Lidocaine is a local anesthetic and class 1b antiarrhythmic that is used intravenously to treat ventricular arrhythmias, especially after a myocardial infarction. It comes in pre-filled syringes and ampoules in concentrations of 1% and 2%. The intravenous injection dose for ventricular arrhythmias is 100 mg administered over 1-2 minutes, followed by an intravenous infusion of 4 mg/minute for 30 minutes then 2 mg/minute for 2 hours then 1 mg/minute. Close monitoring of ECG, heart rate, blood pressure and the infusion site is required when administering intravenous lidocaine due to risks of cardiac toxicity, central nervous system effects and tissue damage from extravasation.
Lidocaine is a local anesthetic and class 1b antiarrhythmic that is used intravenously to treat ventricular arrhythmias, especially after a myocardial infarction. It comes in pre-filled syringes and ampoules in concentrations of 1% and 2%. The intravenous injection dose for ventricular arrhythmias is 100 mg administered over 1-2 minutes, followed by an intravenous infusion of 4 mg/minute for 30 minutes then 2 mg/minute for 2 hours then 1 mg/minute. Close monitoring of ECG, heart rate, blood pressure and the infusion site is required when administering intravenous lidocaine due to risks of cardiac toxicity, central nervous system effects and tissue damage from extravasation.
Lidocaine is a local anesthetic and class 1b antiarrhythmic that is used intravenously to treat ventricular arrhythmias, especially after a myocardial infarction. It comes in pre-filled syringes and ampoules in concentrations of 1% and 2%. The intravenous injection dose for ventricular arrhythmias is 100 mg administered over 1-2 minutes, followed by an intravenous infusion of 4 mg/minute for 30 minutes then 2 mg/minute for 2 hours then 1 mg/minute. Close monitoring of ECG, heart rate, blood pressure and the infusion site is required when administering intravenous lidocaine due to risks of cardiac toxicity, central nervous system effects and tissue damage from extravasation.
Lidocaine is a local anesthetic and class 1b antiarrhythmic that is used intravenously to treat ventricular arrhythmias, especially after a myocardial infarction. It comes in pre-filled syringes and ampoules in concentrations of 1% and 2%. The intravenous injection dose for ventricular arrhythmias is 100 mg administered over 1-2 minutes, followed by an intravenous infusion of 4 mg/minute for 30 minutes then 2 mg/minute for 2 hours then 1 mg/minute. Close monitoring of ECG, heart rate, blood pressure and the infusion site is required when administering intravenous lidocaine due to risks of cardiac toxicity, central nervous system effects and tissue damage from extravasation.
10mg/mL (1%) in 10-mL pre-filled syringes; 20mg/mL (2%) in 5-mL pre-filled
syringes 10mg/mL (1%) solution and 20mg/mL (2%) solution in 2-mL, 5-mL, 10mL and 20-mL ampoules 1mg/mL (0.1%) and 2mg/mL (0.2%) in Gluc 5% in 500mL infusion bags * Lidocaine is a local anaesthetic and it also has class 1b antiarrhythmic effects. * It is used IV to treat ventricular arrhythmias, especially after MI. * Doses are expressed in terms of lidocaine hydrochloride. Products containing adrenaline (epinephrine) or preservatives must not be given by IV injection. Pre-treatment checks * Caution in patients with porphyria. * In IV therapy resuscitative equipment and drugs should be immediately available for the management of severe adverse cardiovascular, respiratory or central nervous system effects. Biochemical and other tests (not all are necessary in an emergency situation) Possibly prior to IV treatment: ECG Electrolytes: serum K (correct #K before commencing therapy) Renal function: U, Cr, CrCl (or eGFR) Dose Ventricular arrhythmias: 100 mg by IV injection in patients without gross circulatory impairment (50 mg in lighter patients or those whose circulation is severely impaired); followed immediately by 4 mg/minute by IV infusion for 30 minutes, then 2 mg/minute for 2 hours, then 1 mg/minute. Reduce the rate further if infusion is continued beyond 24 hours (rarely required). * The IV injection dose can be repeated once or twice at intervals of not less than 10 minutes if an infusion is not immediately available. * Stop the infusion as soon as the basic cardiac rhythm appears to be stable or at the earliest signs of toxicity. Intravenous injection Preparation and administration 1. Select the appropriate pre-filled syringe. Expel any excess lidocaine if necessary. Alternatively, withdraw the required dose. 2. The solution should be clear and colourless. Inspect visually for particulate matter or discoloration prior to administration and discard if present. 3. Give by IV injection at a rate of 25--50 mg/minute, i.e. give 1% injection at 2.5--5 mL/minute; give 2% injection at 1.25--2.5 mL/minute. Continuous intravenous infusion Preparation and administration 1. Select the correct pre-prepared infusion bag. Alternatively, withdraw the required dose of 1% or 2% injection and add to a suitable volume (usually 500 mL) of Gluc 5% to give a solution containing between 1 mg/mL and 4 mg/mL. Mix well. 2. The solution should be clear and colourless. Inspect visually for particulate matter or discoloration prior to administration and discard if present. 3. Give by IV infusion via a volumetric infusion device at the appropriate rate (see Dose above)
Technical information Incompatible with Amphotericin, thiopental sodium. Compatible with Flush: NaCl 0.9% Solutions: Gluc 5%, NaCl 0.9%, Hartmanns (all with added KCl) Y-site: Alteplase, bivalirudin, cisatracurium, ciprofloxacin,
propofol, remifentanil, streptokinase, tirofiban pH 5--7 for injection solutions; 3.5--7 for infusions in Gluc Sodium content Negligible Storage Store below 25C in original packaging. Stability after preparation From a microbiological point of view, should be used immediately; however, prepared infusions may be stored at 2--8C and infused (at room temperature) within 24 hours.
Monitoring Measure
Frequency
ECG, heart rate and blood pressure
Continuously Response to therapy. * #BP and #pulse may lead to cardiac arrest.
CNS toxicity * Infusion site tissue damage
Rationale
Convulsions, respiratory depression may occur. Half-hourly *
Extravasation may cause
Additional information Common and serious undesirable effects Immediate: Anaphylaxis and other hypersensitivity reactions have rarely been reported. Injection/infusion-related: * Too rapid administration: Dizziness, paraesthesia, drowsiness, #BP, #pulse. * Local: Extravasation may cause tissue damage. Other: Apprehension, nervousness, euphoria, tinnitus, blurred or double vision, nystagmus, vomiting, sensations of heat, cold or numbness, twitching, tremors. Pharmacokinetics Plasma concentrations decline rapidly after an IV dose with an initial half-life of less than 30 minutes. Elimination half-life is 1--2 hours but may be prolonged if infusions are given for longer than 24 hours or if hepatic blood flow is reduced. Significant interactions * The following may "lidocaine levels or effect (or "side-effects): antiarrhythmics ("risk of myocardial depression), antipsychotics ("risk of ventricular arrhythmias), atazanavir, betablockers ("risk of myocardial depression), cimetidine ("risk of toxicity), fosamprenavir (avoid combination), quinupristin with dalfopristin ("risk of ventricular arrhythmias). * #K caused by the following may #lidocaine levels or effect: acetazolamide, diuretics-loop, diuretics-thiazide. Action in case of overdose Symptoms to watch for: Medullary depression, seizures, cardiovascular collapse. Antidote: No specific antidote; stop administration and give supportive
therapy as appropriate, which may include diazepam for seizures and
