Lidocaine 2% Inj 25ml
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 1948
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lidocaine is a medication used to numb a specific area of the body to prevent pain during medical procedures, such as 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.
For proper storage and disposal of this medication, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to store it at home.
If you miss a dose, contact your doctor immediately to receive guidance on the appropriate course of action.
For proper storage and disposal of this medication, consult with your doctor, nurse, or pharmacist to determine the best approach if you need to store it at home.
If you miss a dose, contact your doctor immediately 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:
Varies significantly by procedure and site of injection. For local infiltration: 0.5% to 1% solution, up to 4.5 mg/kg (not to exceed 300 mg) without epinephrine, or 7 mg/kg (not to exceed 500 mg) with epinephrine.
Condition-Specific Dosing:
local_infiltration_without_epinephrine:
Up to 4.5 mg/kg (max 300 mg)
local_infiltration_with_epinephrine:
Up to 7 mg/kg (max 500 mg)
peripheral_nerve_block:
50-300 mg (e.g., 1-2% solution)
epidural_anesthesia:
200-300 mg (e.g., 1-2% solution)
intravenous_antiarrhythmic:
Initial bolus 1-1.5 mg/kg, then 1-4 mg/min continuous infusion (for cardiac indications, not typically 2% inj)
Pediatric Dosing
Neonatal:
Not established for routine use; use with extreme caution. Max 2-4 mg/kg for local infiltration.
Infant:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) for local infiltration/nerve block. Use lowest effective dose.
Child:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) for local infiltration/nerve block. Use lowest effective dose.
Adolescent:
Max 4.5 mg/kg (without epinephrine) or 7 mg/kg (with epinephrine) for local infiltration/nerve block. Use lowest effective dose.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required.
Moderate:
No specific adjustment required.
Severe:
No specific adjustment required, but monitor for systemic toxicity due to potential accumulation of metabolites.
Dialysis:
Lidocaine is not significantly removed by hemodialysis. No specific adjustment, but monitor for toxicity.
Hepatic Impairment:
Mild:
Consider dose reduction in patients with mild hepatic impairment.
Moderate:
Reduce dose by 50% or more. Monitor plasma concentrations if possible.
Severe:
Contraindicated or significantly reduced dose (e.g., 75% reduction). Monitor closely for toxicity.
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 depolarization and propagation of action potentials. As an antiarrhythmic, it suppresses automaticity and shortens the effective refractory period and action potential duration in the His-Purkinje system and ventricles.
Pharmacokinetics
Absorption:
Bioavailability:
Varies greatly depending on site of administration (e.g., 35% oral, nearly 100% IV, variable for local/regional).
Tmax:
Variable (e.g., 5-15 minutes for local infiltration, immediate for IV).
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)
CnssPenetration:
Yes (readily crosses blood-brain barrier and placenta)
Elimination:
HalfLife:
1.5-2 hours (prolonged in hepatic dysfunction, heart failure, and in neonates)
Clearance:
Approximately 10 mL/min/kg
ExcretionRoute:
Renal (less than 10% unchanged)
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)
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 or seek immediate 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
+ 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
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Fatigue or weakness
+ Shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Rapid breathing or heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Fatigue or weakness
Respiratory problems, including:
+ Difficulty breathing
+ Slow or shallow breathing
Central nervous system effects, such as:
+ Lightheadedness
+ Drowsiness
+ Confusion
+ Blurred vision
Cardiovascular effects, including:
+ Slow heartbeat
Other symptoms, such as:
+ Nervousness or excitability
+ Speech difficulties
+ Abnormal sensations (burning, numbness, or tingling)
+ Restlessness
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching or shakiness
+ Seizures
+ Feeling excessively hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Additional Side Effects
As with any medication, some people may experience side effects. If you notice any of the following symptoms, contact your doctor:
Injection site reactions (if administered into the spine), such as:
+ Erectile dysfunction
+ Loss of motor function
+ Loss of bladder or bowel control
+ Urinary retention
Reporting Side Effects
If you experience any side effects that bother you or do not go away, contact 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, 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 or seek immediate 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
+ 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
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Fatigue or weakness
+ Shortness of breath
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Rapid breathing or heartbeat
+ Abnormal heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Fatigue or weakness
Respiratory problems, including:
+ Difficulty breathing
+ Slow or shallow breathing
Central nervous system effects, such as:
+ Lightheadedness
+ Drowsiness
+ Confusion
+ Blurred vision
Cardiovascular effects, including:
+ Slow heartbeat
Other symptoms, such as:
+ Nervousness or excitability
+ Speech difficulties
+ Abnormal sensations (burning, numbness, or tingling)
+ Restlessness
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching or shakiness
+ Seizures
+ Feeling excessively hot or cold
+ Metallic taste
+ Chest pain
+ Mood changes
Additional Side Effects
As with any medication, some people may experience side effects. If you notice any of the following symptoms, contact your doctor:
Injection site reactions (if administered into the spine), such as:
+ Erectile dysfunction
+ Loss of motor function
+ Loss of bladder or bowel control
+ Urinary retention
Reporting Side Effects
If you experience any side effects that bother you or do not go away, contact 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)
- Numbness or tingling around the mouth
- Metallic taste in the mouth
- Blurred 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
It is crucial 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 determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
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
It is crucial 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 determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
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 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 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 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 while your mouth is numb, as you may accidentally bite your tongue.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Profound drowsiness or unconsciousness
- Seizures
- Slow or irregular heartbeat (bradycardia)
- Low blood pressure (hypotension)
- Respiratory depression or arrest
- Cardiac arrest
What to Do:
Seek immediate medical attention. Call 911 or Poison Control (1-800-222-1222). Management involves supportive care, airway management, benzodiazepines for seizures, and lipid emulsion therapy for severe systemic toxicity.
