Class: Local Anesthetics
VA Class: CN204
CAS Number: 6108-05-0
Brands: Xylocaine, Xylocaine with Epinephrine, Xylocaine Dental
Introduction
Intermediate-acting local anesthetic (amide type).211 213 214 a
Uses for Lidocaine Hydrochloride (Local Anesthetic)
Local or Regional Anesthesia
Local or regional anesthesia in surgical procedures (including oral surgery), diagnostic and therapeutic procedures, and obstetrical procedures.211 213 214
Lidocaine Hydrochloride (Local Anesthetic) Dosage and Administration
General
Determine dosage based on type and extent of surgical procedure, area to be anesthetized, vascularity of tissues, depth and duration of anesthesia, degree of muscular relaxation, and condition of the patient.211 213 Use lowest concentration and smallest dose required to produce the desired effect.211 213 214
Administration
Injection
For solution and drug compatibility information, see Compatibility under Stability.
Administer by local infiltration, peripheral nerve block, paracervical block, sympathetic nerve block, central neural block (e.g., epidural block), caudal block, or subarachnoid (spinal) block.211 213 214 Has been administered by continuous intra-articular infusion† (e.g., for control of postoperative pain); however, such use associated with chondrolysis.200 201 202 203 204 205 206 207 208 209 211 212 (See Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics under Cautions.)
Consult specialized references for specific techniques and procedures for administering local anesthetics.211 213 214
For IV regional anesthesia, use 50-mL single-dose vials containing lidocaine hydrochloride 0.5% only.211
For paracervical block, inject slowly; allow a 5-minute interval between sides.211
For caudal or lumbar epidural block, avoid rapid injection of large volumes; when feasible, administer in fractional (incremental) doses.211
For epidural or spinal block, avoid using preparations containing antimicrobial preservatives (e.g., methylparaben), since safety of intrathecal administration using these preparations not established.211
For spinal block, inject slowly.214
Aspirate prior to injections to avoid inadvertent intravascular administration.211 212 213 214
For dental anesthesia, lidocaine hydrochloride 2% solution with epinephrine 1:100,000 preferred for most routine procedures; when greater depth and a more pronounced hemostasis are required, use preparation containing epinephrine 1:50,000.213
For chemical disinfection of container surface, moisten cotton or gauze with isopropyl (rubbing) alcohol (91%) or ethyl alcohol (70%) and wipe surface thoroughly just prior to use.211 213 Do not use alcohol brands that are not of USP grade, since these preparations may contain denaturants that may be injurious to rubber.211 213
Dilution
Dilute with 0.9% sodium chloride injection to obtain desired concentration.211
Dosage
Available as lidocaine hydrochloride, as fixed combination containing lidocaine hydrochloride and epinephrine bitartrate or epinephrine hydrochloride, and as lidocaine hydrochloride in dextrose injection.211 213 214 Dosage expressed in terms of lidocaine hydrochloride.211 213 214
When larger dosages (volumes) are required, use preparations containing epinephrine (unless contraindicated).211
Pediatric Patients
Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block
Use lower dosages than those suggested for healthy adults (see Adults under Dosage and Administration).211
Anesthesia in Maxillary and Mandibular Area (for oral surgery)
Children <10 years of age: 18–20 mg (0.9–1 mL) of lidocaine hydrochloride 2% solution is adequate for a procedure involving 1 tooth (local infiltration), 2–3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).213
Adults
Local or Regional Anesthesia
Local Infiltration
Percutaneous: 5–300 mg (1–60 mL) of lidocaine hydrochloride 0.5 or 1% solution (without epinephrine).211
IV regional: 50–300 mg (10–60 mL) of lidocaine hydrochloride 0.5% solution (without epinephrine).211
Peripheral Nerve Block
Brachial: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).211
Dental: 20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution (without epinephrine).211
Intercostal: 30 mg (3 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Paravertebral: 30–50 mg (3–5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Pudendal: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).211
Paracervical Block
Obstetrical analgesia: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).211
Sympathetic Nerve Block
Cervical (stellate ganglion): 50 mg (5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Lumbar: 50–100 mg (5–10 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Retrobulbar Block
120–200 mg (3–5 mL) or 1.7–3 mg/kg of lidocaine hydrochloride 4% solution is suggested; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve.212
Transtracheal Injection
80–120 mg (2–3 mL) of lidocaine hydrochloride 4% solution is administered rapidly.212
If both transtracheal injection and topical application (oropharyngeal spray) are needed to achieve complete analgesia, combined total dose from transtracheal injection and oropharyngeal spray should be ≤200 mg (5 mL) of 4% solution or ≤3 mg/kg.212
Central Neural Block
Prior to lumbar epidural block, administer test dose to detect accidental intravascular injection.211 Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.211 Repeat test dose if patient is moved in a manner that could displace catheter.211
