Drugs List

Therapeutic Indications

Uses

Ventricular arrhythmias

Prevention and control of ventricular arrhythmias during cardiac surgery or following myocardial infarction.

Administration

For intravenous infusion

Contraindications

Atrioventricular block
Bradycardia
Cardiac conduction defects
Cardiac decompensation - unless due to tachyarrhythmias
Hypertension - unless due to tachyarrhythmias
Hypovolaemia
Severe myocardial depression

Precautions and Warnings

Children under 1 year
Elderly
Breastfeeding
Cardiac failure
Circulatory failure
Epileptic disorder
Hepatic impairment
Myasthenia gravis
Porphyria - if to be given intravenously
Pregnancy
Respiratory impairment
Severe renal impairment

Reduce initial dose in severe circulatory failure
Resuscitation facilities must be immediately available
Monitor ECG
Reduce dose in elderly

Pregnancy and Lactation

Pregnancy

Use lidocaine and glucose with caution during pregnancy.

The benefit to the patient should be weighed against the potential risk.

Lidocaine rapidly crosses the placenta to the foetus and can be detected in the foetus a few minutes after maternal administration. Cord: maternal serum ratios range from between 0.50 & 0.70 after IV and epidural anaesthesia (Briggs, 2015).

At present there is no recognized teratogenic effect in human pregnancies. In a study involving 1200 pregnant women, no increase in major or minor abnormalities was seen (Schaefer, 2015).

Schaefer (2015) also suggests that some adverse effects have been demonstrated with the use of lidocaine during pregnancy. These include alterations to the brain-stem evoked potential and possible loss of foetal thermoregulatory control. Epidural anaesthesia has been associated with abnormalities of neurobehavioural testing in the neonate, but recent studies have shown these to be rare and transient. Briggs (2015) notes that lidocaine may produce central nervous system depression in the newborn with high serum levels.

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

Use lidocaine and glucose with caution during breastfeeding.

The manufacturer states that the safety of lidocaine during breastfeeding has not been assessed and caution should be used.

LactMed suggests that during continuous IV infusion lidocaine concentrations in milk are low and that the lidocaine is poorly absorbed by the infant. Consequently, lidocaine is not expected to cause any adverse effects in breastfed infants. Briggs (2015) also notes that exposure to lidocaine via breast milk is unlikely to harm the nursing 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
Anaphylaxis
Arrhythmias
Blurred vision
Bradycardia
Cardiac arrest
Coma
Confusion
Convulsions
Dizziness
Drowsiness
Excitement
Hypersensitivity reactions
Hypertension
Hypotension
Mouth numbness
Muscle twitch
Myocardial depression
Nausea
Nervousness
Nystagmus
Paraesthesia
Peripheral vasodilatation
Respiratory depression
Respiratory failure
Restlessness
Tinnitus
Tongue numbness
Tremor
Vomiting
Yawning

Presentation

Solution for infusion containing lidocaine hydrochloride with glucose.

Drugs List

Therapeutic Indications

Uses

Ventricular arrhythmias

Prevention and control of ventricular arrhythmias during cardiac surgery or following myocardial infarction.

Dosage

Adults

Elderly

Children

Neonates

Administration

For intravenous infusion

Contraindications

Atrioventricular block
Bradycardia
Cardiac conduction defects
Cardiac decompensation - unless due to tachyarrhythmias
Hypertension - unless due to tachyarrhythmias
Hypovolaemia
Severe myocardial depression

Precautions and Warnings

Children under 1 year
Elderly
Breastfeeding
Cardiac failure
Circulatory failure
Epileptic disorder
Hepatic impairment
Myasthenia gravis
Porphyria - if to be given intravenously
Pregnancy
Respiratory impairment
Severe renal impairment

Reduce initial dose in severe circulatory failure
Resuscitation facilities must be immediately available
Monitor ECG
Reduce dose in elderly

Pregnancy and Lactation

Pregnancy

Use lidocaine and glucose with caution during pregnancy.

The benefit to the patient should be weighed against the potential risk.

Lidocaine rapidly crosses the placenta to the foetus and can be detected in the foetus a few minutes after maternal administration. Cord: maternal serum ratios range from between 0.50 & 0.70 after IV and epidural anaesthesia (Briggs, 2015).

At present there is no recognized teratogenic effect in human pregnancies. In a study involving 1200 pregnant women, no increase in major or minor abnormalities was seen (Schaefer, 2015).

Schaefer (2015) also suggests that some adverse effects have been demonstrated with the use of lidocaine during pregnancy. These include alterations to the brain-stem evoked potential and possible loss of foetal thermoregulatory control. Epidural anaesthesia has been associated with abnormalities of neurobehavioural testing in the neonate, but recent studies have shown these to be rare and transient. Briggs (2015) notes that lidocaine may produce central nervous system depression in the newborn with high serum levels.

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

Use lidocaine and glucose with caution during breastfeeding.

The manufacturer states that the safety of lidocaine during breastfeeding has not been assessed and caution should be used.

LactMed suggests that during continuous IV infusion lidocaine concentrations in milk are low and that the lidocaine is poorly absorbed by the infant. Consequently, lidocaine is not expected to cause any adverse effects in breastfed infants. Briggs (2015) also notes that exposure to lidocaine via breast milk is unlikely to harm the nursing 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
Anaphylaxis
Arrhythmias
Blurred vision
Bradycardia
Cardiac arrest
Coma
Confusion
Convulsions
Dizziness
Drowsiness
Excitement
Hypersensitivity reactions
Hypertension
Hypotension
Mouth numbness
Muscle twitch
Myocardial depression
Nausea
Nervousness
Nystagmus
Paraesthesia
Peripheral vasodilatation
Respiratory depression
Respiratory failure
Restlessness
Tinnitus
Tongue numbness
Tremor
Vomiting
Yawning

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: January 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

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 hydrochloride 0.2% and Glucose 5% Infusion BP as Steriflex No. 26 or Freeflex. Fresenius Kabi Limited. Revised May 2004.

Summary of Product Characteristics: Lidocaine hydrochloride 0.4% and Glucose 5% Infusion as Steriflex No. 27 or Freeflex. Fresenius Kabi Limited. Revised May 2004.

N.A.P.O.S The Drug Database for Acute Porphyria, available at; https://www.drugs-porphyria.com/languages/UnitedKingdom/s1.php?l=gbr Last Revised: April 18, 2012 Last Accessed: January 12, 2017

The Welsh Medicines Information Centre (WMIC) - Porphyria Information Service.
Available at: https://www.wmic.wales.nhs.uk/porphyria_info.php
Last revised: May 2016
Last accessed: 23 January 2017

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: 10 January 2017
Last accessed: 12 January 2017

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 11 September 2017