Lidocaine 2% Inj, 10ml
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 (Class IB)
Pharmacologic Class
Voltage-gated Sodium Channel Blocker
Pregnancy Category
Category B
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lidocaine is a medicine used to numb a specific area of your body, preventing you from feeling pain during medical procedures like stitches, minor surgery, or dental work. It works by temporarily blocking nerve signals in that area.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all the information provided. Adhere to the dosage instructions and administration guidelines. 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 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
- Inform your healthcare provider about all medications you are taking, including over-the-counter drugs, supplements, and herbal products.
- Report any unusual symptoms or discomfort during or after the procedure.
- 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:
Highly variable based on procedure, site, and patient factors. Max single dose for local infiltration without epinephrine: 4.5 mg/kg (not to exceed 300 mg). With epinephrine: 7 mg/kg (not to exceed 500 mg).
Condition-Specific Dosing:
localInfiltration:
0.5% to 2% solution, 5-300 mg (max 4.5 mg/kg or 300 mg without epinephrine; 7 mg/kg or 500 mg with epinephrine)
peripheralNerveBlock:
0.5% to 2% solution, 50-300 mg (max as above)
epiduralBlock:
1% to 2% solution, 200-300 mg (max as above)
caudalBlock:
1% solution, 150-300 mg (max as above)
intravenousRegionalAnesthesia:
0.5% solution, 1.5-3 mg/kg (max 300 mg)
Pediatric Dosing
Neonatal:
Not established for routine use; use with extreme caution. Max 2-4 mg/kg for local infiltration.
Infant:
Max 3-5 mg/kg (not to exceed 300 mg) for local infiltration, depending on procedure and presence of epinephrine.
Child:
Max 3-5 mg/kg (not to exceed 300 mg) for local infiltration, depending on procedure and presence of epinephrine.
Adolescent:
Max 3-5 mg/kg (not to exceed 300 mg) for local infiltration, depending on procedure and presence of epinephrine. Adult dosing may apply for older adolescents.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment typically required, but monitor for toxicity.
Moderate:
No specific adjustment typically required, but monitor for toxicity.
Severe:
Use with caution; consider reduced doses and extended intervals due to potential accumulation of lidocaine and its active metabolites. Monitor for toxicity.
Dialysis:
Lidocaine is not significantly removed by hemodialysis. Use with caution; monitor for toxicity.
Hepatic Impairment:
Mild:
Use with caution; consider reduced doses.
Moderate:
Reduce dose by 50% or more; monitor plasma concentrations if possible. Increased risk of toxicity.
Severe:
Contraindicated or use with extreme caution and significant dose reduction (e.g., 75% reduction). Increased risk of toxicity.
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 localizing the anesthetic action. It blocks voltage-gated sodium channels in the neuronal cell membrane, preventing the influx of sodium ions and thus inhibiting depolarization and nerve impulse propagation.
Pharmacokinetics
Absorption:
Bioavailability:
Varies significantly based on site of administration (e.g., highly vascular areas like intercostal blocks lead to faster and higher absorption).
Tmax:
Variable, typically 5-15 minutes after local infiltration, depending on vascularity of injection site.
FoodEffect:
Not applicable for injectable formulation.
Distribution:
Vd:
Approximately 1.1 L/kg (adults)
ProteinBinding:
60-80% (primarily to alpha-1-acid glycoprotein and albumin)
CnssPenetration:
Yes (readily crosses blood-brain barrier)
Elimination:
HalfLife:
1.5-2 hours (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:
Rapid, typically 2-5 minutes after injection.
PeakEffect:
Variable, often within 5-15 minutes.
DurationOfAction:
30-60 minutes (without epinephrine); 60-120 minutes (with epinephrine, depending on dose and site).
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Allergic Reaction: 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, or swelling of the mouth, face, lips, tongue, or throat.
Methemoglobinemia: A blue or gray color of the lips, nails, or skin, abnormal heartbeat, seizures, severe dizziness or fainting, severe headache, excessive sleepiness, feeling tired or weak, or shortness of breath. This rare condition can be life-threatening if left untreated.
Acidosis (Too Much Acid in the Blood): Confusion, rapid breathing, rapid heartbeat, abnormal heartbeat, severe stomach pain, nausea, vomiting, excessive sleepiness, shortness of breath, or feeling extremely tired or weak.
Respiratory Problems: Trouble breathing, slow breathing, or shallow breathing.
Neurological Symptoms: Feeling lightheaded, sleepy, confused, or experiencing blurred vision.
Cardiovascular Issues: Slow heartbeat.
Nervous System Symptoms: Feeling nervous and excitable, trouble speaking, burning, numbness, or tingling sensations, restlessness, anxiety, changes in vision, ringing in the ears, dizziness, or fainting.
