Lidocaine 2% 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, Local Anesthetic
Pharmacologic Class
Class IB Antiarrhythmic, Voltage-gated sodium channel blocker
Pregnancy Category
B
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Lidocaine is a medication given by injection into a vein (IV) to help control certain types of irregular heartbeats (arrhythmias). It works by calming overactive electrical signals in the heart. It can also be used to numb parts of the body for medical procedures.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Adhere to the dosage instructions provided by your healthcare team. This medication 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
- Report any unusual sensations (e.g., numbness, tingling, dizziness, ringing in ears) immediately to your healthcare provider.
- Remain still and follow instructions during administration to ensure proper delivery and minimize risks.
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 1-1.5 mg/kg IV, followed by continuous IV infusion of 1-4 mg/min
Condition-Specific Dosing:
ventricular_arrhythmias:
Initial bolus 1-1.5 mg/kg IV over 2-3 minutes. May repeat bolus (0.5-0.75 mg/kg) every 5-10 minutes up to a total of 3 mg/kg. Follow with continuous IV infusion of 1-4 mg/min (20-50 mcg/kg/min).
Pediatric Dosing
Neonatal:
Not established (use with extreme caution, reduced dose)
Infant:
Initial bolus 1 mg/kg IV, followed by continuous IV infusion of 20-50 mcg/kg/min
Child:
Initial bolus 1 mg/kg IV, followed by continuous IV infusion of 20-50 mcg/kg/min
Adolescent:
Initial bolus 1 mg/kg IV, followed by continuous IV infusion of 20-50 mcg/kg/min
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment
Moderate:
No specific adjustment
Severe:
Monitor for toxicity; consider lower end of dosing range or reduced infusion rate, especially with prolonged use or concomitant liver impairment. Active metabolites may accumulate.
Dialysis:
Lidocaine is not significantly removed by hemodialysis. Monitor for toxicity and adjust dose as needed.
Hepatic Impairment:
Mild:
Consider 25-50% reduction in infusion rate
Moderate:
Consider 50% reduction in infusion rate
Severe:
Consider 50-75% reduction in infusion rate; monitor plasma levels closely
Pharmacology
Mechanism of Action
Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby blocking conduction in nerve fibers. In the heart, it acts as a Class IB antiarrhythmic by binding to and blocking voltage-gated sodium channels during the inactive state, shortening the action potential duration and effective refractory period in Purkinje fibers and ventricular muscle, and suppressing abnormal automaticity.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
Immediate (IV)
FoodEffect:
N/A (IV)
Distribution:
Vd:
0.7-2.7 L/kg (increases in heart failure, liver disease)
ProteinBinding:
60-80% (primarily to alpha-1-acid glycoprotein)
CnssPenetration:
Yes
Elimination:
HalfLife:
1.5-2 hours (prolonged in heart failure, liver disease)
Clearance:
0.95 L/min (average)
ExcretionRoute:
Renal
Unchanged:
<10%
Pharmacodynamics
OnsetOfAction:
<2 minutes (IV)
PeakEffect:
5-10 minutes (IV)
DurationOfAction:
10-20 minutes (after IV bolus); continuous with infusion
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, such as:
+ 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
Other severe side effects, including:
+ Breathing difficulties, such as slow, shallow, or labored 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
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching or shakiness
+ 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. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor or seek medical help if you notice any symptoms that bother you or persist. This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor.
Reporting Side Effects
You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor can also provide guidance on managing side effects and offer medical advice.
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, such as:
+ 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
Other severe side effects, including:
+ Breathing difficulties, such as slow, shallow, or labored 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
+ Anxiety
+ Changes in vision
+ Ringing in the ears
+ Dizziness or fainting
+ Severe headache
+ Twitching or shakiness
+ 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. While many people may not experience any side effects or only minor ones, it's essential to contact your doctor or seek medical help if you notice any symptoms that bother you or persist. This is not an exhaustive list of possible side effects. If you have questions or concerns, consult your doctor.
Reporting Side Effects
You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor can also provide guidance on managing side effects and offer medical advice.
Seek Immediate Medical Attention If You Experience:
- Feeling dizzy or lightheaded
- Numbness or tingling around the mouth or in fingers/toes
- Confusion or disorientation
- Ringing in the ears (tinnitus)
- Blurred or double vision
- Muscle twitching or tremors
- Feeling unusually sleepy or tired
- Slow or irregular heartbeat
- Difficulty breathing or shortness of breath
- Seizures
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 health problems, including any medical conditions or allergies
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe for you to do so. This will help prevent potential interactions between your medications and health problems.