Thoracic epidural: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211 Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).211
Lumbar epidural (for analgesia): 250–300 mg (25–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Lumbar epidural (for anesthesia): 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine) or 200–300 mg (10–15 mL) of lidocaine hydrochloride 2% solution (without epinephrine).211 Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).211
Caudal Block
Prior to caudal block, administer test dose to detect accidental intravascular injection.211 Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.211 Repeat test dose if patient is moved in a manner that could displace catheter.211
Obstetrical analgesia: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).211
Surgical anesthesia: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).211
Subarachnoid (Spinal) Block
Vaginal delivery: Approximately 50 mg (1 mL) of lidocaine hydrochloride 5% in dextrose 7.5% injection.214
Cesarean section or delivery requiring intrauterine manipulations: 75 mg (1.5 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.214
Surgical anesthesia (abdominal): 75–100 mg (1.5–2 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.214
Anesthesia in Maxillary and Mandibular Area (for oral surgery)
20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution with epinephrine 1:50,000 or 1:100,000.213
Prescribing Limits
Pediatric Patients
Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block
For children >3 years of age with normal lean body mass and normal development, maximum dose is determined by child’s age and weight.211 For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).211 For IV regional anesthesia, maximum 3 mg/kg (1.4 mg/lb), using more dilute solutions (e.g., lidocaine hydrochloride 0.25 or 0.5% solution).211 (See Dilution under Dosage and Administration: Administration.)
Anesthesia in Maxillary and Mandibular Area (for oral surgery)
For children <10 years of age with normal lean body mass and normal development, maximum dose is determined by using standard pediatric drug formulas (e.g., Clark’s rule).213 For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).213
Maximum 4.5 mg/kg (2 mg/lb) of body weight (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (with epinephrine).213
Adults
Local or Regional Anesthesia
Local Infiltration, Peripheral/Sympathetic Nerve Block
Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 300 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 500 mg) (with epinephrine).211
IV regional: Maximum 4 mg/kg.211
Paracervical Block
Obstetric or nonobstetric use: Maximum 200 mg (100 mg each side) per 90-minute period.211
Continuous Epidural/Caudal Block
Maximum recommended dosage should not be administered at intervals of <90 minutes.211
Subarachnoid (Spinal) Block
Dosages >100 mg not required if technique and needle placement are correct.214
Anesthesia in Maxillary and Mandibular Area (for oral surgery)
Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 500 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 300 mg) (with epinephrine).213
Special Populations
Hepatic Impairment
Reduce dosage in patients with hepatic impairment.211
Geriatric Patients
Reduce dosage in geriatric patients.211 212 213 214
Other Populations
Reduce dosage in patients with cardiac disease, debilitated patients, and acutely ill patients.211 212 213 214
Cautions for Lidocaine Hydrochloride (Local Anesthetic)
Contraindications
Contraindications to spinal anesthesia: severe hemorrhage, shock, heart block, local infection at site of proposed puncture, and septicemia.214
Known hypersensitivity to local anesthetics of the amide type or to any ingredient in the formulation.211 213 214
Warnings/Precautions
Warnings
Experience of Supervising Clinician
Should be used only by clinicians who are sufficiently knowledgeable in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise. 211 212 213 214 Oxygen, resuscitative equipment, drugs, and personnel required for treatment of adverse reactions must be immediately available.211 212 213 214 Delay in proper management of dose-related toxicity, underventilation, and/or altered sensitivity may result in acidosis, cardiac arrest, and, possibly, death.211 212 213 214
Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics
Chondrolysis (necrosis and destruction of articular cartilage) reported in patients receiving continuous intra-articular infusions of local anesthetics, administered for 48–72 hours via elastomeric infusion devices, for treatment of postoperative pain.200 201 202 203 204 205 206 207 208 209 211 212 Primarily observed in the shoulder joint following arthroscopic or other shoulder surgery.200 211 212 May result in long-term disability; often requires intervention (e.g., debridement, arthroplasty).200 202 203 204 205 206 209 211 212 Not known whether the drug, infusion device, and/or other factors contributed to the development of chondrolysis.200 201 Neither local anesthetics nor elastomeric infusion devices are approved for use for continuous intra-articular infusion therapy.200 201 211 212
Accidental Intravascular Injection
Accidental intravascular injection may result in confusion, seizures, CNS excitement and/or depression, myocardial depression, coma, and/or respiratory arrest.211 213 214 (See Nervous System Effects and also see Cardiovascular Effects, under Cautions.)
