Lidocaine 10mg/ml Inj, 5ml
It is used to treat certain types of abnormal heartbeats.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antiarrhythmic
Pharmacologic Class
Class IB Antiarrhythmic; Voltage-gated Sodium Channel Blocker
Pregnancy Category
Category B
FDA Approved
Sep 1948
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lidocaine is a medication given by injection into a vein to help control certain types of irregular heartbeats (arrhythmias). It works by calming overactive electrical signals in the heart.
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 adhere to all guidelines provided. This drug is administered intravenously over a specified period.
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 promptly 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 promptly to receive guidance on the appropriate course of action.
Lifestyle & Tips
- This medication is typically administered in a hospital setting under close medical supervision.
- Report any unusual feelings or side effects immediately to your nurse or doctor.
- Avoid alcohol and other sedatives while receiving this medication, as they can increase side effects.
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:
Initial bolus 50-100 mg (0.7-1.4 mg/kg) IV over 2-3 minutes, followed by continuous IV infusion 1-4 mg/minute. Additional boluses of 25-50 mg can be given every 5-10 minutes up to a total loading dose of 300 mg.
Dose Range:
1 - 4 mg
Condition-Specific Dosing:
Ventricular Arrhythmias:
Initial bolus 50-100 mg IV over 2-3 minutes, followed by continuous IV infusion 1-4 mg/minute. Max total loading dose 300 mg. Max infusion rate 4 mg/min.
Pediatric Dosing
Neonatal:
Not established for routine antiarrhythmic use; use with extreme caution if at all. Consult cardiology.
Infant:
Loading dose: 1 mg/kg IV bolus. Maintenance infusion: 20-50 mcg/kg/minute IV. Max total loading dose 3-5 mg/kg. Max infusion 50 mcg/kg/min.
Child:
Loading dose: 1 mg/kg IV bolus. Maintenance infusion: 20-50 mcg/kg/minute IV. Max total loading dose 3-5 mg/kg. Max infusion 50 mcg/kg/min.
Adolescent:
Loading dose: 1 mg/kg IV bolus. Maintenance infusion: 20-50 mcg/kg/minute IV. Max total loading dose 3-5 mg/kg. Max infusion 50 mcg/kg/min.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed, but monitor for toxicity.
Moderate:
No specific adjustment needed, but monitor for toxicity.
Severe:
No specific adjustment needed, but monitor for toxicity. Active metabolites may accumulate.
Dialysis:
Lidocaine is not significantly removed by hemodialysis. No specific dose adjustment, but monitor for toxicity.
Hepatic Impairment:
Mild:
Consider 25-50% reduction in maintenance infusion rate.
Moderate:
Reduce maintenance infusion rate by 50% or more. Monitor plasma concentrations.
Severe:
Reduce maintenance infusion rate by 50-75% or more. Monitor plasma concentrations closely. Avoid bolus doses if possible.
Confidence:
Medium
Pharmacology
Mechanism of Action
Lidocaine is a Class IB antiarrhythmic that acts by blocking voltage-gated sodium channels in the cardiac cell membrane. This action decreases the rate of phase 0 depolarization, reduces automaticity, and shortens the effective refractory period and action potential duration in Purkinje fibers and ventricular muscle. It primarily affects ischemic or damaged myocardial tissue, stabilizing the membrane and preventing re-entry arrhythmias.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
Immediate (IV bolus)
FoodEffect:
Not applicable (IV)
Distribution:
Vd:
0.7-2.7 L/kg (increases in CHF, decreases in renal failure)
ProteinBinding:
60-80% (primarily to alpha-1-acid glycoprotein and albumin)
CnssPenetration:
Yes
Elimination:
HalfLife:
1.5-2 hours (initial phase); 10 hours (terminal phase for metabolites)
Clearance:
10-20 mL/min/kg
ExcretionRoute:
Renal (primarily as metabolites)
Unchanged:
Less than 10%
Pharmacodynamics
OnsetOfAction:
Within 1-2 minutes (IV bolus)
PeakEffect:
Within 5-10 minutes (IV bolus)
DurationOfAction:
10-20 minutes (after IV bolus, due to rapid redistribution)
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 while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of methemoglobinemia, a rare but potentially deadly condition, including:
+ Blue or gray discoloration of the lips, nails, or skin
+ Abnormal heartbeat or seizures
+ Severe dizziness or fainting
+ Severe headache or excessive sleepiness
+ Feeling weak or tired, or experiencing shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion or fast breathing
+ Rapid or irregular heartbeat
+ Severe stomach pain, nausea, vomiting, or feeling extremely tired or weak
+ Shortness of breath or excessive sleepiness
Other severe side effects, including:
+ Breathing difficulties, slow or shallow breathing
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Slow heartbeat
+ Nervousness or excitability
+ Speech difficulties
+ Abnormal sensations, such as burning, numbness, or tingling
+ Restlessness or anxiety
+ Changes in vision or hearing (e.g., ringing in the ears)
+ Dizziness or fainting
+ Severe headache or twitching
+ Shakiness or seizures
+ Feeling extremely hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. If you notice any side effects that bother you or persist, contact your doctor for advice. Some people may experience minor side effects that do not require medical attention. However, if you have concerns about side effects, do not hesitate to reach out to your doctor.