Severe Symptoms: Severe headache, twitching, shakiness, seizures, feeling extremely hot or cold, metallic taste, chest pain, or mood changes.
Additional Side Effects of Spinal Injection:
Sexual Dysfunction: Difficulty getting or maintaining an erection.
Mobility and Bladder Control Issues: Inability to move, loss of bladder or bowel control, or trouble urinating.
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. If you have any side effects that bother you or do not go away, contact your doctor for advice. Not all possible side effects are listed here. If you have questions or concerns about side effects, discuss them with your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Allergic Reaction: 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, or swelling of the mouth, face, lips, tongue, or throat.
Methemoglobinemia: A blue or gray color of the lips, nails, or skin, abnormal heartbeat, seizures, severe dizziness or fainting, severe headache, excessive sleepiness, feeling tired or weak, or shortness of breath. This rare condition can be life-threatening if left untreated.
Acidosis (Too Much Acid in the Blood): Confusion, rapid breathing, rapid heartbeat, abnormal heartbeat, severe stomach pain, nausea, vomiting, excessive sleepiness, shortness of breath, or feeling extremely tired or weak.
Respiratory Problems: Trouble breathing, slow breathing, or shallow breathing.
Neurological Symptoms: Feeling lightheaded, sleepy, confused, or experiencing blurred vision.
Cardiovascular Issues: Slow heartbeat.
Nervous System Symptoms: Feeling nervous and excitable, trouble speaking, burning, numbness, or tingling sensations, restlessness, anxiety, changes in vision, ringing in the ears, dizziness, or fainting.
Severe Symptoms: Severe headache, twitching, shakiness, seizures, feeling extremely hot or cold, metallic taste, chest pain, or mood changes.
Additional Side Effects of Spinal Injection:
Sexual Dysfunction: Difficulty getting or maintaining an erection.
Mobility and Bladder Control Issues: Inability to move, loss of bladder or bowel control, or trouble urinating.
Other Possible Side Effects
Like all medications, this drug can cause side effects, although not everyone will experience them. If you have any side effects that bother you or do not go away, contact your doctor for advice. Not all possible side effects are listed here. If you have questions or concerns about side effects, discuss them with your doctor. You can also 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)
- Metallic taste in the mouth
- Numbness or tingling around the mouth
- Blurred vision
- Tremors or muscle twitching
- Feeling unusually sleepy or confused
- Slow or irregular heartbeat
- Difficulty breathing
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
To ensure safe treatment, inform your doctor of the following:
Any allergies you have to this medication, its components, or other substances, including foods and drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
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 medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. This will help your doctor and pharmacist assess potential interactions and ensure safe use of this medication. Do not initiate, stop, or adjust the dosage of any medication without first consulting your doctor.
To ensure safe treatment, inform your doctor of the following:
Any allergies you have to this medication, its components, or other substances, including foods and drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
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 medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. This will help your doctor and pharmacist assess potential interactions and ensure safe use of this medication. Do not initiate, stop, or adjust the dosage 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 with 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 into the Spine
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 until the numbness in your mouth has resolved, as you may inadvertently 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 with 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 into the Spine
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 until the numbness in your mouth has resolved, as you may inadvertently bite your tongue.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Seizures
- Unconsciousness
- Respiratory depression or arrest
- Severe bradycardia
- Hypotension
- Cardiac arrest
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222. Treatment involves supportive care, managing airway/breathing/circulation, and administering anticonvulsants for seizures (e.g., benzodiazepines) or lipid emulsion therapy for severe systemic toxicity.
Drug Interactions
Major Interactions
- Antiarrhythmics (e.g., Class I antiarrhythmics like mexiletine, tocainide): Increased risk of cardiac depression and CNS toxicity.
- Beta-blockers (e.g., propranolol, metoprolol): May decrease hepatic blood flow, reducing lidocaine clearance and increasing plasma levels, leading to increased toxicity risk.
- Cimetidine: Inhibits hepatic metabolism of lidocaine, increasing plasma levels and toxicity risk.
- Succinylcholine: May prolong neuromuscular blockade.
Moderate Interactions
- Phenytoin: May increase lidocaine metabolism; also, additive cardiac effects.
- Amiodarone: Additive cardiac effects, increased risk of bradycardia or AV block.
- Other local anesthetics: Additive systemic toxicity.
- Muscle relaxants: May enhance or prolong neuromuscular blockade.
Minor Interactions
- Dopamine: May increase lidocaine clearance.
- Opioids: Additive CNS depression.
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 or adverse reactions.
Timing: Prior to administration
Site of injection assessment
Rationale: To ensure appropriate site, avoid infection, and assess vascularity.
