Name /bks_53161_deglins_md_disk/lidocaine 02/17/2014 07:05AM Plate # 0-Composite pg 1 # 1

1 High Alert Distribution: Widely distributed. Concentrates in adipose tissue. Crosses the
blood-brain barrier and placenta; enters breast milk.
PDF Page #1
LIDOCAINE Metabolism and Excretion: Mostly metabolized by the liver; 10% excreted in
urine as unchanged drug.
lidocaine (parenteral) Half-life: Biphasic initial phase, 7 30 min; terminal phase, 90 120 min;qin
(lye-doe-kane) HF and liver impairment.
LidoPen, Xylocaine, Xylocard TIME/ACTION PROFILE (IV, IM antiarrhythmic effects; local anesthetic effects)
lidocaine (local anesthetic) ROUTE ONSET PEAK DURATION
Xylocaine
IV immediate immediate 1020 min (up to sev-
lidocaine (mucosal) eral hours after con-
Anestacon, Xylocaine Viscous tinuous infusion)
IM 515 min 2030 min 6090 min
lidocaine patch Local rapid unknown 13 hr
Lidoderm
lidocaine (topical) Contraindications/Precautions
L-M-X 4, L-M-X 5, Solarcaine Aloe Extra Burn Relief, Xylocaine, Zilactin-L Applies mainly to systemic use
Classification Contraindicated in: Hypersensitivity; cross-sensitivity may occur; Third-degree
Therapeutic: anesthetics (topical/local), antiarrhythmics (class IB) heart block.
Pregnancy Category B Use Cautiously in: Liver disease, HF, patients weighing 50 kg, and geriatric pa-
tients (pbolus and/or maintenance dose); Respiratory depression; Shock; Heart
Indications block; OB, Lactation: Safety not established; Pedi: Safety not established for trans-
IV: Ventricular arrhythmias. IM: Self-injected or when IV unavailable (during trans- dermal patch.
port to hospital facilities). Local: Infiltration/mucosal/topical anesthetic. Patch:
Pain due to post-herpetic neuralgia.
Adverse Reactions/Side Effects
Applies mainly to systemic use CNS: SEIZURES, confusion, drowsiness, blurred vision,
Action dizziness, nervousness, slurred speech, tremor. EENT: mucosal usepor absent
IV, IM: Suppresses automaticity and spontaneous depolarization of the ventricles gag reflex. CV: CARDIAC ARREST, arrhythmias, bradycardia, heart block, hypotension.
during diastole by altering the flux of sodium ions across cell membranes with little GI: nausea, vomiting. Resp: bronchospasm. Hemat: methemoglobinemia. Lo-
or no effect on heart rate. Local: Produces local anesthesia by inhibiting transport of cal: stinging, burning, contact dermatitis, erythema. MS: chondrolysis. Misc: aller-
ions across neuronal membranes, thereby preventing initiation and conduction of gic reactions, including ANAPHYLAXIS.
normal nerve impulses. Therapeutic Effects: Control of ventricular arrhythmias.
Local anesthesia. Interactions
Pharmacokinetics Applies mainly to systemic use
Absorption: Well absorbed after administration into the deltoid muscle; some ab- Drug-Drug: qcardiac depression and toxicity with phenytoin, amiodarone,
sorption follows local use. quinidine, procainamide, or propranolol. Cimetidine, azole antifungals,
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/lidocaine 02/17/2014 07:06AM
2 Patch (Adults): Up to 3 patches may be applied once for up to 12 hr in any 24-hr pe-
clarithromycin, erythromycin, fluoxetine, nefazodone, paroxetine, prote-
ase inhibitors, ritonavir, verapamil, and beta blockers maypmetabolism and
qrisk of toxicity. Lidocaine mayqlevels of calcium channel blockers, certain
benzodiazepines, cyclosporine, fluoxetine, lovastatin, simvastatin, mirta-
zapine, paroxetine, ritonavir, tacrolimus, theophylline, tricyclic antide-
pressnts, and venlafaxine. Effects of lidocaine may bepby carbamazepine, phe-
nobarbital, phenytoin, and rifampin.
