Lidocaine 2% Inj, 20ml
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. It works by temporarily blocking nerve signals in that area, so you don't feel pain during minor procedures like stitches, dental work, or small surgeries. It's given as an injection by a healthcare professional.
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 medication is administered via injection.
For proper storage and disposal, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to store this medication at home.
If you miss a dose, contact your doctor immediately to receive guidance on the next steps to take.
For proper storage and disposal, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to store this medication at home.
If you miss a dose, contact your doctor immediately to receive guidance on the next steps to take.
Lifestyle & Tips
- Inform your doctor about all medications, supplements, and herbal products you are taking.
- Inform your doctor about any allergies, especially to other numbing medicines.
- Report any unusual symptoms during or after the injection, such as dizziness, ringing in the ears, numbness around the mouth, or feeling lightheaded.
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 by procedure and site. For local infiltration: 0.5% to 1% solution, up to 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine). Max single dose typically 300 mg (without epinephrine) or 500 mg (with epinephrine).
Condition-Specific Dosing:
local_infiltration:
Max 4.5 mg/kg (300 mg total) without epinephrine; Max 7 mg/kg (500 mg total) with epinephrine.
peripheral_nerve_block:
Varies by nerve, e.g., 5-30 mL of 1% or 2% solution.
epidural_anesthesia:
10-20 mL of 1% or 2% solution (lumbar); 2-3 mL/segment of 1.5% or 2% solution (thoracic).
Pediatric Dosing
Neonatal:
Not established for routine use; use with extreme caution. Max 2-3 mg/kg.
Infant:
Max 2-3 mg/kg (without epinephrine); Max 4-5 mg/kg (with epinephrine).
Child:
Max 2-3 mg/kg (without epinephrine); Max 4-5 mg/kg (with epinephrine).
Adolescent:
Max 4.5 mg/kg (without epinephrine); Max 7 mg/kg (with epinephrine).
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required for single dose local anesthetic use.
Moderate:
No specific adjustment required for single dose local anesthetic use.
Severe:
Use with caution; consider lower doses due to potential for accumulation of lidocaine and its metabolites. Monitor for toxicity.
Dialysis:
Lidocaine is minimally dialyzable. Use with caution; monitor for toxicity.
Hepatic Impairment:
Mild:
No specific adjustment required for single dose local anesthetic use.
Moderate:
Use with caution; consider lower doses (e.g., 50% reduction) due to impaired metabolism and increased half-life. Monitor for toxicity.
Severe:
Contraindicated or use with extreme caution; significantly reduced clearance. Monitor for toxicity closely.
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 effecting local anesthetic action. It blocks voltage-gated sodium channels in the neuronal cell membrane, preventing the influx of sodium ions and thus inhibiting depolarization and propagation of action potentials.
Pharmacokinetics
Absorption:
Bioavailability:
Varies greatly depending on site of administration, presence of vasoconstrictor (epinephrine), dose, and vascularity of tissue. Systemic absorption occurs from all sites of administration.
Tmax:
Varies by route: e.g., intercostal block (5-15 min), epidural (10-20 min), subcutaneous (5-30 min).
FoodEffect:
Not applicable for injectable forms.
Distribution:
Vd:
0.7-2.7 L/kg (average 1.1 L/kg)
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 (prolonged in hepatic dysfunction, CHF, or renal failure)
Clearance:
Approximately 10 mL/min/kg
ExcretionRoute:
Renal (less than 10% as unchanged drug)
Unchanged:
Less than 10%
Pharmacodynamics
OnsetOfAction:
2-5 minutes (for local infiltration)
PeakEffect:
5-15 minutes (for local infiltration)
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, 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:
Signs of an allergic reaction, including:
+ 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 deadly condition, including:
+ 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
+ Shortness of breath
Signs of too much acid in the blood (acidosis), including:
+ Confusion
+ Rapid breathing
+ Rapid heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling tired or weak
Other severe side effects, including:
+ Trouble breathing, slow breathing, or shallow breathing
+ Feeling lightheaded, sleepy, confused, or having blurred vision
+ Slow heartbeat
+ Feeling nervous and 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 of Spinal Injection
If you receive this medication via spinal injection, you may experience:
Erectile dysfunction
Loss of movement
Loss of bladder or bowel control
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. 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:
Signs of an allergic reaction, including:
+ 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 deadly condition, including:
+ 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
+ Shortness of breath
Signs of too much acid in the blood (acidosis), including:
+ Confusion
+ Rapid breathing
+ Rapid heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling tired or weak
Other severe side effects, including:
+ Trouble breathing, slow breathing, or shallow breathing
+ Feeling lightheaded, sleepy, confused, or having blurred vision
+ Slow heartbeat
+ Feeling nervous and 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 of Spinal Injection
If you receive this medication via spinal injection, you may experience:
Erectile dysfunction
Loss of movement
Loss of bladder or bowel control
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. 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)
- Numbness or tingling around the mouth
- Metallic taste in the mouth
- Blurred vision or double vision
- Tremors or muscle twitching
- Feeling unusually sleepy or confused
- 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 to this medication, its components, or other substances, including foods and drugs. Describe the allergic reactions you experienced.
