Lidocaine 1% Inj, 30ml
It is used to numb an area before a procedure.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Local Anesthetic; Antiarrhythmic
Pharmacologic Class
Voltage-gated Sodium Channel Blocker; Class IB Antiarrhythmic
Pregnancy Category
Category B
FDA Approved
Aug 1948
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lidocaine is a medication used to numb a specific area of the body, preventing you from feeling pain during medical procedures like stitches, minor surgeries, or dental work. It works by temporarily blocking nerve signals in the area where it's injected.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Take this medication exactly as directed, and be sure to follow all instructions provided. This medication is administered via injection.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor to receive guidance on the appropriate course of action.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor to receive guidance on the appropriate course of action.
Lifestyle & Tips
- Inform your healthcare provider about all your medical conditions and medications, especially heart problems, liver disease, or other numbing medicines.
- Report any unusual sensations or discomfort during or after the injection.
- Avoid touching or putting pressure on the numb area until sensation returns to prevent injury.
Available Forms & Alternatives
Available Strengths:
- Lidocaine 4% Top Soln 50ml
- Lidocaine 2% Visc Oral Solution
- Lidocaine 1% Inj, 10ml
- Lidocaine 2% Inj, 2ml
- Lidocaine 4% Injection, 5ml
- Lidocaine 1% Inj, 5ml
- Lidocaine 1% Inj, 20ml
- Lidocaine 2% Inj, 20ml
- Lidocaine 1% Inj, 2ml
- Lidocaine 1% Inj, 50ml
- Lidocaine 2% Inj, 5ml
- Lidocaine 2% Inj, 10ml
- Lidocaine 1% Inj, 30ml
- Lidocaine 2% Inj, 50ml
- Lidocaine 2% Inj, 5ml
- Lidocaine 10mg/ml Inj, 5ml
- Lidocaine 3% Cream 28.35gm
- Lidocaine 3% Cream 85gm
- Lidocaine 2% Topical Jelly 5ml
- Lidocaine 2% Topical Jelly 10ml
- Lidocaine 2% Topical Jelly 20ml
- Lidocaine 20mg/ml Inj, 5ml
- Lidocaine 2% Jelly Gel (uro-Jet)5ml
- Lidocaine 0.5% Inj, 50ml
- Lidocaine 5% Patch
- Lidocaine 5% Topical Ointment 30gm
- Lidocaine 5% Topical Oint 35.44gm
- Lidocaine 5% Topical Ointment 50gm
- Lidocaine 1.5% Inj, 1 Ampule
- Lidocaine 5% Top/oral Oint 50gm
- Lidocaine 4% Cream 15gm
- Lidocaine 4% Cream 30gm
- Lidocaine 4% Cream 5gm
- Lidocaine 3% Cream 85gm
- Lidocaine Pain Relief 4% Patch
- Lidocaine 5% Top/oral Oint (sprmt)
- Lidocaine 5% Anorectal Cream
- Lidocaine 4% Cream 15gm
- Lidocaine 5% Topical Ointment 30gm
- Lidocaine 5% Anorectal Cream 15gm
- Lidocaine Pain Relief 4% Patch
- Lidocaine 5% Cream 30gm
- Lidocaine 2% Inj 25ml
- Lidocaine 5% Ointment 50gm
- Lidocaine 4% Cream 15gm
- Lidocaine 4% Topical Pain Patch
- Lidocaine 3%/hc 0.5% Cream 28.3gm
- Lidocaine 2% Topical Jelly 30ml
Dosing & Administration
Adult Dosing
Standard Dose:
Varies significantly based on procedure and site of injection. For local infiltration: 0.5% to 1% solution, up to 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) per single administration, not exceeding 300 mg (without epinephrine) or 500 mg (with epinephrine).
Condition-Specific Dosing:
localInfiltration:
Up to 4.5 mg/kg (max 300 mg) without epinephrine; up to 7 mg/kg (max 500 mg) with epinephrine.
peripheralNerveBlock:
50-300 mg (e.g., 5-30 mL of 1% solution).
epiduralAnesthesia:
250-300 mg (e.g., 25-30 mL of 1% solution).
caudalAnesthesia:
225-300 mg (e.g., 22.5-30 mL of 1% solution).
Pediatric Dosing
Neonatal:
Not established for routine use; use with extreme caution and reduced doses if necessary. Max 2-3 mg/kg.
Infant:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) per single administration, not exceeding 300 mg (without epinephrine) or 500 mg (with epinephrine). Doses should be individualized and the lowest effective dose used.
