Lidocaine with preservative parenteral
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Parenteral formulations of lidocaine with preservative
200 mg maximum single dose.
For subcutaneous injection only.
Third degree atrioventricular block
Precautions and Warnings
Children under 18 years
Cardiac conduction defects
Congestive cardiac failure
Renal impairment - creatinine clearance below 10ml/minute
Advise patient ability to drive or operate machinery may be impaired
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
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 ).
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
Cauda equina syndrome
Loss of vision(transient)
Paralysis in the extremities
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 ).
Last Full Review Date: May 2017
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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