Route/Dosage
Ventricular Tachycardia (with a Pulse) or Pulseless Ventricular
Tachycardia/Ventricular Fibrillation
IV (Adults): 1 1.5 mg/kg bolus; may repeat doses of 0.5 0.75 mg/kg q 5 10 min
up to a total dose of 3 mg/kg; may then start continuous infusion of 1 4 mg/min.
Endotracheal (Adults): Give 2 2.5 times the IV loading dose down the endotra-
cheal tube, followed by a 10 mL saline flush.
IV (Children): 1 mg/kg bolus (not to exceed 100 mg), followed by 20 50 mcg/kg/
min continuous infusion (range 20 50 mcg/kg/min); may administer second bolus
of 0.5 1 mg/kg if delay between bolus and continuous infusion.
Endotracheal (Children): Give 2 3 mg/kg down the endotracheal tube followed
by a 5 mL saline flush.
IM (Adults and Children 50 kg): 300 mg (4.5 mg/kg); may be repeated in 60
90 min.
Local
Infiltration (Adults and Children): Infiltrate affected area as needed (increased
amount and frequency of use increases likelihood of systemic absorption and ad-
verse reactions).
Topical (Adults): Apply to affected area 2 3 times daily.
Mucosal (Adults): For anesthetizing oral surfaces 20 mg as 2 sprays/quadrant
(not to exceed 30 mg/quadrant) may be used. 15 mL of the viscous solution may be
used q 3 hr for oral or pharyngeal pain. For anesthetizing the female urethra 3
5 mL of the jelly or 20 mg as 2% solution may be used. For anesthetizing the male
urethra 5 10 mL of the jelly or 5 15 mL of 2% solution may be used before cath-
eterization or 30 mL of jelly before cystoscopy or similar procedures. Topical solu-
tions may be used to anesthetize mucous membranes of the larynx, trachea, or esoph-
agus.
Plate # 0-Composite pg 2 # 2
riod; consider smaller areas of application in geriatric or debilitated patients.
PDF Page #2
NURSING IMPLICATIONS
Assessment
Antiarrhythmic: Monitor ECG continuously and BP and respiratory
status frequently during administration.
Anesthetic: Assess degree of numbness of affected part.
Transdermal: Monitor for pain intensity in affected area periodically during
therapy.
Lab Test Considerations: Serum electrolyte levels should be monitored peri-
odically during prolonged therapy.
IM administration may causeqCPK levels.
Toxicity and Overdose: Serum lidocaine levels should be monitored periodi-
cally during prolonged or high-dose IV therapy. Therapeutic serum lidocaine lev-
els range from 1.5 to 5 mcg/mL.
Signs and symptoms of toxicity include confusion, excitation, blurred or double vi-
sion, nausea, vomiting, ringing in ears, tremors, twitching, seizures, difficulty
breathing, severe dizziness or fainting, and unusually slow heart rate.
If symptoms of overdose occur, stop infusion and monitor patient closely.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)
Acute pain (Indications)
Implementation
High Alert: Lidocaine is readily absorbed through mucous membranes. Inadver-
tent overdosage of lidocaine jelly and spray has resulted in patient harm or death
from neurologic and/or cardiac toxicity. Do not exceed recommended doses.
Throat Spray: Ensure that gag reflex is intact before allowing patient to drink or
eat.
IM: IM injections are recommended only when ECG monitoring is not available
and benefits outweigh risks. Administer IM injections only into deltoid muscle
while frequently aspirating to prevent IV injection.
IV Administration
Direct IV: Only 1% and 2% solutions are used for direct IV injection. Diluent:
Administer undiluted. Rate: Administer loading dose over 2 3 min. Follow by IV
continuous infusion.
2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/lidocaine 02/17/2014 07:06AM
3 sium chloride, procainamide, prochlorperazine, promethazine, propranolol,
CONTINUED
LIDOCAINE
Continuous Infusion: Diluent: Lidocaine vials need to be further diluted. Di-
lute 2 g of lidocaine in 250 mL or 500 mL of D5W or 0.9% NaCl. Admixed infusion
stable for 24 hr at room temperature. Premixed infusions are already diluted and
ready to use. Concentration: 4 8 mg/mL. Rate: See Route/Dosage section.
