Drugs List

Therapeutic Indications

Uses

Anaesthesia - regional
Local anaesthesia
Local anaesthetic for dental infiltration anaesthesia
Ventricular arrhythmias especially after myocardial infarction

Unlicensed Uses

Neonatal seizures

Dosage

Due to the complexity and specialist nature of using anaesthesia, specific dosing information on this agent is not included.

When using this agent, specialist literature, nation guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of all relevant patient factors.

Administration

Ventricular arrhythmias
For intravenous injection or infusion only. Intraosseous route, unlicensed in children.

Constant ECG monitoring is recommended, however if this equipment is not available and a ventricular arrhythmia is suspected, a single intramuscular dose may be administered if bradycardia is not present. The deltoid muscle is the preferred site for intramuscular injection.

Local anaesthesia or nerve blocks
See product literature for specific information on each brand.

Contraindications

Familial history of malignant hyperthermia
Recent anticoagulant therapy
Acute cardiac failure
Atrioventricular block
Bradycardia with pulse rate at rest < 50 beats per minute
Coagulopathy
Hypovolaemia
Porphyria - if to be given intravenously
Severe cardiac conduction defects
Severe myocardial depression
Stokes-Adams attacks
Wolff-Parkinson-White syndrome

Precautions and Warnings

Administration site infection
Children under 1 year
Debilitation
Elderly
Inflammation of injection site
Shock
Bradycardia
Breastfeeding
Cardiac impairment
Cardiac surgery
Cardiovascular disorder
Congestive cardiac failure
Epileptic disorder
Hepatic impairment
History of narrow angle glaucoma
Hypotension
Myasthenia gravis
Pregnancy
Renal impairment
Respiratory depression
Respiratory impairment
Shallow anterior chamber of eye

Advise patient ability to drive or operate machinery may be impaired
Correct acid-base disorders prior to treatment
Correct hypoxia prior to treatment
Correct potassium imbalance prior to treatment
Not all available brands are licensed for all age groups
Not all available brands are licensed for all indications
Aspirate prior to injection to avoid intravascular administration
Effect may be reduced if injected into an inflamed or infected area
Monitor blood pressure continuously
Resuscitation facilities must be immediately available
Monitor ECG
Monitor patients with epilepsy while taking this treatment
Consider dose reduction if cardiac failure occurs
Discontinue immediately on the first signs of toxicity
May increase risk of seizure
Consider dose reduction in hepatic impairment
Consider dose reduction in renal impairment
In obese patients dosing should be based on ideal weight
Maintain treatment at the lowest effective dose
Reduce dose in debilitated patients
Reduce dose in elderly

Lidocaine given by the intramuscular route may increase creatinine phosphokinase concentrations which can interfere with the diagnosis of acute myocardial infarction.

Preloading the circulation with crystalloidal or colloidal solutions may reduce the risk of hypotension and bradycardia during epidural anaesthesia.

Injections in the head and neck may be inadvertently made into an artery causing cerebral symptoms even with low doses.

Retrobulbar injections may reach the cranial subarachnoid space, leading to serious reactions including cardiovascular collapse, apnoea, convulsions and temporary blindness.

Retro- and peribulbar injections of local anaesthetics carry a low risk of persistent ocular motor dysfunction. The primary causes include trauma and/or local toxic effects on muscles and/or nerves.

Pregnancy and Lactation

Pregnancy

Use lidocaine with caution during pregnancy.

The manufacturer advises caution if lidocaine is used during pregnancy. Animal studies have not shown teratogenic effects, however lidocaine is known to cross the placenta and should not be administered during early pregnancy unless the benefits outweigh the potential risks. Lidocaine crosses rapidly into foetal circulation when given by epidural or paracervical block or by local infiltration prior to delivery. The elimination half life in the newborn is around 3 hours, compared with 100 minutes in the adult. Elevated lidocaine levels may persist in the newborn for at least 48 hours after delivery. Adverse effects such as foetal or neonatal bradycardia, hypotonia or respiratory depression may occur, particularly when large doses are given. Foetal heart rate must be carefully monitored following paracervical block. Briggs (2015) describes lidocaine as the treatment of choice for ventricular arrhythmias.

Lactation

Use lidocaine with caution during breastfeeding.

The manufacturer advises caution if lidocaine is used when breastfeeding. Lidocaine is excreted in small amounts into human breast milk. LactMed (2020), states that lidocaine is poorly absorbed by breastfed infants and is not expected to cause any adverse effects. However, some manufacturers comment that the possibility of an allergic reaction in the infant, albeit remote, should be borne in mind when using lidocaine in nursing mothers, so caution must still be observed.