Aspirate prior to administration to guard against intravascular injection.211 212 213 214
Injection During Uterine Contractions
Do not inject spinal anesthetics during uterine contractions, since spinal fluid current may carry drug further cephalad than desired.214
Epinephrine Administration
Some lidocaine hydrochloride preparations contain epinephrine, which may cause ischemic injury or necrosis.211 213 Consider usual precautions associated with epinephrine administration.211 213 (See Cardiovascular Effects under Cautions.)
Sensitivity Reactions
Hypersensitivity Reactions and Cross Hypersensitivity
Possible cutaneous lesions, urticaria, edema, or anaphylactoid reactions.211 213 214
No cross hypersensitivity reported in patients allergic to para-aminobenzoic derivatives (e.g., benzocaine, procaine, tetracaine).211 213 214
Use with caution in patients with known drug sensitivities.211 213 214
Sulfite Sensitivity
Some epinephrine-containing lidocaine preparations contain sodium metabisulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.211 213
General Precautions
Nervous System Effects
Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse CNS effects (e.g., lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, seizures, unconsciousness, respiratory arrest).211 214 Carefully monitor level of consciousness after each local anesthetic injection.211 213 214
Spinal anesthesia may be associated with adverse neurologic effects (e.g., loss of perineal sensation and sexual function, persistent anesthesia, paresthesia, weakness and paralysis of the lower extremities, headache).214
Risk of nerve injury with use of small-bore needles and microcatheters for spinal anesthesia; possibly a result of drug pooling and inconsistent distribution of concentrated anesthetic within the subarachnoid space.214 If an incomplete or patchy block occurs and is not responsive to patient repositioning, the drug may be missplaced or inadequately distributed.214 Use of a spinal needle of sufficient gauge may facilitate intrathecal distribution; in clinical trials, 22- and 25-gauge spinal needles were used safely for single-injection lidocaine spinal anesthesia.214 Animal studies suggest that dilution of 5% lidocaine hydrochloride with an equal volume of CSF or preservative-free 0.9% sodium chloride may decrease risk of nerve injury from pooling of concentrated drug.214
Cardiovascular Effects
Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse cardiovascular effects (e.g., bradycardia, hypotension, and cardiovascular collapse, cardiac arrest).211 213 214 Carefully monitor cardiovascular and respiratory vital signs after each local anesthetic injection.211 213 214
Use with caution in patients with impaired cardiovascular function, severe shock, or heart block.211 213 214
Some lidocaine hydrochloride preparations contain epinephrine; risk of exaggerated vasoconstrictor response in patients with peripheral or hypertensive vascular disease.211 213 Use with caution and in carefully restricted quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply (e.g., digits, nose, external ear, penis).211 213
Familial Malignant Hyperthermia
Many drugs used during the conduct of anesthesia may trigger familial malignant hyperthermia; not known whether amide-type local anesthetics trigger this reaction.211 213 214 However, standard protocol for management should be available.211 213 214 Early unexplained signs of tachycardia, tachypnea, labile BP, and metabolic acidosis may precede temperature elevation.211 213 214 If familial malignant hyperthermia is confirmed, discontinue triggering agent and initiate appropriate therapy (e.g., oxygen, dantrolene) and other supportive measures.211 213 214
Preexisting Conditions
Employ lumbar epidural and caudal block with extreme caution in patients with preexisting neurological disease, spinal deformities, septicemia, and severe hypertension.211
Conditions that may preclude the use of spinal anesthesia (depending upon the clinician’s evaluation of the situation and ability to manage potential complications) include preexisting CNS disease (e.g., disease associated with pernicious anemia, poliomyelitis, paralysis from nerve injuries and syphilis); hematological disorders predisposing to coagulopathies; current anticoagulant therapy; chronic backache; preoperative headache; hypotension or hypertension; technical problems (persistent paresthesias, persistent bloody spinal tap); arthritis or spinal deformity; extremes of age; and psychosis or other causes of poor patient cooperation.214
Risks Associated with Various Administration Techniques
Paracervical block: Possible rapid systemic absorption.211 Maternal seizures and cardiovascular collapse reported following paracervical block with certain local anesthetics (used to induce anesthesia for elective abortion).211 Administer dose slowly; do not exceed recommended maximum dose.211 (See Administration and see Prescribing Limits, under Dosage and Administration and also see Labor and Delivery under Cautions.)
