Case reports of maternal convulsions and cardiovascular collapse following use of some local anesthetics for paracervical block in early pregnancy (as anesthesia for elective abortion) suggest that systemic absorption under these circumstances may be rapid. Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Lidocaine Hydrochloride Injection, USP is supplied as follows: Sterile, Nonpyrogenic Lidocaine belongs to a class of drugs known as local anesthetics. With central neural blockade these changes may be attributable to block of autonomic fibers, a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system, and/or the beta-adrenergic receptor stimulating action of epinephrine when present. When used without epinephrine the maximum individual dose should not exceed 4.5 mg/kg (2 mg/lb) of body weight, and in general it is recommended that the maximum total dose does not exceed 300 mg. For continuous epidural or caudal anesthesia, the maximum recommended dosage should not be administered at intervals of less than 90 minutes. -Caudal and Lumbar Epidural Block: A test dose (e.g., 2 to 3 mL) of solution should be administered at least 5 minutes prior to injecting the total volume required as a precaution against unintentional penetration of the subarachnoid space. Allergic reactions, including anaphylactic reactions, may occur as a result of sensitivity to lidocaine, but are infrequent. Hyderabad - 500038 As soln: Apply 40-200 mg to affected area. If injected intravenously, it may cause cerebral effects such as confusion, changes in vision, numbness, tingling, and vomiting. Binding is also dependent on the plasma concentration of the alpha-1-acid glycoprotein. Subscribe to newsletters for the latest medication news, new drug approvals, alerts and updates. Lignocaine (Cadila) 2 % Injection is an effective agent that is used to numb a specific area of the body to reduce pain and discomfort caused by surgical or other invasive medical procedures such as needle punctures, or insertion of a catheter or breathing tube. What is the dosage for lidocaine injection (local)? May need to reduce dose … Supplier. Indications and dose For LIDOCAINE HYDROCHLORIDE. In epidural anaesthesia 2-3 mls of 1% solution is usually required for each dermatome to be anaesthetised. Discontinue lidocaine hydrochloride and any other oxidizing agents. Because many drugs are excreted in human milk, caution should be exercised when lidocaine hydrochloride is administered to a nursing woman. The safety and effectiveness of lidocaine depend on proper dosage, correct technique, adequate precautions, andreadiness for emergencies (see WARNINGS and ADVERSE REACTIONS). Dosage of Lidocaine: Adult and Pediatric Dosage … Local anesthetics produce vasodilation by blocking sympathetic nerves. Inject slowly, five minutes between sides (see also discussion of paracervical block in PRECAUTIONS). N-dealkylation, a major pathway of biotransformation, yields the metabolites monoethylglycinexylidide and glycinexylidide. Lidocaine plasma levels were evaluated after nebulized administration. -Sufficient time should be allowed to enable a slow circulation to carry this drug to the site of action. E. Windsor, NJ 08520 Syringe aspirations should also be performed before and during each supplemental injection when using indwelling catheter techniques. Serious adverse experiences are generally systemic in nature. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The use of even more dilute solutions (i.e., 0.25 to 0.5%) and total dosages not to exceed 3 mg/kg (1.4 mg/lb) are recommended for induction of intravenous regional anesthesia in children. Epinephrine, if contained in the test dose (10 to 15 mcg have been suggested), may serve as a warning of unintentional intravascular injection. Available Products. In order to guard against systemic toxicity, the lowest effective concentration and lowest effective dose should be used at all times. Manufactured by: Fetal heart rate should always be monitored during paracervical anesthesia. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient “epinephrine response” within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor, palpitations and nervousness in the unsedated patient. Other brands: Xylocaine-MPF, Xylocaine HCl, atenolol, propranolol, amiodarone, lidocaine, verapamil, fentanyl, flecainide, hyoscyamine, ketamine, Inderal. In one study, paracervical block anesthesia was associated with a decrease in the mean duration of first stage labor and facilitation of cervical dilation. Studies of lidocaine hydrochloride in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility have not been conducted. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations. Lidocaine hydrochloride is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. NOTE: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever the solution and container permit. Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. The use of obstetrical anesthesia may increase the need for forceps assistance. The pharmacological/toxicological actions of these metabolites are similar to, but less potent than, those of lidocaine hydrochloride. Separate doses by at least 3 hours (Max: 8 doses/day). Drug information provided by: IBM Micromedex. Methemoglobinemia Select one or more newsletters to continue. Dosage Form: injection, solution. Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6 mcg free base per mL. The detection of sensitivity by skin testing is of doubtful value. -Initial dose: 1 mg/kg IV or intraosseous once -Do not administer unless solution is clear and seal is intact. In some cases it will be necessary to dilute available concentrations with 0.9% sodium chloride injection in order to obtain the required final concentration. [2] Application to real-life: Using 5-mL of 4% topical lidocaine solution via nebulizer will provide a total dose of 200 mg. Careful adherence to recommended dosage is of the utmost importance in obstetrical paracervical block. Although not all of these side effects may occur, if … Lidocaine hydrochloride crosses the blood-brain and placental barriers, presumably by passive diffusion. Renal dysfunction does not affect lidocaine hydrochloride kinetics but may increase the accumulation of metabolites. -Drug clearance may be reduced in these patient populations and a continuous infusion when treating ventricular arrhythmias should not exceed 20 mcg/kg/min. Preparations containing a vasoconstrictor should be used with caution in patients during or following the administration of potent general anesthetic agents, since cardiac arrhythmias may occur under such conditions. Lidocaine belongs to a class of drugs known as local anesthetics. Endotracheal: May be administered endotracheally (bolus dose only) if IV access unavailable at a dose of 2 to 2.5 times the IV dose diluted in 5 to 10 mL NS or distilled water For epidural anesthesia the following dosage form of lidocaine hydrochloride injection is recommended: Maximum dose of lidocaine (plain, without vasoconstrictor) is 4.5 mg/kg (not to exceed 300 mg) Example patient weight - 10 kg; Total dose that can be used for this patient = 4.5 mg/kg x 10 kg = 45 mg; Maximum volume of lidocaine administered . Approximately 90% of lidocaine hydrochloride administered is excreted in the form of various metabolites, and less than 10% is excreted unchanged. Babies so affected present with unexplained neonatal depression at birth, which correlates with high local anesthetic serum levels, and often manifest seizures within six hours. Lidocaine Hydrochloride and Epinephrine, USP is a sterile isotonic solution containing a local anesthetic agent, Lidocaine Hydrochloride, and a vasoconstrictor, Epinephrine (as bitartrate) and are administered parenterally by injection. Cases compatible with unintended fetal intracranial injection of local anesthetic solution have been reported following intended paracervical or pudendal block or both. Drug information provided by: IBM Micromedex Along with its needed effects, a medicine may cause some unwanted effects. These reactions may be due to intra-arterial injection of the local anesthetic with retrograde flow to the cerebral circulation. XYLOCAINE INJECTION prescription and dosage sizes information for physicians and healthcare professionals. -For continuous epidural or caudal anesthesia, the maximum recommended dose should not be administered at intervals of less than 90 minutes. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Drowsiness following the administration of lidocaine hydrochloride is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Medically reviewed by on Sep 23, 2020 – Written by Cerner Multum. Data sources include IBM Watson Micromedex (updated 2 Nov 2020), Cerner Multum™ (updated 2 Nov 2020), ASHP (updated 23 Oct 2020) and others. Low dose lidocaine pretreatment with venous occlusion upstream (≤ 20 mg or ≤ 0.2 mg/kg), 4. -Loading dose: 25 to 50 mg IV bolus once There is insufficient information to determine whether shorter infusion periods are not associated with these findings. Find everything you need to know about Lidocaine Injection (Xylocaine-MPF), including what it is used for, warnings, reviews, side effects, and interactions. During the administration of epidural anesthesia, it is recommended that a test dose be administered initially and that the patient be monitored for central nervous system toxicity and cardiovascular toxicity, as well as for signs of unintended intrathecal administration, before proceeding. IV: In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3 mL of the indicated concentration per dermatome). Lidocaine injection is used to cause numbness or loss of feeling for patients having certain medical procedures (by blocking certain nerves using the brachial plexus, intercostal, lumbar, or epidural blocking techniques). Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor as directed by the clinical situation (e.g., ephedrine). Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Reproduction studies have been performed in rats at doses up to 6.6 times the human dose and have revealed no evidence of harm to the fetus caused by lidocaine hydrochloride. Lidocaine toxicity not only is determined by the total dose (usually 4.5 mg/kg) but also by the rate of absorption, which is dependent on the blood flow of that tissue. See INDICATIONS AND USAGE section for specific uses. For Neonate. Description and Brand Names; Before Using; Proper Use; Precautions; Side Effects; Products and services. Applies to the following strengths: 2%; 1%; 1% preservative-free; 0.5%; 4%; 1.5%; 7.5%-5%; 20%; 10%; 5%-0.2%; 5%-0.4%; 5%-0.8%; 2% preservative-free; 1.5% preservative-free; 0.5% preservative-free; 4% preservative-free; 5%; hydrochloride; 1%-NaCl 0.9%, Initial dose: 50 to 100 mg IV bolus once over 2 to 3 minutes; may repeat after 5 minutes if necessary not to exceed up to 300 mg in a 1-hour period -Protect from light. Which drugs or supplements interact with … THE ABOVE SUGGESTED CONCENTRATIONS AND VOLUMES SERVE ONLY AS A GUIDE. Medically reviewed by Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously. As 2% gel: Approx 120-220 mg into urethra several min before examination. Max: 1 patch/24 hr. The usual dose is 50 to 100 mg of lidocaine hydrochloride (0.70 … 270.8. At the first sign of change, oxygen should be administered. Lidocaine hydrochloride should also be used with caution in patients with severe shock or heart block. Monitoring: Lidocaine is a … Pharmacology, adverse reactions, warnings and side effects. Underventilation or apnea due to unintentional subarachnoid injection of local anesthetic solution may produce these same signs and also lead to cardiac arrest if ventilatory support is not instituted. Many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia. For Infiltration and Nerve Block. To avoid intravascular injection, aspiration should be performed before the local anesthetic solution is injected. Concurrent administration of vasopressor drugs (for the treatment of hypotension related to obstetric blocks) and ergot-type oxytocic drugs may cause severe, persistent hypertension or cerebrovascular accidents. The dosages suggested in this table are for normal healthy adults and refer to the use of epinephrine-free solutions. All of these techniques decreased pain on injection. -Cardiovascular: Continuous ECG monitoring should occur during IV administration. It does not contain a preservative. Local anesthetics rapidly cross the placenta and when used for epidural, paracervical, pudendal or caudal block anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity (see CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism). For example, in a child of 5 years weighing 50 lbs the dose of lidocaine hydrochloride should not exceed 75 to 100 mg (1.5 to 2 mg/lb). A dose of 400 mg (5.7 mg/kg in a 70 kg patient) produced a peak of 1.1 mcg/mL, far below the 5 mcg/ml level associated with toxicity. Administration advice: Tolerance to elevated bloo… Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Although the incidence of side effects with lidocaine hydrochloride is quite low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose of local anesthetic agent injected. However, increasing the volume and concentration of lidocaine hydrochloride injection may result in a more profound fall in blood pressure when used in epidural anesthesia. Lidocaine hydrochloride (C14H22N2O • HCl) has the following structural formula: Lidocaine hydrochloride injection, USP is a sterile, nonpyrogenic, isotonic solution containing sodium chloride. Patients on beta blockers may not manifest changes in heart rate, but blood pressure monitoring can detect an evanescent rise in systolic blood pressure. The physician should weigh the possible advantages against risks when considering a paracervical block in prematurity, toxemia of pregnancy, and fetal distress. Single Direct Intravenous Injection (bolus): ONLY THE 5 mL, 50 MG or 100 MG DOSAGE SIZES should be used for direct intravenous injection. Xylocaine® (lidocaine HCl and epinephrine) Injection, USP . The lowest dosage that results ineffective anesthesia should be used to avoid high plasma levels and serious adverse effects. Dosage recommendations should not be exceeded (see DOSAGE AND ADMINISTRATION). Possible target organs include the nervous system and cardiovascular system. Reproduction studies have been performed in rats at doses up to five times maximum human dose and have revealed no significant findings; however, no adequate and well-controlled studies in pregnant women available; physicians should carefully consider potential risks and benefits for each specific patient before prescribing lidocaine … Revised: February 2020, atenolol, propranolol, amiodarone, lidocaine, verapamil, fentanyl, flecainide, hyoscyamine, ketamine, Inderal. Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with the following conditions: existing neurological disease, spinal deformities, septicemia, and severe hypertension. The dosage of 2% Xylocaine DENTAL solutions (lidocaine HCl and epinephrine) depends on the physical status of the patient, the area of the oral cavity to be anesthetized, the vascularity of the oral tissues, and the technique of anesthesia used. Select one or more newsletters to continue. The elimination half-life of lidocaine hydrochloride following an intravenous bolus injection is typically 1.5 to 2 hours. Successful outcome is dependent on early diagnosis, prompt discontinuance of the suspect triggering agent(s) and institution of treatment, including oxygen therapy, indicated supportive measures and dantrolene (consult dantrolene sodium intravenous package insert before using). Anaphylactic reactions may occur following administration of lidocaine hydrochloride (see ADVERSE REACTIONS). Lidocaine hydrochloride injection, USP contains lidocaine hydrochloride, which is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl)-, monohydrochloride and has the molecular weight 270.8. For intravenous regional anesthesia, the dose administered should not exceed 4 mg/kg in adults. Adult: As hyperbaric soln of 1.5% or 5% lidocaine in 7.5% glucose soln. Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood. One half of the total dose is usually administered to each side. In the practice of caudal or lumbar epidural block, occasional unintentional penetration of the subarachnoid space by the catheter may occur. Unfortunately, unless you are a physician, you cannot purchase lidocaine for injections. Dosing varies considerably depending on the use. The vial stopper is not made with natural rubber latex. CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism, lidocaine hydrochloride injection, solution, We comply with the HONcode standard for trustworthy health information -, INFILTRATION, PERINEURAL, INTRACAUDAL, EPIDURAL. Dosage of Lidocaine: Adult and Pediatric Dosage Forms and Strengths. Xylocaine® (lidocaine HCl) Injection, USP. The rapid injection of a large volume of lidocaine hydrochloride injection through the catheter should be avoided, and, when feasible, fractional doses should be administered. Use: For the production of local or regional anesthesia by infiltration techniques such as percutaneous injection and IV regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed, The manufacturer gives no specific dosing instructions. US Brand Name. The fetal heart rate also should be monitored continuously, and electronic fetal monitoring is highly advisable. The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse effects. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted. -Maximum individual dose: 4 mg/kg (IV regional anesthesia); 4.5 mg/kg (infiltration)-Maximum total dose: 300 mg Comments:-The manufacturer product information should be consulted.-Dose … -Maximum total dose: 300 mg Patients with reduced hepatic function or diminished hepatic blood flow should receive half the usual loading dose and lower maintenance doses IV: It works by causing a temporary loss of feeling in the area where you apply the patch. 279 Princeton-Hightstown Rd. Lidocaine hydrochloride injection, USP is sterile, nonpyrogenic, aqueous solution that contains a local anesthetic agent and is administered parenterally by injection. Resuscitative equipment and personnel for treating adverse reactions should be immediately available. Available for Android and iOS devices. A single dose of lidocaine should not exceed 4.5 mg/kg (Max: 300 mg); swish and spit solution for use in the mouth or gargle and swallow for use in the pharynx. -Store at controlled room temperature. This solution contains no bacteriostatic agent. The majority of reported cases of chondrolysis have involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intra-articular infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours. Factors such as acidosis and the use of CNS stimulants and depressants affect the CNS levels of lidocaine hydrochloride required to produce overt systemic effects. The oral LD50 of lidocaine hydrochloride in non-fasted female rats is 459 (346 to 773) mg/kg (as the salt) and 214 (159 to 324) mg/kg (as the salt) in fasted female rats. Dosage Forms & Strengths injectable solution. Fresenius Kabi had generic lidocaine presentations on shortage due to a supply interruption of raw ingredients. -Dose varies with procedure, depth of anesthesia and degree of muscle relaxation needed, duration of anesthesia required, and physical condition of patient.
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