 mg/kg)

Pediatric:

1 mg/kg IV/IO per dose; Infusion: 20-50 mcg/kg/minute

Ventricular ectopy with a pulse

Adult:

1-1 5 mg/kg IV push. Additional boluses of 0 5-0.75 mg/kg can be given every 5-1 0 min (maximum dose 3 mg/kg). With resolution of ventricular ectopy, continuous infusion should be inititated at 2-4 mg/min.

Pediatric:

1 mg/kg IV/IO per dose; Infusion: 20-50 mcg/kg/min

LIDOCAINE (XYLOCAINE)
Special Considerations

Pregnancy safety: Category B.

Therapeutic plasma levels of lidocaine between 2-6 mcg/ml suppress ventricular dysrhythmias. A 75- to 100-mg bolus maintains adequate blood levels for only 20 min. If bradycardia occurs in conjunction with PVCs, always treat the bradycardia first with atropine, isoproterenol, or both. Exceedingly high doses of lidocaine can result in coma or death. Avoid lidocaine for reperfusion dysrhythmias after thrombolytic therapy.