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 injection site
This list is not exhaustive, and it is crucial to discuss all your health conditions and medications with your doctor.
Provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Natural products
Vitamins
Health problems
Verify with your doctor that it is safe to take this medication in combination with your other medications and health conditions. Do not initiate, discontinue, or adjust the dosage of any medication without consulting your doctor.
To ensure safe treatment, inform your doctor about the following:
Any allergies you have to this medication, its components, or other substances, including foods and drugs. Describe the allergic reactions you experienced.
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 injection site
This list is not exhaustive, and it is crucial to discuss all your health conditions and medications with your doctor.
Provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter medications you are taking
Natural products
Vitamins
Health problems
Verify with your doctor that it is safe to take this medication in combination with your other medications and health conditions. Do not initiate, discontinue, or adjust the dosage of any medication without 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.
Post-Treatment Precautions
Avoid driving and engaging in activities that require alertness until the effects of this medication have worn off and you feel fully awake. 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. Similarly, if the patient is a child, use this medication with caution, as the risk of certain side effects may be higher in children.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor.
Spinal Injection
If this medication is administered into the spine, you may experience 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 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 your doctor, as some products may contain sulfites.
Post-Treatment Precautions
Avoid driving and engaging in activities that require alertness until the effects of this medication have worn off and you feel fully awake. 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. Similarly, if the patient is a child, use this medication with caution, as the risk of certain side effects may be higher in children.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor.
Spinal Injection
If this medication is administered into the spine, you may experience 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 inadvertently bite your tongue.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Profound drowsiness or unconsciousness
- Generalized seizures
- Severe low blood pressure (hypotension)
- Slow heart rate (bradycardia)
- Cardiac arrest
- Respiratory arrest
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. In the US, you can call Poison Control at 1-800-222-1222.
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.
- Cimetidine: Inhibits lidocaine metabolism, increasing plasma levels and risk of toxicity.
- Amiodarone: Increased risk of cardiac depression and CNS toxicity.
Moderate Interactions
- Succinylcholine: Lidocaine may prolong the neuromuscular blockade of succinylcholine.
- Phenytoin: May increase lidocaine metabolism; also, both can cause CNS depression.
- Other local anesthetics: Additive systemic toxicity.
- CYP1A2/3A4 inhibitors (e.g., macrolide antibiotics, azole antifungals, protease inhibitors): May increase lidocaine levels.
- CYP1A2/3A4 inducers (e.g., rifampin, carbamazepine, phenytoin): May decrease lidocaine levels.
Monitoring
Baseline Monitoring
Allergy history
Rationale: To identify hypersensitivity reactions to lidocaine or other amide-type local anesthetics.
Timing: Prior to administration
Vital signs (HR, BP, RR)
Rationale: To establish baseline and detect early signs of systemic toxicity or cardiovascular effects.
Timing: Prior to administration
Patient's medical history (especially cardiac, hepatic, renal, neurological conditions)
Rationale: To identify contraindications or conditions requiring dose adjustment.
Timing: Prior to administration
Routine Monitoring
Vital signs (HR, BP, RR)
Frequency: During and immediately after administration, then as clinically indicated.
Target: Within patient's normal range; significant deviations warrant investigation.
