Drugs List

Therapeutic Indications

Uses

Local anaesthesia during obstetric delivery
Local anaesthetic for minor surgery of nasal cavity, pharynx and epipharynx
Local anaesthetic for mucous membranes for bronchoscopy,bronchography, etc
Local anaesthetic for mucous membranes for endotracheal intubation
Local anaesthetic for mucous membranes for laryngoscopy,oesophagoscopy,etc
Local anaesthetic for mucous membranes in dentistry

Provides topical anaesthesia for pain associated with:

Otorhinolaryngology
Puncture of the maxillary sinus and minor surgical procedures in the nasal cavity, pharynx and epipharynx.

Paracentesis

Obstetrics
During the final stages of delivery and before episiotomy and perineal suturing as supplementary pain management.

Introduction of instruments and catheters into the respiratory and digestive tract
Provides surface anaesthesia for the oropharyngeal and tracheal areas to reduce reflex activity, attenuate haemodynamic response and to facilitate insertion of the tube/instrument during endotracheal intubation, laryngoscopy, bronchoscopy, and oesophagoscopy.

Dental
Prior to injections, dental impressions, X-ray photography and removal of calculus.

Contraindications

None known

Precautions and Warnings

Children under 18 years
Debilitation
Elderly
Shock
Bradycardia
Cardiac conduction defects
Cardiac failure
Cardiovascular disorder
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Porphyria
Respiratory impairment
Severe renal impairment

Advise ability to drive/operate machinery may be affected by side effects
Contains alcohol
Contains propylene glycol: may cause irritation
Damages endotracheal cuffs made of plastic (PVC + non PVC)
Avoid broken or inflamed skin
Avoid contact with eyes
Do not allow contact with middle ear
Not to be applied to infected skin
Resuscitation facilities must be immediately available
Anaesthesia of the pharynx may occur with increased risk of choking
Anaesthetic effect may impair swallowing

Higher concentrations in the blood may occur in paralysed patients under general anaesthesia.

Oropharyngeal administration may impair swallowing and consequently produce a risk of aspiration. This is of particular relevance in children due to their frequency of eating. Numbness of the tongue or buccal mucosa may lead to an increased risk of biting trauma. Avoid use of this medication on the pharynx before meals.

Since cardiac effects may be additive, patients treated with antiarrhythmic drugs class 3 (e.g. Amiodarone) should be kept under close supervision and ECG monitoring should be considered.

Pregnancy and Lactation

Pregnancy

Lidocaine is considered safe for use in pregnancy.

There is limited data regarding the safety of lidocaine administration during pregnancy, however it has been widely used for many years and no ill effects have been documented. Animal studies also indicate no hazard.

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 to 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

Lidocaine is considered safe for use in breastfeeding.

Lidocaine is excreted in human breast milk, however at therapeutic doses, the excreted amounts are not high enough to be of risk to the infant.

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

Allergic reaction
Anaphylactic shock
Arrhythmias
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular effects
CNS effects
Coma
Convulsions
Dizziness
Drowsiness
Excitation
Headache
Hoarseness
Hypotension
Irritation at application site
Light-headedness
Muscle twitch
Myocardial depression
Nausea
Nervousness
Numbness
Paraesthesia
Peripheral vasodilatation
Respiratory arrest
Respiratory depression
Restlessness
Sensation of cold
Sensation of heat
Sore throat
Tinnitus
Tremor
Unconsciousness
Voice changes
Vomiting

Presentation

Pump spray containing lidocaine

Drugs List

Therapeutic Indications

Uses

Local anaesthesia during obstetric delivery
Local anaesthetic for minor surgery of nasal cavity, pharynx and epipharynx
Local anaesthetic for mucous membranes for bronchoscopy,bronchography, etc
Local anaesthetic for mucous membranes for endotracheal intubation
Local anaesthetic for mucous membranes for laryngoscopy,oesophagoscopy,etc
Local anaesthetic for mucous membranes in dentistry

Provides topical anaesthesia for pain associated with:

Otorhinolaryngology
Puncture of the maxillary sinus and minor surgical procedures in the nasal cavity, pharynx and epipharynx.

Paracentesis

Obstetrics
During the final stages of delivery and before episiotomy and perineal suturing as supplementary pain management.

Introduction of instruments and catheters into the respiratory and digestive tract
Provides surface anaesthesia for the oropharyngeal and tracheal areas to reduce reflex activity, attenuate haemodynamic response and to facilitate insertion of the tube/instrument during endotracheal intubation, laryngoscopy, bronchoscopy, and oesophagoscopy.

Dental
Prior to injections, dental impressions, X-ray photography and removal of calculus.

Dosage

As with any local anaesthetic, the minimal effective dose should be employed to reduce the incidence of reactions and complications.

Anaesthesia usually occurs within 5 minutes.

Adults

Elderly

Children

Contraindications

None known

Precautions and Warnings

Children under 18 years
Debilitation
Elderly
Shock
Bradycardia
Cardiac conduction defects
Cardiac failure
Cardiovascular disorder
Epileptic disorder
Hepatic impairment
Hypovolaemia
Myasthenia gravis
Porphyria
Respiratory impairment
Severe renal impairment

Advise ability to drive/operate machinery may be affected by side effects
Contains alcohol
Contains propylene glycol: may cause irritation
Damages endotracheal cuffs made of plastic (PVC + non PVC)
Avoid broken or inflamed skin
Avoid contact with eyes
Do not allow contact with middle ear
Not to be applied to infected skin
Resuscitation facilities must be immediately available
Anaesthesia of the pharynx may occur with increased risk of choking
Anaesthetic effect may impair swallowing

Higher concentrations in the blood may occur in paralysed patients under general anaesthesia.

Oropharyngeal administration may impair swallowing and consequently produce a risk of aspiration. This is of particular relevance in children due to their frequency of eating. Numbness of the tongue or buccal mucosa may lead to an increased risk of biting trauma. Avoid use of this medication on the pharynx before meals.

Since cardiac effects may be additive, patients treated with antiarrhythmic drugs class 3 (e.g. Amiodarone) should be kept under close supervision and ECG monitoring should be considered.

Pregnancy and Lactation

Pregnancy

Lidocaine is considered safe for use in pregnancy.

There is limited data regarding the safety of lidocaine administration during pregnancy, however it has been widely used for many years and no ill effects have been documented. Animal studies also indicate no hazard.

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 to 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

Lidocaine is considered safe for use in breastfeeding.

Lidocaine is excreted in human breast milk, however at therapeutic doses, the excreted amounts are not high enough to be of risk to the infant.

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

Allergic reaction
Anaphylactic shock
Arrhythmias
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular effects
CNS effects
Coma
Convulsions
Dizziness
Drowsiness
Excitation
Headache
Hoarseness
Hypotension
Irritation at application site
Light-headedness
Muscle twitch
Myocardial depression
Nausea
Nervousness
Numbness
Paraesthesia
Peripheral vasodilatation
Respiratory arrest
Respiratory depression
Restlessness
Sensation of cold
Sensation of heat
Sore throat
Tinnitus
Tremor
Unconsciousness
Voice changes
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: May 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference. 39th Edition. London: Brayfield A (ed). Pharmaceutical Press; 2017.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Xylocaine Spray. AstraZeneca UK Limited. Revised February 2015.

The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 08 September 2017

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 21 May 2015

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Lidocaine. Last revised: 08 July 2014
Last accessed: 21 May 2015