Retrobulbar block: Possible permanent injury to extraocular muscles requiring surgical repair.211 213
Serious Adverse Effects Associated with Local Anesthetics
Risk of serious adverse effects (e.g., seizures, coma, irregular heart beat, respiratory depression) with use of topical local anesthetics; generally reported following application of extemporaneously prepared topical preparations containing high concentrations of anesthetics.e
Potential for life-threatening adverse effects (e.g., irregular heart beat, seizures, breathing difficulties, coma, death) when topical local anesthetics are applied to a large area of skin, when the area of application is covered with an occlusive dressing, if a large amount of topical anesthetic is applied, if the anesthetic is applied to irritated or broken skin, or if the skin temperature increases (from exercise or use of a heating pad).101 102
Lidocaine 4% gel has been investigated to reduce discomfort during mammography.101 103 Whether such use could result in serious reactions has not been determined.101 103 Patients should speak with their clinician if they are considering using a topical anesthetic before obtaining a mammogram.101
When a topical anesthetic is needed for a procedure, use of an FDA-approved preparation has been recommended.e Use a preparation containing the lowest concentration of anesthetic likely to be effective; apply a small amount of the preparation to the affected area for the shortest period necessary for the desired effect, and do not apply to broken or irritated skin.101
Use of Fixed Combination
When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.
Specific Populations
Pregnancy
Category B.211 213 214
Labor and Delivery
Maternal hypotension reported.211 214 To prevent decreases in BP, elevate patient’s legs and position patient on her left side.211 214 Monitor fetal heart rate continuously; electronic fetal monitoring highly advisable.211 214
Accidental intravascular or fetal intracranial injection following paracervical and/or may result in unexplained neonatal depression at birth or seizures within 6 hours after birth.211
Paracervical block may decrease duration of first stage labor and facilitate cervical dilation.211 214 Possible fetal bradycardia and acidosis; always monitor fetal heart rate.211 For paracervical block in prematurity, toxemia of pregnancy, or presence of fetal distress, weigh benefit of therapy versus risk.211
Epidural and spinal anesthesia may prolong second stage of labor (by removing parturient’s reflex urge to bear down or by interfering with motor function); may increase need for forceps assistance.211 214
Possible diminished muscle strength and tone on neonate’s first or second day of life.211
Lactation
Not known whether lidocaine is distributed into milk.211 213 214 Caution if used in nursing women.211 213 214
Pediatric Use
Safety and efficacy of lidocaine hydrochloride in dextrose injection not established in pediatric patients <16 years of age.214
Geriatric Use
Dosage reduction recommended.211 213 214
Hepatic Impairment
Possible increased risk of toxicity, particularly in patients with severe hepatic impairment.211 213 214 Use with caution.211 214 Dosage adjustments recommended.211
Common Adverse Effects
Adverse nervous system and cardiovascular effects.211 213 214 (See Nervous System Effects and Cardiovascular Effects, under Cautions.)