Child:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) per single administration, not exceeding 300 mg (without epinephrine) or 500 mg (with epinephrine). Doses should be individualized and the lowest effective dose used.
Adolescent:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) per single administration, not exceeding 300 mg (without epinephrine) or 500 mg (with epinephrine). Doses should be individualized and the lowest effective dose used.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment generally required for single-dose local anesthesia.
Moderate:
No specific adjustment generally required for single-dose local anesthesia.
Severe:
No specific adjustment generally required for single-dose local anesthesia, but caution advised due to potential for accumulation of metabolites with prolonged or repeated use.
Dialysis:
Lidocaine is not significantly removed by hemodialysis. No specific adjustment for single-dose local anesthesia, but caution with repeated doses.
Hepatic Impairment:
Mild:
Caution advised; consider lower doses.
Moderate:
Reduce dose by 50% or more; monitor for toxicity. Lidocaine clearance is significantly reduced.
Severe:
Contraindicated or significantly reduced dose (e.g., 75% reduction); monitor closely for toxicity. Lidocaine clearance is significantly reduced.
Confidence:
Medium
Pharmacology
Mechanism of Action
Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby exerting a local anesthetic action. It blocks voltage-gated sodium channels, preventing the depolarization of the nerve cell membrane and the propagation of action potentials.
Pharmacokinetics
Absorption:
Bioavailability:
Variable; depends on site of administration, vascularity of tissue, and presence of vasoconstrictor (e.g., epinephrine). Rapidly absorbed from injection sites.
Tmax:
5-15 minutes (after subcutaneous injection), 10-20 minutes (after epidural injection).
FoodEffect:
Not applicable (parenteral administration).
Distribution:
Vd:
0.7-2.7 L/kg (average 1.1 L/kg in healthy adults).
ProteinBinding:
60-80% (primarily to alpha-1-acid glycoprotein and albumin).
CnssPenetration:
Yes (readily crosses blood-brain barrier and placenta).
Elimination:
HalfLife:
1.5-2 hours (in healthy adults); prolonged in hepatic dysfunction or heart failure.
Clearance:
Approximately 10 mL/min/kg.
ExcretionRoute:
Renal (less than 10% as unchanged drug).
Unchanged:
Less than 10%
Pharmacodynamics
OnsetOfAction:
2-5 minutes (infiltration, nerve block).
PeakEffect:
5-15 minutes (infiltration, nerve block).
DurationOfAction:
30-60 minutes (without epinephrine); 60-120 minutes (with epinephrine).
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of methemoglobinemia, a rare but potentially life-threatening condition, such as:
+ Blue or gray discoloration of the lips, nails, or skin
+ Abnormal heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling weak or tired
+ Shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Rapid breathing
+ Rapid heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling weak or tired
Other severe side effects, such as:
+ Trouble breathing, slow breathing, or shallow breathing
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Slow heartbeat
+ Feeling nervous or excitable
+ Trouble speaking
+ Burning, numbness, or tingling sensations
+ Restlessness
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching
+ Shakiness
+ Seizures
+ Feeling hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Additional Side Effects (Injection into the Spine)
If you receive this medication via injection into the spine, you may also experience:
Erectile dysfunction
Loss of movement or mobility
Loss of bladder or bowel control
Trouble urinating
Other Possible Side Effects
As with any medication, you may experience side effects that are not severe enough to require immediate medical attention. However, if you experience any side effects that bother you or persist, contact your doctor for guidance. Not all possible side effects are listed here. If you have questions or concerns about side effects, consult your doctor.
Reporting Side Effects
You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of methemoglobinemia, a rare but potentially life-threatening condition, such as:
+ Blue or gray discoloration of the lips, nails, or skin
+ Abnormal heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling weak or tired
+ Shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Rapid breathing
+ Rapid heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling weak or tired
Other severe side effects, such as:
+ Trouble breathing, slow breathing, or shallow breathing
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Slow heartbeat
+ Feeling nervous or excitable
+ Trouble speaking
+ Burning, numbness, or tingling sensations
+ Restlessness
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching
+ Shakiness
+ Seizures
+ Feeling hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Additional Side Effects (Injection into the Spine)
If you receive this medication via injection into the spine, you may also experience:
Erectile dysfunction
Loss of movement or mobility
Loss of bladder or bowel control
Trouble urinating
Other Possible Side Effects
As with any medication, you may experience side effects that are not severe enough to require immediate medical attention. However, if you experience any side effects that bother you or persist, contact your doctor for guidance. Not all possible side effects are listed here. If you have questions or concerns about side effects, consult your doctor.