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 health problems, including any medical conditions or allergies
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe for you to do so. This will help prevent potential interactions between your medications and health problems.
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, regularly have your blood work checked and an electrocardiogram (ECG) performed to monitor your heart's activity.
There is a risk of developing a severe blood condition called methemoglobinemia associated with this type of medication. Certain factors may increase this risk, including having glucose-6-phosphate dehydrogenase (G6PD) deficiency, pre-existing heart or lung problems, taking specific other medications, or being an infant under 6 months of age. If you have a history of methemoglobinemia, notify your doctor.
If you are 65 years or older, exercise caution when using this medication, as you may be more susceptible to experiencing side effects. Similarly, when administering this drug to children, use it with caution, as they may have a higher risk of developing certain side effects.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
There is a risk of developing a severe blood condition called methemoglobinemia associated with this type of medication. Certain factors may increase this risk, including having glucose-6-phosphate dehydrogenase (G6PD) deficiency, pre-existing heart or lung problems, taking specific other medications, or being an infant under 6 months of age. If you have a history of methemoglobinemia, notify your doctor.
If you are 65 years or older, exercise caution when using this medication, as you may be more susceptible to experiencing side effects. Similarly, when administering this drug to children, use it with caution, as they may have a higher risk of developing certain side effects.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Profound confusion or unconsciousness
- Generalized seizures
- Severe bradycardia (very slow heart rate)
- Hypotension (very low blood pressure)
- Cardiac arrest
- Respiratory arrest
What to Do:
Immediate medical attention is required. Call 911 or emergency services. For general poison control, call 1-800-222-1222.
Drug Interactions
Contraindicated Interactions
- Patients with Adams-Stokes syndrome, Wolff-Parkinson-White (WPW) syndrome, or severe degrees of sinoatrial, atrioventricular, or intraventricular heart block in the absence of a pacemaker.
Major Interactions
- Amiodarone (increased lidocaine levels, increased risk of toxicity)
- Beta-blockers (e.g., Propranolol, Metoprolol - decreased hepatic blood flow, increased lidocaine levels)
- Cimetidine (inhibits lidocaine metabolism, increased lidocaine levels)
- Phenytoin (additive cardiac depressant effects, increased risk of CNS toxicity)
- Other antiarrhythmics (additive cardiac effects, increased risk of proarrhythmia)
- Succinylcholine (prolonged neuromuscular blockade)
Moderate Interactions
- Macrolide antibiotics (e.g., Erythromycin - CYP3A4 inhibition, increased lidocaine levels)
- SSRIs (e.g., Fluvoxamine - CYP1A2 inhibition, increased lidocaine levels)
- Local anesthetics (additive systemic toxicity if used concurrently)
Minor Interactions
- Not many clinically significant minor interactions for IV lidocaine.
Monitoring
Baseline Monitoring
Electrocardiogram (ECG)
Rationale: To assess baseline cardiac rhythm and conduction, and identify pre-existing heart block.
Timing: Prior to initiation of therapy
Serum Electrolytes (Potassium, Magnesium)
Rationale: To correct any imbalances that may reduce lidocaine efficacy or increase proarrhythmic risk.
Timing: Prior to initiation of therapy
Liver Function Tests (LFTs)
Rationale: To assess hepatic function, as lidocaine is primarily metabolized by the liver; guides dose adjustment in hepatic impairment.