Spinal block: Positional headache, hypotension, backache, shivering.211 214
Interactions for Lidocaine Hydrochloride (Local Anesthetic)
Consider usual drug interactions associated with epinephrine administration.211 213 214
Specific Drugs and Laboratory Tests
Drug | Interaction | Comments |
|---|---|---|
Anesthetics, general | Possible cardiac arrhythmias due to epinephrine component.211 213 | Use with caution. |
Antidepressants, tricyclics | Possible severe, prolonged hypertension due to epinephrine component.211 213 214 | Avoid concomitant use;211 213 214 if must be used concomitantly, careful monitoring is required.211 213 214 |
Butyrophenones | Possible reduction or reversal of pressor effect of epinephrine.211 214 | Avoid concomitant use;211 if must be used concomitantly, careful monitoring is required.211 |
Ergot alkaloid oxytocics (ergonovine, methylergonovine) | Possible severe, persistent hypertension or cerebrovascular accidents due to epinephrine component.211 213 214 | |
MAO inhibitors | Possible severe, prolonged hypertension due to epinephrine component.211 213 214 | Avoid concomitant use;211 213 214 if must be used concomitantly, careful monitoring is required.211 213 214 |
Phenothiazines | Possible reduction or reversal of pressor effect of epinephrine.211 214 | Avoid concomitant use;211 if must be used concomitantly, careful monitoring is required.211 |
Vasopressors | Possible severe, persistent hypertension or cerebrovascular accidents due to epinephrine component.211 213 214 | |
Test for CPK | Possible increased CPK concentrations following IM injection of lidocaine.211 213 | Accuracy as diagnostic test for AMI compromised if used without isoenzyme separation.211 213 |
Lidocaine Hydrochloride (Local Anesthetic) Pharmacokinetics
Absorption
Bioavailability
Systemic absorption dependent upon route of administration, administration site, and presence or absence of epinephrine in formulation.211 213 214 Except for intravascular administration, intercostal nerve block results in highest blood levels, and sub-Q administration results in lowest blood levels.211 213 214
Possible accumulation with repeated dosing.211 213 214
Onset
More rapid onset of anesthesia compared with procaine hydrochloride.a
For dental anesthesia, onset <2 minutes following infiltration with 2% solution (with or without epinephrine).213 Onset of 2–4 minutes following nerve block with 2% solution (with or without epinephrine).213
Duration
Longer duration of anesthesia compared with procaine hydrochloride.a
Duration of about 100 minutes following lumbar epidural block with 2% solution.a
Duration of about 75–135 minutes following caudal block with 1 or 2% solution.a
Following spinal block with 50 mg (1 mL) of 5% solution, duration of perineal anesthesia is about 100 minutes; analgesic effects continue for another 40 minutes.214 Duration of surgical anesthesia is about 2 hours with 75–100 mg (1.5–2 mL) of 5% solution.214
For dental anesthesia, pulp anesthesia persists for 5 minutes following infiltration with 2% solution without epinephrine.213 Pulp anesthesia persists for at least 60 minutes following infiltration with 2% solution with epinephrine; average duration of soft tissue anesthesia is approximately 2.5 hours.213 Following nerve block with the 2% solution with epinephrine, pulp anesthesia persists for at least 90 minutes, and soft tissue anesthesia persists for 3.25 hours.213
Distribution
Extent
Crosses blood-brain and placental barriers.211 213 214
Plasma Protein Binding
Protein binding dependent upon drug concentration and concentration of α-1-acid glycoprotein; fraction bound decreases with increasing drug concentration.211 213 214 At concentrations of 1–4 mcg/mL, 60–80% of drug is bound.211 213 214
Elimination
Metabolism
Systemically absorbed lidocaine is rapidly metabolized in the liver.211 213 214
Pharmacological or toxicological effects of metabolites are similar to but less potent than those of parent drug.211 213 214
Elimination Route
Excreted principally in urine as metabolites (90%) and small amounts (<10%) of unchanged drug.211 213 214
Half-life
1.5–2 hours following IV injection.211 213 214
Special Populations
Prolonged half-life in patients with hepatic dysfunction.211 213
Increased accumulation of metabolites in patients with renal impairment.211 213
Stability
Storage
Parenteral
Injection
Room temperature (approximately 20–25°C).211 213 214 Protect epinephrine-containing solutions from light.211 213
Compatibility
For information on systemic interactions resulting from concomitant use, see Interactions.
