Lidocaine (lignocaine) hydrochloride -- intravenous administration

10mg/mL (1%) in 10-mL pre-filled syringes; 20mg/mL (2%) in 5-mL pre-filled

syringes 10mg/mL (1%) solution and 20mg/mL (2%) solution in 2-mL, 5-mL, 10mL and 20-mL ampoules 1mg/mL (0.1%) and 2mg/mL (0.2%) in Gluc 5% in 500mL infusion bags * Lidocaine is a local anaesthetic and it also has class 1b
antiarrhythmic effects. * It is used IV to treat ventricular arrhythmias, especially
after MI. * Doses are expressed in terms of lidocaine hydrochloride.
Products containing adrenaline (epinephrine) or preservatives must not be given
by IV injection. Pre-treatment checks * Caution in patients with porphyria. * In IV
therapy resuscitative equipment and drugs should be immediately available for
the management of severe adverse cardiovascular, respiratory or central
nervous system effects. Biochemical and other tests (not all are necessary in an
emergency situation) Possibly prior to IV treatment: ECG Electrolytes: serum K
(correct #K before commencing therapy) Renal function: U, Cr, CrCl (or eGFR)
Dose Ventricular arrhythmias: 100 mg by IV injection in patients without gross
circulatory impairment (50 mg in lighter patients or those whose circulation is
severely impaired); followed immediately by 4 mg/minute by IV infusion for 30
minutes, then 2 mg/minute for 2 hours, then 1 mg/minute. Reduce the rate
further if infusion is continued beyond 24 hours (rarely required). * The IV
injection dose can be repeated once or twice at intervals of not less than 10
minutes if an infusion is not immediately available. * Stop the infusion as soon as
the basic cardiac rhythm appears to be stable or at the earliest signs of toxicity.
Intravenous injection Preparation and administration 1. Select the appropriate
pre-filled syringe. Expel any excess lidocaine if necessary. Alternatively, withdraw
the required dose. 2. The solution should be clear and colourless. Inspect visually
for particulate matter or discoloration prior to administration and discard if
present. 3. Give by IV injection at a rate of 25--50 mg/minute, i.e. give 1%
injection at 2.5--5 mL/minute; give 2% injection at 1.25--2.5 mL/minute.
Continuous intravenous infusion Preparation and administration 1. Select the
correct pre-prepared infusion bag. Alternatively, withdraw the required dose of
1% or 2% injection and add to a suitable volume (usually 500 mL) of Gluc 5% to
give a solution containing between 1 mg/mL and 4 mg/mL. Mix well. 2. The
solution should be clear and colourless. Inspect visually for particulate matter or
discoloration prior to administration and discard if present. 3. Give by IV infusion
via a volumetric infusion device at the appropriate rate (see Dose above)

Technical information
Incompatible with Amphotericin, thiopental sodium.
Compatible with Flush: NaCl 0.9% Solutions: Gluc 5%, NaCl 0.9%, Hartmanns (all
with added KCl) Y-site: Alteplase, bivalirudin, cisatracurium, ciprofloxacin,

clarithromycin, dobutamine, dopamine, glyceryl trinitrate, linezolid, micafungin,

propofol, remifentanil, streptokinase, tirofiban
pH 5--7 for injection solutions; 3.5--7 for infusions in Gluc
Sodium content Negligible
Storage Store below 25C in original packaging.
Stability after preparation From a microbiological point of view, should be used
immediately; however, prepared infusions may be stored at 2--8C and infused (at
room temperature) within 24 hours.

Monitoring Measure

Frequency

ECG, heart rate and blood pressure

Continuously
Response to therapy. *
#BP
and #pulse may lead to
cardiac arrest.

CNS toxicity *
Infusion site
tissue damage

Rationale

Convulsions, respiratory
depression may occur.
Half-hourly *

Extravasation may cause

Additional information
Common and serious undesirable effects
Immediate: Anaphylaxis and other hypersensitivity reactions have rarely been
reported. Injection/infusion-related: * Too rapid administration: Dizziness,
paraesthesia, drowsiness, #BP, #pulse. * Local: Extravasation may cause tissue
damage. Other: Apprehension, nervousness, euphoria, tinnitus, blurred or double
vision, nystagmus, vomiting, sensations of heat, cold or numbness, twitching,
tremors. Pharmacokinetics Plasma concentrations decline rapidly after an IV dose
with an initial half-life of less than 30 minutes. Elimination half-life is 1--2 hours
but may be prolonged if infusions are given for longer than 24 hours or if hepatic
blood flow is reduced. Significant interactions * The following may "lidocaine
levels or effect (or "side-effects): antiarrhythmics ("risk of myocardial
depression), antipsychotics ("risk of ventricular arrhythmias), atazanavir, betablockers ("risk of myocardial depression), cimetidine ("risk of toxicity),
fosamprenavir (avoid combination), quinupristin with dalfopristin ("risk of
ventricular arrhythmias). * #K caused by the following may #lidocaine levels or
effect: acetazolamide, diuretics-loop, diuretics-thiazide. Action in case of
overdose Symptoms to watch for: Medullary depression, seizures, cardiovascular
collapse. Antidote: No specific antidote; stop administration and give supportive

therapy as appropriate, which may include diazepam for seizures and

metaraminol for #BP.