Side Effects

Allergic reaction
Anaphylactic shock
Anaphylactoid reaction
Angioedema
Anorexia
Apnoea
Arachnoiditis
Arrhythmias
Back pain
Blurred vision
Bowel dysfunction
Bradycardia
Bronchospasm
Buttock pain
Cardiac arrest
Cardiovascular collapse
Cauda equina syndrome
Chills
Circulatory collapse
Coma
Confusion
Convulsions
Cranial nerve lesions
Decrease in blood pressure
Depression
Diplopia
Dizziness
Double vision
Drowsiness
Dysarthria
Dysphagia
Dyspnoea
Euphoria
Exanthema
Facial oedema
Flushing
Hallucinations
Harlequin syndrome
Headache
Hemiparesis
Horner's syndrome
Hyperacusis
Hypersensitivity reactions
Hypertension
Hypoglycaemia
Hypotension
Hypoventilation
Irritability
Leg pain
Light-headedness
Loss of consciousness (transient)
Loss of vision(transient)
Methaemoglobinaemia
Muscle twitch
Myocardial depression
Nausea
Nervousness
Neurological effects
Neuropathy
Oedema
Orbital inflammation
Paraesthesia
Paralysis in the lower limbs
Paresis
Photophobia
Rash
Respiratory arrest
Respiratory depression
Restlessness
Sensorineural deafness
Shock
Skin tingling
Sleepiness
Tachyarrhythmia
Tinnitus
Tongue numbness
Tremor
Urinary dysfunction
Urticaria
Vertigo
Vomiting

Presentation

Parenteral formulations of lidocaine preservative-free.

Drugs List

Therapeutic Indications

Uses

Anaesthesia - regional
Local anaesthesia
Local anaesthetic for dental infiltration anaesthesia
Ventricular arrhythmias especially after myocardial infarction

Unlicensed Uses

Neonatal seizures

Dosage

Due to the complexity and specialist nature of using anaesthesia, specific dosing information on this agent is not included.

When using this agent, specialist literature, nation guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of all relevant patient factors.

Administration

Ventricular arrhythmias
For intravenous injection or infusion only. Intraosseous route, unlicensed in children.

Constant ECG monitoring is recommended, however if this equipment is not available and a ventricular arrhythmia is suspected, a single intramuscular dose may be administered if bradycardia is not present. The deltoid muscle is the preferred site for intramuscular injection.

Local anaesthesia or nerve blocks
See product literature for specific information on each brand.

Contraindications

Familial history of malignant hyperthermia
Recent anticoagulant therapy
Acute cardiac failure
Atrioventricular block
Bradycardia with pulse rate at rest < 50 beats per minute
Coagulopathy
Hypovolaemia
Porphyria - if to be given intravenously
Severe cardiac conduction defects
Severe myocardial depression
Stokes-Adams attacks
Wolff-Parkinson-White syndrome

Precautions and Warnings

Administration site infection
Children under 1 year
Debilitation
Elderly
Inflammation of injection site
Shock
Bradycardia
Breastfeeding
Cardiac impairment
Cardiac surgery
Cardiovascular disorder
Congestive cardiac failure
Epileptic disorder
Hepatic impairment
History of narrow angle glaucoma
Hypotension
Myasthenia gravis
Pregnancy
Renal impairment
Respiratory depression
Respiratory impairment
Shallow anterior chamber of eye

Advise patient ability to drive or operate machinery may be impaired
Correct acid-base disorders prior to treatment
Correct hypoxia prior to treatment
Correct potassium imbalance prior to treatment
Not all available brands are licensed for all age groups
Not all available brands are licensed for all indications
Aspirate prior to injection to avoid intravascular administration
Effect may be reduced if injected into an inflamed or infected area
Monitor blood pressure continuously
Resuscitation facilities must be immediately available
Monitor ECG
Monitor patients with epilepsy while taking this treatment
Consider dose reduction if cardiac failure occurs
Discontinue immediately on the first signs of toxicity
May increase risk of seizure
Consider dose reduction in hepatic impairment
Consider dose reduction in renal impairment
In obese patients dosing should be based on ideal weight
Maintain treatment at the lowest effective dose
Reduce dose in debilitated patients
Reduce dose in elderly

Lidocaine given by the intramuscular route may increase creatinine phosphokinase concentrations which can interfere with the diagnosis of acute myocardial infarction.

Preloading the circulation with crystalloidal or colloidal solutions may reduce the risk of hypotension and bradycardia during epidural anaesthesia.

Injections in the head and neck may be inadvertently made into an artery causing cerebral symptoms even with low doses.