Drug Interactions
Major Interactions
- Antiarrhythmics (e.g., amiodarone, procainamide, quinidine, flecainide): Increased risk of cardiac depression and arrhythmias.
- Beta-blockers (e.g., propranolol, metoprolol): Decreased hepatic clearance of lidocaine, leading to increased lidocaine levels and toxicity.
- Cimetidine: Decreased hepatic clearance of lidocaine, leading to increased lidocaine levels and toxicity.
- Succinylcholine: Prolonged neuromuscular blockade.
Moderate Interactions
- Phenytoin: May increase lidocaine metabolism (less common interaction).
- Rifampin: May increase lidocaine metabolism.
- Other local anesthetics: Additive systemic toxicity.
- Class I antiarrhythmics: Additive cardiac effects.
Minor Interactions
- Dopamine: May increase lidocaine clearance.
- Opioids: May have additive CNS depressant effects.
Monitoring
Baseline Monitoring
Patient history (allergies, cardiac, hepatic, renal disease)
Rationale: Identify contraindications, risk factors for toxicity, and potential drug interactions.
Timing: Prior to administration
Vital Signs (HR, BP, RR)
Rationale: Establish baseline and detect early signs of systemic toxicity or adverse reactions.
Timing: Prior to administration
ECG (if large doses or IV administration)
Rationale: Assess for pre-existing conduction abnormalities or risk of arrhythmias.
Timing: Prior to administration
Routine Monitoring
Vital Signs (HR, BP, RR)
Frequency: Every 5-15 minutes 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) or signs of systemic toxicity.
Neurological status (CNS changes)
Frequency: Continuously during and immediately after administration.
Target: Alert and oriented, no tremors, dizziness, or seizures.
Action Threshold: Dizziness, tinnitus, circumoral numbness, metallic taste, tremors, muscle twitching, seizures, altered mental status.
ECG monitoring (if large doses or IV administration)
Frequency: Continuous during and immediately after administration.
Target: Normal sinus rhythm, no significant conduction delays or arrhythmias.
Action Threshold: Bradycardia, heart block, QRS widening, ventricular arrhythmias.
Symptom Monitoring
- Lightheadedness
- Dizziness
- Tinnitus
- Blurred vision
- Numbness of lips/tongue (circumoral numbness)
- Metallic taste
- Drowsiness
- Confusion
- Tremors
- Muscle twitching
- Seizures
- Bradycardia
- Hypotension
- Respiratory depression
- Cardiac arrest
Special Patient Groups
Pregnancy
Lidocaine is generally considered safe for use during pregnancy (Category B). It crosses the placenta but has not been shown to cause fetal harm in animal studies or in well-controlled human studies when used appropriately. Use the lowest effective dose.
Trimester-Specific Risks:
First Trimester:
No increased risk of congenital anomalies observed.
Second Trimester:
Generally considered safe.
Third Trimester:
Generally considered safe; commonly used for epidural anesthesia during labor. Fetal bradycardia can occur if maternal hypotension is severe.
Lactation
Lidocaine is excreted into breast milk in small amounts. The amount ingested by the infant is typically very low and unlikely to cause adverse effects. Considered compatible with breastfeeding (L2).
Infant Risk:
Low risk. Monitor infant for drowsiness or feeding difficulties, though unlikely.
Pediatric Use
Use with caution, especially in neonates and infants, due to increased susceptibility to systemic toxicity. Dosing must be carefully calculated based on weight and age. Avoid formulations with preservatives (e.g., benzyl alcohol) in neonates.
Geriatric Use
Elderly patients may be more susceptible to systemic toxicity due to decreased hepatic function, reduced protein binding, and altered body composition. Use lower doses and monitor closely. Consider age-related decline in renal and hepatic function.
Clinical Information
Clinical Pearls
- Always aspirate prior to injection to avoid 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 circulation (e.g., fingers, toes, nose, ears, penis) due to risk of ischemia.
- Lidocaine systemic toxicity (LAST) can manifest as CNS symptoms (tinnitus, circumoral numbness, seizures) and/or cardiovascular symptoms (bradycardia, hypotension, arrhythmias, cardiac arrest).
- Intravenous lipid emulsion (ILE) therapy is the antidote for severe LAST.
- The 2% solution is commonly used for nerve blocks and epidural anesthesia, while lower concentrations (0.5-1%) are often used for local infiltration.
Alternative Therapies
- Bupivacaine (longer acting local anesthetic)
- Ropivacaine (longer acting local anesthetic, less cardiotoxic than bupivacaine)
- Mepivacaine (intermediate acting local anesthetic)
- Procaine (ester local anesthetic)
- Chloroprocaine (ester local anesthetic)
- Benzocaine (topical local anesthetic)
Cost & Coverage
Average Cost:
Not available Not available
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 your safety and the safety of others, never share your prescription medications with anyone, and do not take medications that have been prescribed to someone else.
All medications should be stored in a secure location, out of the reach of children and pets, to prevent accidental ingestion or exposure.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. Instead, consult with your pharmacist to determine the best method for disposal, as some communities may have designated drug take-back programs.
Some medications may come with an additional patient information leaflet; if you have questions or concerns, consult with your pharmacist.
If you have any questions or concerns about your medication, it is crucial 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 your safety and the safety of others, never share your prescription medications with anyone, and do not take medications that have been prescribed to someone else.
All medications should be stored in a secure location, out of the reach of children and pets, to prevent accidental ingestion or exposure.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by a healthcare professional or pharmacist. Instead, consult with your pharmacist to determine the best method for disposal, as some communities may have designated drug take-back programs.
Some medications may come with an additional patient information leaflet; if you have questions or concerns, consult with your pharmacist.
If you have any questions or concerns about your medication, it is crucial 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.