Reporting Side Effects
You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Dizziness or lightheadedness
- Ringing in the ears (tinnitus)
- Numbness or tingling around the mouth
- Metallic taste in the mouth
- Blurred vision
- Tremors or muscle twitching
- Confusion or drowsiness
- Slow or irregular heartbeat
- Difficulty breathing
- Seizures
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
To ensure safe treatment, inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the symptoms you experienced with these allergies.
If you are scheduled to receive this medication via spinal injection, tell your doctor if you have:
+ Heart block
+ Severe bleeding
+ Severe infection
+ An infection at the site where the injection will be administered
It is essential to disclose all your health conditions and medications to your doctor and pharmacist, including:
Prescription and over-the-counter (OTC) medications
Natural products
* Vitamins
This will help your healthcare team assess potential interactions and ensure it is safe for you to take this medication with your existing health conditions and medications. Never start, stop, or change the dose of any medication without first consulting your doctor.
To ensure safe treatment, inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the symptoms you experienced with these allergies.
If you are scheduled to receive this medication via spinal injection, tell your doctor if you have:
+ Heart block
+ Severe bleeding
+ Severe infection
+ An infection at the site where the injection will be administered
It is essential to disclose all your health conditions and medications to your doctor and pharmacist, including:
Prescription and over-the-counter (OTC) medications
Natural products
* Vitamins
This will help your healthcare team assess potential interactions and ensure it is safe for you to take this medication with your existing health conditions and medications. Never start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Risk of Methemoglobinemia
A severe blood disorder called methemoglobinemia has been associated with drugs like this one. Your risk may be increased if you have:
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Heart problems
Lung problems
Are taking certain other medications
Are an infant younger than 6 months of age
If you have a history of methemoglobinemia, notify your doctor.
Sulfite Allergy
If you are allergic to sulfites, consult your doctor, as some products may contain sulfites.
Caution with Daily Activities
Avoid driving and engaging in activities that require alertness until the effects of this medication have worn off and you feel fully awake.
Post-Treatment Precautions
If you are discharged before the numbness has resolved, protect the treated area from injury until you have regained sensation.
Special Considerations
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
If the patient is a child, use this medication with caution, as the risk of certain side effects may be higher in children.
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks with your doctor.
Injection (Spinal Administration)
This medication may cause temporary loss of feeling and motor function in the lower half of your body. Do not attempt to get out of bed or perform other activities until sensation and motor function have returned to normal.
Mouth and Dental Procedures
Do not eat while your mouth is numb, as you may accidentally bite your tongue.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Risk of Methemoglobinemia
A severe blood disorder called methemoglobinemia has been associated with drugs like this one. Your risk may be increased if you have:
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Heart problems
Lung problems
Are taking certain other medications
Are an infant younger than 6 months of age
If you have a history of methemoglobinemia, notify your doctor.
Sulfite Allergy
If you are allergic to sulfites, consult your doctor, as some products may contain sulfites.
Caution with Daily Activities
Avoid driving and engaging in activities that require alertness until the effects of this medication have worn off and you feel fully awake.
Post-Treatment Precautions
If you are discharged before the numbness has resolved, protect the treated area from injury until you have regained sensation.
Special Considerations
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
If the patient is a child, use this medication with caution, as the risk of certain side effects may be higher in children.
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks with your doctor.
Injection (Spinal Administration)
This medication may cause temporary loss of feeling and motor function in the lower half of your body. Do not attempt to get out of bed or perform other activities until sensation and motor function have returned to normal.
Mouth and Dental Procedures
Do not eat while your mouth is numb, as you may accidentally bite your tongue.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Confusion
- Tremors or muscle twitching leading to seizures
- Difficulty breathing or respiratory arrest
- Severe drowsiness or unconsciousness
- Slow heart rate (bradycardia)
- Low blood pressure (hypotension)
- Cardiac arrest
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment involves supportive care, managing seizures (e.g., with benzodiazepines), and addressing cardiovascular collapse (e.g., with lipid emulsion therapy).
Drug Interactions
Major Interactions
- Antiarrhythmics (e.g., amiodarone, mexiletine, procainamide, quinidine): Increased risk of cardiac depression and arrhythmias.
- Beta-blockers (e.g., propranolol, metoprolol): Decreased hepatic blood flow, leading to reduced lidocaine clearance and increased systemic levels, enhancing toxicity risk.