Reporting Side Effects
If you experience any side effects, you can report them to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor is also available to provide guidance on managing side effects and answering any questions you may have.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of methemoglobinemia, a rare but potentially deadly condition, including:
+ Blue or gray discoloration of the lips, nails, or skin
+ Abnormal heartbeat or seizures
+ Severe dizziness or fainting
+ Severe headache or excessive sleepiness
+ Feeling weak or tired, or experiencing shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion or fast breathing
+ Rapid or irregular heartbeat
+ Severe stomach pain, nausea, vomiting, or feeling extremely tired or weak
+ Shortness of breath or excessive sleepiness
Other severe side effects, including:
+ Breathing difficulties, slow or shallow breathing
+ Feeling lightheaded, sleepy, confused, or experiencing blurred vision
+ Slow heartbeat
+ Nervousness or excitability
+ Speech difficulties
+ Abnormal sensations, such as burning, numbness, or tingling
+ Restlessness or anxiety
+ Changes in vision or hearing (e.g., ringing in the ears)
+ Dizziness or fainting
+ Severe headache or twitching
+ Shakiness or seizures
+ Feeling extremely hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. If you notice any side effects that bother you or persist, contact your doctor for advice. Some people may experience minor side effects that do not require medical attention. However, if you have concerns about side effects, do not hesitate to reach out to your doctor.
Reporting Side Effects
If you experience any side effects, you can report them to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor is also available to provide guidance on managing side effects and answering any questions you may have.
Seek Immediate Medical Attention If You Experience:
- Feeling dizzy or lightheaded
- Feeling unusually sleepy or confused
- Numbness or tingling sensations (especially around the mouth)
- Tremors or muscle twitching
- Blurred vision or seeing double
- Ringing in the ears (tinnitus)
- Slurred speech
- Any new or worsening irregular heartbeats
- Chest pain
- Difficulty breathing
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to 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. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain heart conditions, including heart block, Stokes-Adams syndrome, or Wolff-Parkinson-White syndrome.
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure your safety, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your complete medical history, including any health problems you have
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so. This will help prevent potential interactions and ensure the safe use of this medication.
It is essential to 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. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain heart conditions, including heart block, Stokes-Adams syndrome, or Wolff-Parkinson-White syndrome.
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure your safety, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your complete medical history, including any health problems you have
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so. This will help prevent potential interactions and ensure the safe use of this medication.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. As directed by your doctor, regular blood tests and electrocardiograms (ECGs) will be necessary to monitor how your heart is functioning.
There is a risk of developing a severe blood disorder called methemoglobinemia associated with this type of medication. Certain factors may increase this risk, including a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), pre-existing heart or lung problems, concurrent use of specific other medications, and age (particularly in infants under 6 months old). If you have a history of methemoglobinemia, it is crucial to notify your doctor.
If you are 65 years or older, caution is advised when using this medication, as you may be more susceptible to experiencing side effects. Similarly, when administering this drug to children, caution is necessary due to the potential for a higher risk of certain side effects.
Before taking this medication, it is essential to discuss your pregnancy status or plans for pregnancy, as well as whether you are breastfeeding, with your doctor. This will enable a thorough discussion of the potential benefits and risks of the medication to both you and your baby.
