Drugs List

Therapeutic Indications

Uses

Local anaesthetic for use during catheterisation, cystoscopy, exploratory and intra-operative investigations, exchange of fistula catheters, protection against iatrogenic damage in the rectum and colon and for use during gynaecological investigation.

Administration

For topical application

Contraindications

Known hypersensitivity to amide-type anaesthetics
Damaged or bleeding mucous membranes

Precautions and Warnings

Traumatised mucosa and/or sepsis in region of application as this will increase the systemic absorption of lidocaine.

Oropharyngeal use may cause difficulty in swallowing increasing the possible danger of aspiration. Numbness of the tongue and buccal mucosa may also increase the chance of biting trauma.

Local anaesthetics should be used with caution in patients with impaired cardiac conditions, hepatic insufficiency and epilepsy.

First trimester of pregnancy ( See Pregnancy section)

Ability to drive or operate machinery may be slightly impaired after use. Advise patient not to drive or use machinery if affected.

Treatment of large areas for more than 3 days especially in young children is not recommended as it may lead to increased systemic toxicity.

Pregnancy and Lactation

Pregnancy

First trimester of pregnancy use only if benefits outweigh potential risks

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

The amount of lidocaine excreted in breast milk is too small to be harmful.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Convulsions
Hypotension
Hypersensitivity reactions
Bradycardia

Presentation

Gel containing lidocaine hydrochloride 2% and chlorhexidine gluconate solution 0.25%

Drugs List

Therapeutic Indications

Uses

Local anaesthetic for use during catheterisation, cystoscopy, exploratory and intra-operative investigations, exchange of fistula catheters, protection against iatrogenic damage in the rectum and colon and for use during gynaecological investigation.

Dosage

Adults

Elderly

Children

Patients with Hepatic Impairment

Administration

For topical application

Contraindications

Known hypersensitivity to amide-type anaesthetics
Damaged or bleeding mucous membranes

Precautions and Warnings

Traumatised mucosa and/or sepsis in region of application as this will increase the systemic absorption of lidocaine.

Oropharyngeal use may cause difficulty in swallowing increasing the possible danger of aspiration. Numbness of the tongue and buccal mucosa may also increase the chance of biting trauma.

Local anaesthetics should be used with caution in patients with impaired cardiac conditions, hepatic insufficiency and epilepsy.

First trimester of pregnancy ( See Pregnancy section)

Ability to drive or operate machinery may be slightly impaired after use. Advise patient not to drive or use machinery if affected.

Treatment of large areas for more than 3 days especially in young children is not recommended as it may lead to increased systemic toxicity.

Pregnancy and Lactation

Pregnancy

First trimester of pregnancy use only if benefits outweigh potential risks

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

The amount of lidocaine excreted in breast milk is too small to be harmful.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Effects on Ability to Drive and Operate Machinery

Ability to drive or operate machinery may be slightly impaired after use. Advise patient not to drive or use machinery if affected.

Counselling

Ability to drive or operate machinery may be slightly impaired after use. Advise patient not to drive or use machinery if affected.

Side Effects

Convulsions
Hypotension
Hypersensitivity reactions
Bradycardia

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Shelf Life and Storage

Store below 25 degrees C.

Further Information

Last Full Review Date: October 2010

Reference Sources

British National Formulary, 60th Edition (2010) Pharmaceutical Press, London.

BNF for Children (2010-2011) Pharmaceutical Press, London.

Martindale: The Complete Drug Reference, 36th edition (2009) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Instillagel. Cliniflex. Revised October 2004.