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Lidocaine with preservative parenteral

Presentation

Parenteral formulations of lidocaine with preservative

Drugs List

  • lidocaine 200mg/20ml (1%) solution for injection vial (with preservative)
  • lidocaine 400mg/20ml (2%) solution for injection vial (with preservative)
  • Therapeutic Indications

    Uses

    Local anaesthesia

    Dosage

    200 mg maximum single dose.

    Administration

    For subcutaneous injection only.

    Contraindications

    Neonates
    Hypovolaemia
    Third degree atrioventricular block

    Precautions and Warnings

    Children under 18 years
    Debilitation
    Elderly
    Acute porphyria
    Bradycardia
    Breastfeeding
    Cardiac conduction defects
    Cardiogenic shock
    Congestive cardiac failure
    Epileptic disorder
    Hepatic impairment
    Myasthenia gravis
    Pregnancy
    Renal impairment - creatinine clearance below 10ml/minute
    Respiratory impairment

    Advise patient ability to drive or operate machinery may be impaired
    Contains hydroxybenzoate
    Effect may be reduced if injected into an inflamed or infected area
    For subcutaneous use only
    Resuscitation facilities must be immediately available
    Dosage must be individualised for each patient, especially children
    Maintain treatment at the lowest effective dose

    Pregnancy and Lactation

    Pregnancy

    Use lidocaine with caution in pregnancy.

    Lidocaine readily crosses the placenta and has been detected in foetal circulation within minutes of administration, although studies in animals have shown no evidence of foetal harm. Briggs (2015) states that reproductive studies in rats have shown no evidence of foetal harm in doses up to 6.6 times the recommended human dose, however Schaefer (2015) states lidocaine has been found to cause CNS depression in neonates when administered during labour. Elevated lidocaine levels have been detected in neonates for at least 48 hours after delivery and have been known to cause hypotonia, respiratory depression and foetal bradycardia or neonatal bradycardia.
    The manufacturer recommends to only administer lidocaine if the potential benefit to the mother outweighs any potential risk to the foetus.

    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 with caution in breastfeeding.

    Lidocaine is excreted in small amounts in breast milk. Hale (2014), Briggs (2015) and Schaefer (2015) all state the poor availability of lidocaine in breast milk suggests a low risk of harm to the breastfed 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
    Anaphylactoid reaction
    Angioedema
    Arachnoiditis
    Back pain
    Blurred vision
    Bowel dysfunction
    Bradycardia
    Bronchospasm
    Buttock pain
    Cardiac arrest
    Cardiac arrhythmias
    Cardiovascular disturbances
    Cauda equina syndrome
    Circulatory collapse
    Circumoral paraesthesia
    CNS excitation
    Coma
    Confusion
    Convulsions
    Diplopia
    Dizziness
    Drowsiness
    Dyspnoea
    Facial oedema
    Hyperacusis
    Hypersensitivity reactions
    Hypotension
    Leg pain
    Loss of vision(transient)
    Methaemoglobinaemia
    Myocardial depression
    Nausea
    Nervousness
    Oedema
    Orbital inflammation
    Paraesthesia
    Paralysis in the extremities
    Rash
    Respiratory arrest
    Respiratory depression
    Respiratory failure
    Tinnitus
    Tongue numbness
    Tremor
    Urinary dysfunction
    Urticaria
    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 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.

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

    Summary of Product Characteristics: Lidocaine Hydrochloride injection BP with preservative 1%. Hameln pharmaceuticals Ltd. Revised June 2015.

    Summary of Product Characteristics: Lidocaine Hydrochloride injection BP with preservative 2%. Hameln pharmaceuticals Ltd. Revised June 2015.

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

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