Indications

Suppression of ventricular extrasystoles and ventricular tachycardia, especially after an acute myocardial infarction.

Local anaesthesia by surface infiltration, regional, epidural and caudal routes, dental anaesthesia, either alone or in combination with adrenaline.

Lidocaine may also be administered by subcutaneous, intramuscular or intravenous injection.

This particular medicinal product (i.e. Lidocaine Hydrochloride Injection 2% w/v) is contraindicated for intraocular use because its formulation is neither isotonic nor pH neutral

Dosage and Administration

Usage: I.V.

1.In ventricular arrhythmias

The usual adult IV bolus dose is 50-100 mg administered at a rate of approximately 25-50 mg per minute. 

Adults: 20-50 micrograms/kg/minute (1-4 mg/minute in an average 70 kg adult).

Infants and children may be given an initial IV bolus of 0.5-1 mg/kg.

2.In Local Anaesthesia

Usual doses should generally be reduced in children and in elderly or debilitated patients. To minimise the possibility of toxic reactions, children should be given Lidocaine Hydrochloride solutions in concentrations of 0.5% or 1%.

Single doses of Lidocaine (for anaesthesia other than spinal) should not exceed 4.5 mg/kg (or 200 mg) in adults or children 12 – 18 years of age. Lidocaine by local infiltration for children under the age of 12 years should not exceed 3mg/kg, repeated not more often than every 4 hours.

Precautions & Warning:

1.As with other local anaesthetics, Lidocaine should be used with caution in patients with epilepsy, myasthenia gravis, cardiac conduction disturbances, congestive heart failure, bradycardia, severe shock, impaired respiratory function or impaired renal function with a creatinine clearance of less than 10mL/minute.

2.Central nerve blocks may cause cardiovascular depression, especially in the presence of hypovolaemia, and therefore epidural anaesthesia should be used with caution in patients with impaired cardiovascular function.

•Blood pressure should be monitored during spinal anaesthesia. Epidural anaesthesia may lead to hypotension and bradycardia. This risk can be reduced by preloading the circulation with crystalloidal or colloidal solutions. Hypotension should be treated promptly.

•Paracervical block can sometimes cause foetal bradycardia or tachycardia, and careful monitoring of the foetal heart rate is necessary

Contraindications:

1.Known hypersensitivity to lidocaine, to other anaesthetics of the amide type, or any of the excipients

2.In ventricular arrhythmia: Sino-atrial disorders; All grades of atrioventricular block; Severe myocardial depression; Porphyria (use with caution in local anaesthesia)

3.In local anaesthesia: Complete heart block; Hypovolaemia;

4.Intraocular use

This medicinal product (i.e. hameln Lidocaine Hydrochloride Injection BP 2% w/v) is neither isotonic nor pH neutral and is therefore contraindicated for intraocular use. If intraocular use is required, administration of medicinal products more suitable for intraocular use should be considered.

Adverse Reactions:

In common with other local anaesthetics, adverse reactions to Lidocaine are rare and are usually the result of raised plasma concentrations due to accidental intravascular injection, excessive dosage or rapid absorption from highly vascular areas, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient. Systemic toxicity mainly involves the central nervous system and/or the cardiovascular system

Drug interactions:

1.Lidocaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics (e.g. anti-arrhythmics, such as mexiletine),

2.The clearance of Lidocaine may be reduced by beta-adrenoceptor blocking agents (e.g. propranolol) and by cimetidine, requiring a reduction in the dosage of lidocaine. Increase in serum levels of lidocaine may also occur with anti-viral agents (e.g. amprenavir, atazanavir, darunavir, lopinavir).

Storage instructions:

Store at less than 25°C. Protect from light.