Timing: Prior to initiation, especially if hepatic impairment suspected
Routine Monitoring
Continuous ECG Monitoring
Frequency: Continuously during infusion
Target: Normal sinus rhythm or controlled arrhythmia
Action Threshold: Development of new arrhythmias, worsening of existing arrhythmias, or signs of heart block (e.g., PR prolongation, QRS widening, bradycardia)
Blood Pressure and Heart Rate
Frequency: Every 5-15 minutes initially, then hourly or as clinically indicated during infusion
Target: Maintain within patient's normal range
Action Threshold: Significant hypotension or bradycardia
Neurological Status (CNS toxicity)
Frequency: Hourly or as clinically indicated
Target: Alert and oriented, no signs of toxicity
Action Threshold: Signs of CNS toxicity (e.g., dizziness, paresthesias, confusion, tinnitus, blurred vision, muscle twitching, seizures)
Lidocaine Plasma Levels (Therapeutic Drug Monitoring)
Frequency: As indicated (e.g., after 6-12 hours of infusion, with dose changes, in renal/hepatic impairment, or suspected toxicity)
Target: 1.5-5 mcg/mL (antiarrhythmic)
Action Threshold: Levels >5 mcg/mL (increased risk of CNS toxicity); levels >9 mcg/mL (increased risk of cardiovascular toxicity)
Symptom Monitoring
- Dizziness
- Lightheadedness
- Paresthesias (numbness/tingling, especially perioral)
- Confusion
- Disorientation
- Tinnitus (ringing in ears)
- Blurred or double vision
- Slurred speech
- Muscle twitching or tremors
- Seizures
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Respiratory depression or arrest
Special Patient Groups
Pregnancy
Category B. Studies in animals have not shown fetal harm, and there are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits outweigh the potential risks to the fetus. Fetal bradycardia has been reported.
Trimester-Specific Risks:
First Trimester:
Generally considered low risk, but use only if clearly indicated.
Second Trimester:
Generally considered low risk, but use only if clearly indicated.
Third Trimester:
Generally considered low risk, but use only if clearly indicated. Monitor for fetal bradycardia.
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. Generally considered compatible with breastfeeding.
Infant Risk:
Low risk. Monitor infant for signs of sedation or feeding difficulties, though unlikely with typical IV doses.
Pediatric Use
Dosing is weight-based. Pediatric patients, especially neonates and infants, may be more susceptible to systemic toxicity due to immature hepatic metabolism and higher volume of distribution. Close monitoring for adverse effects (especially CNS and cardiovascular) is crucial. Use lowest effective dose.
Geriatric Use
Elderly patients may have reduced hepatic blood flow, decreased protein binding, and increased sensitivity to CNS effects, leading to higher plasma concentrations and increased risk of toxicity. A reduced initial bolus and/or infusion rate (e.g., 50% reduction) may be necessary. Monitor closely for adverse effects.
Clinical Information
Clinical Pearls
- Always have resuscitation equipment (e.g., intubation supplies, defibrillator, vasopressors) readily available when administering IV lidocaine due to the risk of severe cardiac and CNS toxicity.
- Monitor for early signs of CNS toxicity (e.g., perioral numbness, tinnitus, dizziness, confusion, muscle twitching) as these often precede more severe complications like seizures and cardiovascular collapse.
- Correct hypokalemia and hypomagnesemia prior to or during lidocaine administration, as these electrolyte imbalances can reduce lidocaine's efficacy and increase the risk of proarrhythmia.
- Dose adjustments are critical in patients with heart failure, liver disease, or advanced age due to altered pharmacokinetics and increased sensitivity.
- Lidocaine is generally reserved for ventricular arrhythmias that are refractory to other treatments or when other agents are contraindicated, particularly in the setting of acute myocardial infarction.
Alternative Therapies
- Other Class I antiarrhythmics (e.g., Procainamide, Flecainide - different subclasses and mechanisms)
- Class III antiarrhythmics (e.g., Amiodarone, Sotalol - for ventricular arrhythmias)
- Beta-blockers (e.g., Metoprolol, Esmolol - for rate control and some ventricular arrhythmias)
- Magnesium sulfate (for Torsades de Pointes or refractory ventricular arrhythmias)
- For local anesthesia: Bupivacaine, Ropivacaine, Mepivacaine
Cost & Coverage
Average Cost:
Relatively inexpensive per 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 guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion.
Proper disposal of unused or expired medications is crucial. Do not dispose of them by flushing down the toilet or pouring down the drain unless specifically instructed to do so. If you are unsure about the correct disposal method, consult your pharmacist for advice. Many communities have drug take-back programs, which your pharmacist can help you locate.
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, 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 emergency 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 prompt and effective treatment.
Proper disposal of unused or expired medications is crucial. Do not dispose of them by flushing down the toilet or pouring down the drain unless specifically instructed to do so. If you are unsure about the correct disposal method, consult your pharmacist for advice. Many communities have drug take-back programs, which your pharmacist can help you locate.
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, 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 emergency 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 prompt and effective treatment.