There is a risk of developing a severe blood disorder called methemoglobinemia associated with this type of medication. Certain factors may increase this risk, including a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), pre-existing heart or lung problems, concurrent use of specific other medications, and age (particularly in infants under 6 months old). If you have a history of methemoglobinemia, it is crucial to notify your doctor.
If you are 65 years or older, caution is advised when using this medication, as you may be more susceptible to experiencing side effects. Similarly, when administering this drug to children, caution is necessary due to the potential for a higher risk of certain side effects.
Before taking this medication, it is essential to discuss your pregnancy status or plans for pregnancy, as well as whether you are breastfeeding, with your doctor. This will enable a thorough discussion of the potential benefits and risks of the medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Profound drowsiness or unconsciousness
- Seizures
- Respiratory depression (slow, shallow breathing)
- Severe hypotension (very low blood pressure)
- Bradycardia (very slow heart rate)
- Cardiac arrest
What to Do:
Immediate medical attention is required. Call 911 or your local emergency number. Management includes stopping the infusion, maintaining airway, breathing, and circulation, administering anticonvulsants for seizures, and vasopressors for hypotension. Lipid emulsion therapy may be considered for severe systemic toxicity. Call 1-800-222-1222 (Poison Control Center) for further guidance.
Drug Interactions
Major Interactions
- Amiodarone (increased lidocaine levels, risk of toxicity)
- Beta-blockers (e.g., Propranolol, Metoprolol - decreased lidocaine clearance, increased toxicity risk)
- Cimetidine (decreased lidocaine clearance, increased toxicity risk)
- Phenytoin (increased lidocaine clearance, decreased efficacy; also increased phenytoin levels)
- Procainamide (additive cardiac effects, increased risk of toxicity)
- Class I antiarrhythmics (additive cardiac effects, increased risk of toxicity)
Moderate Interactions
- Other antiarrhythmics (additive effects on cardiac conduction)
- Skeletal muscle relaxants (prolonged neuromuscular blockade)
- Succinylcholine (prolonged neuromuscular blockade)
- CYP1A2 inhibitors (e.g., Fluvoxamine, Ciprofloxacin - increased lidocaine levels)
- CYP3A4 inhibitors (e.g., Macrolide antibiotics, Azole antifungals - increased lidocaine levels)
- CYP1A2 inducers (e.g., Rifampin, Carbamazepine - decreased lidocaine levels)
- CYP3A4 inducers (e.g., Phenobarbital, St. John's Wort - decreased lidocaine levels)
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
ECG (12-lead)
Rationale: To assess baseline cardiac rhythm, identify underlying arrhythmias, and detect pre-existing conduction abnormalities.
Timing: Prior to initiation
Blood Pressure
Rationale: To establish baseline and monitor for hypotension.
Timing: Prior to initiation
Heart Rate
Rationale: To establish baseline and monitor for bradycardia.
Timing: Prior to initiation
Renal Function (BUN, Creatinine)
Rationale: To assess baseline renal clearance, though not primary elimination route, metabolites are renally cleared.
Timing: Prior to initiation
Liver Function Tests (ALT, AST, Bilirubin)
Rationale: Lidocaine is extensively metabolized by the liver; hepatic impairment necessitates dose adjustment.
Timing: Prior to initiation
Electrolytes (Potassium, Magnesium)
Rationale: Electrolyte imbalances can exacerbate arrhythmias and affect lidocaine efficacy.
Timing: Prior to initiation
Routine Monitoring
ECG (Continuous Cardiac Monitoring)
Frequency: Continuously during infusion
Target: Resolution of ventricular arrhythmias without significant bradycardia or heart block
Action Threshold: New or worsening arrhythmias, significant bradycardia (<50 bpm), heart block (2nd/3rd degree), QRS widening (>25% of baseline), QT prolongation. Reduce infusion or discontinue.
Blood Pressure
Frequency: Every 5-15 minutes during bolus/initiation, then hourly or as clinically indicated during infusion
Target: Maintain within patient's normal range
Action Threshold: Symptomatic hypotension (e.g., SBP <90 mmHg or significant drop from baseline). Reduce infusion or discontinue.