Parenteral
Syringe CompatibilityHID
aWith epinephrine HCl 1:80,000, 1:100,000, 1:200,000 added.
Compatible |
|---|
Caffeine citrate |
Clonidine HCl with fentanyl citrate |
Heparin sodium |
Hydroxyzine HCl |
Metoclopramide HCI |
Milrinone lactate |
Nalbuphine HCI |
Incompatible |
Cefazolin sodium |
Dantoprazole sodium |
Variable |
Ampicillin sodium |
Ceftriaxone sodium |
Sodium bicarbonatea |
ActionsActions
Local anesthetics block the generation and conduction of nerve impulses by increasing the threshold for electrical excitation, slowing the propagation of the nerve impulse, and reducing the rate of rise of the action potential.211 213 214
Some preparations formulated with epinephrine to decrease lidocaine’s rate and extent of systemic absorption and to prolong its duration of action.a 211 213
Has intermediate duration of action.a
Advice to Patients
Prior to administration, advise patients of the possibility of temporary loss of sensation and muscle function (e.g., in lower half of body following lumbar epidural or subarachnoid block).211 213 214
Advise patients to avoid inadvertent trauma to the lips, tongue, cheek mucosae, or soft palate when these structures are anesthetized for dental procedures; postpone ingestion of food until normal function returns.213 Advise patient to consult dentist if anesthesia persists or if rash develops.213
Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., cardiovascular or liver disease).211 213 214
Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.211 213 214
Importance of informing patients of other important precautionary information. 211 213 214 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | Injection | 0.5%* | Lidocaine Hydrochloride Injection | |
Xylocaine | APP Pharmaceuticals | |||
Xylocaine-MPF | APP Pharmaceuticals | |||
1%* | Lidocaine Hydrochloride Injection | |||
Xylocaine | APP Pharmaceuticals | |||
Xylocaine-MPF | APP Pharmaceuticals | |||
1.5%* | Lidocaine Hydrochloride Injection | |||
Xylocaine-MPF | APP Pharmaceuticals | |||
2%* | Lidocaine Hydrochloride Injection | |||
Xylocaine | APP Pharmaceuticals | |||
Xylocaine Dental (available as dental cartridge) | Dentsply | |||
Xylocaine-MPF | APP Pharmaceuticals | |||
4%* | Lidocaine Hydrochloride Injection | |||
Xylocaine-MPF Sterile Solution | APP Pharmaceuticals |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | Injection | 5% Lidocaine Hydrochloride in 7.5% Dextrose* | Lidocaine Hydrochloride Injection in Dextrose |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | Injection | 0.5% with Epinephrine 1:200,000* | Lidocaine Hydrochloride and Epinephrine Injection | |
Xylocaine with Epinephrine | APP Pharmaceuticals | |||
1% with Epinephrine 1:100,000* | Lidocaine Hydrochloride and Epinephrine Injection | |||
Xylocaine with Epinephrine | APP Pharmaceuticals | |||
1% with Epinephrine 1:200,000 | Xylocaine-MPF with Epinephrine | APP Pharmaceuticals | ||
1.5% with Epinephrine 1:200,00* | Lidocaine Hydrochloride and Epinephrine Injection | |||
Xylocaine-MPF with Epinephrine | APP Pharmaceuticals | |||
2% with Epinephrine Hydrochloride 1:100,000 (of epinephrine)* | Lidocaine Hydrochloride and Epinephrine Injection | |||
Xylocaine with Epinephrine | APP Pharmaceuticals | |||
2% with Epinephrine Hydrochloride 1:200,000 (of epinephrine)* | Lidocaine Hydrochloride and Epinephrine Injection | |||
Xylocaine-MPF with Epinephrine | APP Pharmaceuticals | |||
2% with Epinephrine Bitartrate 1:50,000 (of epinephrine)* | Lidocaine Hydrochloride and Epinephrine Injection (available as dental cartridge) | |||
Xylocaine Dental (available as dental cartridge) | Dentsply | |||
2% with Epinephrine Bitartrate 1:100,000 (of epinephrine)* | Lidocaine Hydrochloride and Epinephrine Injection (available as dental cartridge) | |||
Xylocaine Dental (available as dental cartridge) | Dentsply |
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided here
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