LIDOCAINE HYDROCHLORIDE

In ventricular arrhythmias The usual adult IV bolus dose is 50-100 mg administered at a rate of approximately 25-50 mg per minute. If the desired response is not achieved, a second dose may be administered 5 minutes after completion of the first injection.

Not more than 200-300 mg should be administered during a one hour period. Elderly patients and those with congestive heart failure or cardiogenic shock may require smaller bolus doses. 4% solution in 5% glucose. Adults: 20-50 micrograms/kg/minute (1-4 mg/minute in an average 70 kg adult).

Slower infusion rates should be used in patients with congestive heart failure or liver disease; no dosing modification appears necessary in patients with renal failure. When arrhythmias reappear during a constant infusion of Lidocaine, a small bolus may be given to rapidly increase plasma concentration of the drug; the infusion rate is increased simultaneously.

The infusion should be terminated as soon as the patient’s basic cardiac rhythm appears to be stable or at the earliest sign of toxicity. 5-1 mg/kg. This dose may be repeated according to the response of the patient, but the total dose should not exceed 3-5 mg/kg.

A maintenance IV infusion of 10-50 micrograms/kg per minute may be given via an infusion pump. For advanced cardiac life support in children, the recommended dosage is an initial IV bolus of 1 mg/kg. If ventricular tachycardia or ventricular fibrillation is not corrected following defibrillation and an initial bolus, an IV infusion should be started at a rate of 20-50 mcg/kg per minute.

Constant ECG monitoring is recommended during therapy with Lidocaine Hydrochloride, however if this equipment is not available and a ventricular arrhythmia is suspected, a single IM dose may be administered if bradycardia is not present.

The deltoid muscle is the preferred site for IM injection. In Local Anaesthesia Usual doses should generally be reduced in children and in elderly or debilitated patients. 5% or 1%. 5 mg/kg (or 200 mg) in adults or children 12 – 18 years of age.

Lidocaine by local infiltration for children under the age of 12 years should not exceed 3mg/kg, repeated not more often than every 4 hours. For spinal anaesthesia, up to 100 mg of the drug may be given. 5 hours. 5 hours. 5% solution, the dose administered should not exceed 4 mg/kg.

Solutions of 1% Lidocaine Hydrochloride (without preservative) are used for epidural or caudal anaesthesia. To prevent intravascular or subarachnoid injection of a large epidural dose of Lidocaine, a test dose of 2-5 mls should be injected at least 5 minutes prior to administering the total dose.

In epidural anaesthesia 2-3 mls of 1% solution is usually required for each dermatome to be anaesthetised. In caudal block for production of obstetric analgesia or in epidural thoracic block, 20-30 mls of a 1% solution (200-300 mg) of the drug may be used.

For epidural lumbar anaesthesia, the dose is 25-30 mls (250-300 mg) of a 1% solution. For intercostal nerve block: 3 mls of a 1% solution (30 mg). For paravertebral nerve block: 3-5 mls of a 1% solution (30-50 mg). For pudendal nerve block (each side): 10 mls of a 1% solution (100 mg).

For paracervical nerve block (each side) for obstetric analgesia: 10 mls of a 1% solution (100 mg).

For sympathetic nerve blocks:

Cervical (stellate ganglion) nerve block: 5 mls of a 1% solution (50 mg). Lumbar nerve block: 5-10 mls of a 1% solution (50-100mg). 5 to 30ml of a 1% solution (5-300mg). 5% solution (50-300 mg).

In common with other local anaesthetics, adverse reactions to Lidocaine are rare and are usually the result of raised plasma concentrations due to accidental intravascular injection, excessive dosage or rapid absorption from highly vascular areas, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient.

Systemic toxicity mainly involves the central nervous system and/or the cardiovascular system (see also

3), congestive heart failure, bradycardia, severe shock, impaired respiratory function or impaired renal function with a creatinine clearance of less than 10mL/minute. Lidocaine is metabolised in the liver and it should be used with caution in patients with impaired hepatic function.

2 Posology). Hypokalaemia, hypoxia and disorders of acid-base balance should be corrected before treatment with intravenous lidocaine begins. Facilities for resuscitation should be available when administering local anaesthetics. The effect of local anaesthetics may be reduced if the injection is made into an inflamed or infected area.

Intra-articular administration of lidocaine may cause chondrotoxicity. Certain local anaesthetic procedures may be associated with serious adverse reactions, regardless of the local anaesthetic drug used. • Central nerve blocks may cause cardiovascular depression, especially in the presence of hypovolaemia, and therefore epidural anaesthesia should be used with caution in patients with impaired cardiovascular function.

• Blood pressure should be monitored during spinal anaesthesia. Epidural anaesthesia may lead to hypotension and bradycardia. This risk can be reduced by preloading the circulation with crystalloidal or colloidal solutions. Hypotension should be treated promptly.

• Paracervical block can sometimes cause foetal bradycardia or tachycardia, and careful monitoring of the foetal heart rate is necessary • Injections in the head and neck regions may be made inadvertently into an artery, causing cerebral symptoms even at low doses.

• Retrobulbar injections may rarely reach the cranial subarachnoid space, causing serious/severe reactions, including cardiovascular collapse, apnoea, convulsions and temporary blindness • Retro- and peribulbar injections of local anaesthetics carry a low risk of persistent ocular motor dysfunction.

The primary causes include trauma and/or local toxic effects on muscles and/or nerves. The severity of such tissue reactions is related to the degree of trauma, the concentration of the local anaesthetic and the duration of exposure of the tissue to the local anaesthetic.

For this reason, as with all local anaesthetics, the lowest effective concentration and dose of local anaesthetic should be used. Intramuscular Lidocaine may increase creatinine phosphokinase concentrations which can interfere with the diagnosis of acute myocardial infarction.

Lidocaine has been shown to be porphyrinogenic in animals and should be avoided in persons suffering from porphyria. Hameln Lidocaine Injection is not recommended for use in neonates. The optimum serum concentration of lidocaine required to avoid toxicity, such as convulsions and cardiac arrhythmias, in this age group is not known.

1. e. hameln Lidocaine Hydrochloride Injection BP 1% w/v) is neither isotonic nor pH neutral and is therefore contraindicated for intraocular use. If intraocular use is required, administration of medicinal products more suitable for intraocular use should be considered.