Timing: Prior to administration
Routine Monitoring
Vital signs (heart rate, blood pressure, respiratory rate)
Frequency: Continuously during and immediately after administration, then periodically as clinically indicated.
Target: Within patient's normal range; significant deviations warrant investigation.
Action Threshold: Bradycardia, hypotension, hypertension, respiratory depression, or significant changes from baseline.
Neurological status (mental status, dizziness, tinnitus, perioral numbness, tremors, seizures)
Frequency: Continuously during and immediately after administration, then periodically as clinically indicated.
Target: Alert and oriented, no signs of CNS excitation or depression.
Action Threshold: Any signs of CNS toxicity (e.g., metallic taste, tinnitus, dizziness, confusion, muscle twitching, seizures).
ECG monitoring (if large doses or IV administration)
Frequency: Continuous during and immediately after administration.
Target: Normal sinus rhythm, no significant arrhythmias or conduction disturbances.
Action Threshold: Bradycardia, heart block, QRS widening, ventricular arrhythmias.
Symptom Monitoring
- Lightheadedness
- Dizziness
- Tinnitus
- Metallic taste
- Numbness of lips/tongue (perioral numbness)
- Blurred vision
- Tremors
- Muscle twitching
- Confusion
- Drowsiness
- Seizures
- Bradycardia
- Hypotension
- Cardiac arrest
Special Patient Groups
Pregnancy
Lidocaine is classified as Pregnancy Category B. Studies in animals have not shown harm to the fetus, and there are no adequate and well-controlled studies in pregnant women. It is generally considered safe for use during pregnancy when clinically indicated, especially for local anesthesia. Use the lowest effective dose.
Trimester-Specific Risks:
First Trimester:
Generally considered low risk; no evidence of teratogenicity.
Second Trimester:
Generally considered low risk.
Third Trimester:
Generally considered low risk; may cross the placenta and cause fetal bradycardia or CNS depression if high maternal levels occur, especially during labor and delivery.
Lactation
Lidocaine is excreted in breast milk in small amounts. The amount transferred to the infant is generally considered too small to cause adverse effects. It is rated L2 (safer drug) by LactMed. Breastfeeding can usually continue after lidocaine administration for local anesthesia.
Infant Risk:
Low risk; monitor infant for drowsiness or feeding difficulties, though unlikely.
Pediatric Use
Pediatric patients, especially infants and young children, are more susceptible to systemic toxicity due to differences in metabolism, distribution, and lower body weight. Dosing must be carefully calculated based on weight (mg/kg) and not exceed recommended maximums. Monitor closely for signs of toxicity.
Geriatric Use
Elderly patients may have reduced hepatic blood flow, decreased plasma protein binding, and impaired renal function, leading to reduced clearance and increased plasma concentrations of lidocaine and its metabolites. Use with caution, consider lower doses, and monitor closely for signs of toxicity.
Clinical Information
Clinical Pearls
- Always aspirate prior to injection to avoid inadvertent intravascular administration, which can lead to rapid systemic toxicity.
- The addition of epinephrine prolongs the duration of action and reduces systemic absorption, but should be avoided in areas with end-arterial circulation (e.g., fingers, toes, nose, penis, ears) due to risk of ischemia.
- Maximum doses are critical; exceeding them significantly increases the risk of systemic toxicity.
- Signs of CNS toxicity (e.g., metallic taste, tinnitus, perioral numbness, dizziness) often precede more severe symptoms like seizures and cardiovascular collapse.
- Lipid emulsion therapy (Intralipid) is an antidote for severe local anesthetic systemic toxicity (LAST).
Alternative Therapies
- Bupivacaine (longer duration of action)
- Ropivacaine (less cardiotoxic than bupivacaine)
- Mepivacaine (intermediate duration)
- Prilocaine (less CNS toxicity, but risk of methemoglobinemia)
- Chloroprocaine (very short duration, rapid metabolism)
Cost & Coverage
Average Cost:
Low cost per 10ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further evaluation and guidance. To ensure safe and effective treatment, never share your medication with others, and do not take medication prescribed for someone else.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Properly dispose of unused or expired medications by checking with your pharmacist for guidance on the best disposal method. Unless instructed to do so, avoid flushing medications down the toilet or pouring them down the drain, as this can harm the environment. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, consult with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. Be prepared to provide critical information, including the name of the medication, the amount taken, and the time it was taken, to ensure prompt and effective treatment.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Properly dispose of unused or expired medications by checking with your pharmacist for guidance on the best disposal method. Unless instructed to do so, avoid flushing medications down the toilet or pouring them down the drain, as this can harm the environment. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, consult with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. Be prepared to provide critical information, including the name of the medication, the amount taken, and the time it was taken, to ensure prompt and effective treatment.