Heart Rate
Frequency: Every 5-15 minutes during bolus/initiation, then hourly or as clinically indicated during infusion
Target: Maintain within patient's normal range
Action Threshold: Symptomatic bradycardia (<50 bpm). Reduce infusion or discontinue.
Neurological Status (CNS toxicity)
Frequency: Continuously, especially during bolus and initiation of infusion
Target: Absence of CNS symptoms
Action Threshold: Drowsiness, dizziness, paresthesias, confusion, slurred speech, muscle twitching, seizures. Reduce infusion or discontinue.
Lidocaine Plasma Concentration (Therapeutic Drug Monitoring)
Frequency: If toxicity suspected, or in patients with hepatic/renal impairment, CHF, or prolonged infusions
Target: 1.5-5 mcg/mL (antiarrhythmic effect)
Action Threshold: >5 mcg/mL (increased risk of CNS toxicity); >9 mcg/mL (increased risk of seizures/cardiac depression). Adjust dose or discontinue.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Drowsiness
- Confusion
- Paresthesias (numbness, tingling)
- Tremors
- Muscle twitching
- Slurred speech
- Visual disturbances (blurred vision, diplopia)
- Tinnitus
- Nausea
- Vomiting
- Hypotension
- Bradycardia
- Seizures
Special Patient Groups
Pregnancy
Lidocaine is classified as Pregnancy Category B. Animal reproduction studies have shown no evidence of harm to the fetus. It crosses the placenta. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
No increased risk of congenital anomalies observed in human studies.
Second Trimester:
Generally considered safe if clinically indicated, with careful monitoring.
Third Trimester:
Generally considered safe if clinically indicated, with careful monitoring. May affect fetal heart rate or neonatal neurological status if high maternal levels occur, especially near term.
Lactation
Lidocaine is excreted into breast milk in small amounts. The amount ingested by the infant is generally considered low and unlikely to cause adverse effects. It is rated L2 (Safer) by LactMed.
Infant Risk:
Low risk of adverse effects to the breastfed infant. Monitor infant for drowsiness or feeding difficulties, though unlikely.
Pediatric Use
Dosing must be carefully calculated based on weight. Pediatric patients, especially neonates and infants, may be more susceptible to adverse effects due to immature hepatic metabolism and higher volume of distribution. Close monitoring for CNS and cardiovascular toxicity is essential.
Geriatric Use
Elderly patients may have reduced hepatic blood flow and metabolism, leading to decreased clearance and increased risk of toxicity. A reduced maintenance infusion rate (e.g., 50% of usual) may be necessary. Monitor closely for CNS and cardiovascular adverse effects.
Clinical Information
Clinical Pearls
- Lidocaine is the drug of choice for acute ventricular arrhythmias, especially post-MI, when amiodarone is not available or contraindicated.
- Always administer IV lidocaine with continuous ECG monitoring and resuscitation equipment readily available.
- CNS toxicity (e.g., perioral numbness, dizziness, confusion, seizures) often precedes cardiovascular toxicity (hypotension, bradycardia, asystole). Monitor for these early signs.
- Patients with heart failure, liver disease, or advanced age are at higher risk for toxicity due to reduced clearance.
- The therapeutic range for antiarrhythmic effect is 1.5-5 mcg/mL. Levels >5 mcg/mL increase risk of CNS toxicity; >9 mcg/mL increase risk of seizures and cardiac depression.
- Ensure proper IV access and avoid extravasation, though not a vesicant, local irritation can occur.
Alternative Therapies
- Amiodarone (for ventricular arrhythmias)
- Procainamide (for ventricular arrhythmias)
- Magnesium sulfate (for Torsades de Pointes)
- Beta-blockers (e.g., Metoprolol, Esmolol - for certain ventricular arrhythmias or rate control)
- Defibrillation/Cardioversion (for unstable ventricular arrhythmias)
Cost & Coverage
Average Cost:
Check current per 5ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance.
To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not flush medications down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult with your pharmacist, who can provide guidance on safe disposal practices or inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, it is important to 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 amount, and the time it was taken, as this will aid in providing appropriate treatment.
To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not flush medications down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. If you are unsure about the correct disposal method, consult with your pharmacist, who can provide guidance on safe disposal practices or inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, it is important to 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 amount, and the time it was taken, as this will aid in providing appropriate treatment.