- Cimetidine: Inhibits lidocaine metabolism (CYP1A2, CYP3A4), increasing lidocaine plasma concentrations and toxicity risk.
- Succinylcholine: Prolonged neuromuscular blockade due to inhibition of plasma cholinesterase by lidocaine.
Moderate Interactions
- Phenytoin: May increase lidocaine metabolism; also, both can cause cardiac depression.
- Other local anesthetics: Additive systemic toxicity.
- Skeletal muscle relaxants (non-depolarizing): May enhance or prolong neuromuscular blockade.
- Dopamine: May increase risk of ventricular arrhythmias.
- MAOIs, TCAs (if lidocaine contains epinephrine): Risk of severe hypertension and arrhythmias.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Patient history (allergies, cardiac/hepatic/renal disease, medications)
Rationale: To identify contraindications, risk factors for toxicity, and potential drug interactions.
Timing: Prior to administration
Vital signs (heart rate, blood pressure, respiratory rate)
Rationale: To establish baseline and detect early signs of systemic toxicity.
Timing: Prior to administration
Routine Monitoring
Vital signs (heart rate, blood pressure, respiratory rate)
Frequency: During and immediately after administration, then as clinically indicated.
Target: Within patient's normal range.
Action Threshold: Significant deviations (e.g., bradycardia, hypotension, respiratory depression) warrant immediate intervention.
Neurological status (mental status, signs of CNS toxicity)
Frequency: During and immediately after administration, then as clinically indicated.
Target: Alert and oriented, no signs of CNS excitation or depression.
Action Threshold: Dizziness, tinnitus, perioral numbness, metallic taste, confusion, tremors, seizures.
ECG monitoring (especially with large doses or high-risk patients)
Frequency: Continuous during administration of large doses or in patients with cardiac disease.
Target: Normal sinus rhythm, no significant arrhythmias.
Action Threshold: Bradycardia, heart block, ventricular arrhythmias.
Symptom Monitoring
- Lightheadedness
- Dizziness
- Tinnitus
- Perioral numbness
- Metallic taste
- Blurred vision
- Tremors
- Muscle twitching
- Confusion
- Drowsiness
- Seizures
- Bradycardia
- Hypotension
- Respiratory depression
Special Patient Groups
Pregnancy
Lidocaine is generally considered safe for use during pregnancy (Category B). It crosses the placenta but is rapidly metabolized by the fetus. Use the lowest effective dose.
Trimester-Specific Risks:
First Trimester:
No evidence of increased risk of congenital anomalies.
Second Trimester:
Generally considered safe; no specific risks identified.
Third Trimester:
Generally considered safe; caution with paracervical block due to potential for fetal bradycardia.
Lactation
Lidocaine is excreted into breast milk in small amounts. The amount ingested by the infant is very low and unlikely to cause adverse effects. Considered compatible with breastfeeding (L2).
Infant Risk:
Low risk; monitor for drowsiness or feeding difficulties, though unlikely.
Pediatric Use
Dosing must be carefully calculated based on weight and age to avoid systemic toxicity. Use the lowest effective concentration and volume. Monitor closely for signs of toxicity, as children may be more susceptible.
Geriatric Use
Elderly patients may be more susceptible to systemic toxicity due to decreased hepatic function, reduced protein binding, and altered body composition. Lower doses and careful monitoring are recommended.
Clinical Information
Clinical Pearls
- Always aspirate prior to injection to avoid inadvertent intravascular administration, which can lead to systemic toxicity.
- The addition of epinephrine prolongs the duration of action and reduces systemic absorption, but should be avoided in areas with end-arterial supply (e.g., fingers, toes, nose, penis, earlobe) due to risk of ischemia.
- Systemic toxicity typically manifests as CNS symptoms first (e.g., perioral numbness, tinnitus, lightheadedness, seizures), followed by cardiovascular effects (e.g., bradycardia, hypotension, cardiac arrest).
- Lipid emulsion therapy (Intralipid) is the antidote for severe local anesthetic systemic toxicity (LAST).
- Ensure proper patient positioning and monitoring, especially when administering large volumes or in high-risk areas.
Alternative Therapies
- Bupivacaine (longer duration of action)
- Ropivacaine (less cardiotoxic than bupivacaine)
- Mepivacaine
- Chloroprocaine (short duration, rapid metabolism)
- Procaine
- Tetracaine
Cost & Coverage
Average Cost:
Not available per 30ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the quantity, and the time of ingestion.