Retrobulbar injections may reach the cranial subarachnoid space, leading to serious reactions including cardiovascular collapse, apnoea, convulsions and temporary blindness.

Retro- and peribulbar injections of local anaesthetics carry a low risk of persistent ocular motor dysfunction. The primary causes include trauma and/or local toxic effects on muscles and/or nerves.

Pregnancy and Lactation

Pregnancy

Use lidocaine with caution during pregnancy.

The manufacturer advises caution if lidocaine is used during pregnancy. Animal studies have not shown teratogenic effects, however lidocaine is known to cross the placenta and should not be administered during early pregnancy unless the benefits outweigh the potential risks. Lidocaine crosses rapidly into foetal circulation when given by epidural or paracervical block or by local infiltration prior to delivery. The elimination half life in the newborn is around 3 hours, compared with 100 minutes in the adult. Elevated lidocaine levels may persist in the newborn for at least 48 hours after delivery. Adverse effects such as foetal or neonatal bradycardia, hypotonia or respiratory depression may occur, particularly when large doses are given. Foetal heart rate must be carefully monitored following paracervical block. Briggs (2015) describes lidocaine as the treatment of choice for ventricular arrhythmias.

Lactation

Use lidocaine with caution during breastfeeding.

The manufacturer advises caution if lidocaine is used when breastfeeding. Lidocaine is excreted in small amounts into human breast milk. LactMed (2020), states that lidocaine is poorly absorbed by breastfed infants and is not expected to cause any adverse effects. However, some manufacturers comment that the possibility of an allergic reaction in the infant, albeit remote, should be borne in mind when using lidocaine in nursing mothers, so caution must still be observed.

Counselling

When outpatient anaesthesia affects areas of the body involved in driving or operating machinery, patients should be advised to avoid these activities until normal function is fully restored.

Side Effects

Allergic reaction
Anaphylactic shock
Anaphylactoid reaction
Angioedema
Anorexia
Apnoea
Arachnoiditis
Arrhythmias
Back pain
Blurred vision
Bowel dysfunction
Bradycardia
Bronchospasm
Buttock pain
Cardiac arrest
Cardiovascular collapse
Cauda equina syndrome
Chills
Circulatory collapse
Coma
Confusion
Convulsions
Cranial nerve lesions
Decrease in blood pressure
Depression
Diplopia
Dizziness
Double vision
Drowsiness
Dysarthria
Dysphagia
Dyspnoea
Euphoria
Exanthema
Facial oedema
Flushing
Hallucinations
Harlequin syndrome
Headache
Hemiparesis
Horner's syndrome
Hyperacusis
Hypersensitivity reactions
Hypertension
Hypoglycaemia
Hypotension
Hypoventilation
Irritability
Leg pain
Light-headedness
Loss of consciousness (transient)
Loss of vision(transient)
Methaemoglobinaemia
Muscle twitch
Myocardial depression
Nausea
Nervousness
Neurological effects
Neuropathy
Oedema
Orbital inflammation
Paraesthesia
Paralysis in the lower limbs
Paresis
Photophobia
Rash
Respiratory arrest
Respiratory depression
Restlessness
Sensorineural deafness
Shock
Skin tingling
Sleepiness
Tachyarrhythmia
Tinnitus
Tongue numbness
Tremor
Urinary dysfunction
Urticaria
Vertigo
Vomiting

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 ).

Further Information

Last Full Review Date: November 2022

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Lidocaine 10mg/ml solution for injection in pre-filled syringe. Aguettant Ltd. Revised July 2018.

Summary of Product Characteristics: Lidocaine Hydrochloride 0.5% w/v Solution for Injection. Mercury Pharmaceuticals Limited. Revised December 2021.

Summary of Product Characteristics: Lidocaine Hydrochloride 1% w/v Solution for Injection. Mercury Pharmaceuticals Limited. Revised December 2021.
Summary of Product Characteristics: Lidocaine Hydrochloride Injection BP 1% w/v. hameln pharma ltd. Revised February 2022.
Summary of Product Characteristics: Lidocaine Injection BP 1% w/v. B. Braun Melsungen AG. Revised April 2015.

Summary of Product Characteristics: Lidocaine Hydrochloride 2% w/v Solution for Injection. Mercury Pharmaceuticals Ltd. Revised July 2021.
Summary of Product Characteristics: Lidocaine Hydrochloride Injection BP 2% w/v. hameln pharma ltd. Revised February 2022.
Summary of Product Characteristics: Lidocaine Injection BP 2% w/v. B. Braun Melsungen AG. Revised April 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 08 November 2022

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Lidocaine. Last revised: 16 November 2020
Last accessed: 09 November 2022