Action Threshold: Bradycardia, hypotension, or respiratory depression.
Signs and symptoms of CNS toxicity
Frequency: Continuously during and for at least 30 minutes after administration.
Target: Absence of symptoms.
Action Threshold: Lightheadedness, dizziness, tinnitus, perioral numbness, metallic taste, blurred vision, tremors, muscle twitching, drowsiness, seizures.
Signs and symptoms of cardiovascular toxicity
Frequency: Continuously during and for at least 30 minutes after administration.
Target: Absence of symptoms.
Action Threshold: Bradycardia, hypotension, arrhythmias, cardiac arrest.
Effectiveness of anesthesia
Frequency: During and after administration.
Target: Adequate pain control/anesthesia for the procedure.
Action Threshold: Inadequate anesthesia requiring re-dosing or alternative.
Symptom Monitoring
- Lightheadedness
- Dizziness
- Tinnitus
- Perioral numbness
- Metallic taste
- Blurred vision
- Tremors
- Muscle twitching
- Drowsiness
- Confusion
- Seizures
- Bradycardia
- Hypotension
- Arrhythmias
- Respiratory depression
- Cardiac arrest
Special Patient Groups
Pregnancy
Category B. Lidocaine crosses the placenta. It has been widely used in obstetrics (e.g., epidural anesthesia) with no evidence of harm to the fetus. Use during pregnancy should be based on clinical need, with the lowest effective dose.
Trimester-Specific Risks:
First Trimester:
No increased risk of congenital anomalies observed.
Second Trimester:
Generally considered safe for use.
Third Trimester:
Commonly used for labor and delivery; monitor for fetal bradycardia if used in large doses or accidentally injected intravascularly.
Lactation
Lidocaine is excreted into breast milk in small amounts. The amount ingested by the infant is generally considered too small to cause adverse effects. L2 (likely compatible).
Infant Risk:
Low risk of adverse effects to the breastfed infant. Monitor for drowsiness or feeding difficulties, though unlikely.
Pediatric Use
Use with caution. Children, especially infants and neonates, may be more susceptible to systemic toxicity due to differences in metabolism, distribution, and higher relative doses per kg. Calculate doses carefully based on weight and avoid exceeding maximum recommended doses. Monitor closely for signs of toxicity.
Geriatric Use
Use with caution. Elderly patients may have reduced hepatic function, decreased plasma protein binding, and reduced renal clearance, leading to higher plasma concentrations and increased risk of toxicity. Consider lower doses and monitor closely for adverse effects.
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 supply (e.g., fingers, toes, nose, penis, ears) due to risk of ischemia.
- Systemic toxicity primarily affects the CNS and cardiovascular system. Early CNS symptoms (e.g., perioral numbness, tinnitus, lightheadedness) often precede more severe effects like seizures and cardiac depression.
- Lipid emulsion therapy (Intralipid) is an antidote for severe local anesthetic systemic toxicity (LAST).
- Patients with severe hepatic impairment are at significantly increased risk of toxicity due to impaired metabolism.
Alternative Therapies
- Bupivacaine (longer acting local anesthetic)
- Ropivacaine (longer acting local anesthetic, less cardiotoxic than bupivacaine)
- Mepivacaine (intermediate acting local anesthetic)
- Procaine (ester-type local anesthetic, shorter acting)
- Chloroprocaine (ester-type local anesthetic, very short acting)
- Topical anesthetics (e.g., benzocaine, tetracaine)
Cost & Coverage
Average Cost:
Varies widely, typically low cost for generic injectable solutions. per 20ml vial
Generic Available:
Yes
Insurance Coverage:
Generally covered by most insurance plans as a generic, often Tier 1 or 2.
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 guidance. To ensure your safety and the safety of others, never share your medication with anyone, and do not take medication prescribed to someone else.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the proper disposal method, consult your pharmacist, as they 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, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate 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 medical attention. Be prepared to provide detailed information about the overdose, including the name of the medication, the amount taken, and the time it occurred, to ensure you receive appropriate care.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the proper disposal method, consult your pharmacist, as they 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, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate 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 medical attention. Be prepared to provide detailed information about the overdose, including the name of the medication, the amount taken, and the time it occurred, to ensure you receive appropriate care.