Administer via infusion pump for accurate dose.
Y-Site Compatibility: acetaminophen, alemtuzumab, alfentanyl, alteplase, ami-
kacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid
complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid,
atracurium, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleo-
mycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium glu-
conate, carboplatin, carmustine, cefazolin, cefoperazone, cefotaxime, cefoxitin,
ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorprom-
azine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cy-
clophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexame-
thasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem,
diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin, doxorubicin
liposomal, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin
alfa, eptifibatide, ertapenem, erythromycin, esmolol, etomidate, etoposide, eto-
poside phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine,
fluorouracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate,
granisetron, heparin, hetastarch, hydrocortisone sodium succinate, hydromor-
phone, idarubicin, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irino-
tecan, isoproterenol, ketorolac, labetalol, levofloxacin, linezolid, lorazepam,
magnesium sulfate, mannitol, mechlorethamine, meperidine, methotrexate,
methyldopate, methylprednisolone sodium succinate, metoclopramide, metroni-
dazole, micafungin, midazolam, mitoxantrone, morphine, moxifloxacin, multivi-
tamins, mycophenolate, nafcillin, nalbuphine, naloxone, nicardipine, nitroglyc-
erin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin,
oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pa-
paverine, pemetrexed, penicillin G, pentamidine, pentazocine, phentolamine,
phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potas-
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent.
Plate # 0-Composite pg 3 # 3
protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rocu-
PDF Page #3
ronium, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, su-
fentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/cla-
vulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin,
vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, vitamin
B complex with C , voriconazole, warfarin, zoledronic acid.
Y-Site Incompatibility: acyclovir, amphotericin B cholesteryl, amphotericin B
colloidal, azathioprine, caspofungin, dantrolene, diazepam, diazoxide, ganciclo-
vir, milrinone, pantoprazole, pentobarbital, phenobarbital, phenytoin, thiopental,
trimethoprim/sulfamethoxazole.
Infiltration: Lidocaine with epinephrine may be used to minimize systemic ab-
sorption and prolong local anesthesia.
Transdermal: When used concomitantly with other products containing local
anesthetic agents, consider amount absorbed from all formulations.
Patient/Family Teaching
May cause drowsiness and dizziness. Advise patient to call for assistance during
ambulation and transfer.
IM: Available in LidoPen Auto-Injector for use outside the hospital setting. Advise
patient to telephone health care professional immediately if symptoms of a heart
attack occur. Do not administer unless instructed by health care professional. To
administer, remove safety cap and place back end on thickest part of thigh or del-
toid muscle. Press hard until needle prick is felt. Hold in place for 10 sec, then
massage area for 10 sec. Do not drive after administration unless absolutely nec-
essary.
Topical: Apply Lidoderm Patch to intact skin to cover the most painful area.
Patch may be cut to smaller sizes with scissors before removing release liner.
Clothing may be worn over patch. If irritation or burning sensation occurs during
application, remove patch until irritation subsides. Wash hands after application;
avoid contact with eyes. Dispose of used patch to avoid access by children or pets.
Caution women to consult health care professional before using a topical anes-
thetic for a mammogram or other procedures. If recommended, use lowest drug
concentration, and apply it sparingly. Do not apply to broken or irritated skin, do
not wrap skin, and do not apply heat to area (heating pad/electric blanket), to de-
crease chance that drug may be absorbed into the body. May result in seizures,
cardiac arrhythmias, respiratory failure, coma, and death.
Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/lidocaine 02/17/2014 07:06AM Plate # 0-Composite pg 4 # 4

4
Advise patient referred for MRI test to discuss patch with referring health care pro- PDF Page #4
fessional and MRI facility to determine if removal of patch is necessary prior to test
and for directions for replacing patch.
Evaluation/Desired Outcomes
Decrease in ventricular arrhythmias.
Local anesthesia.
Why was this drug prescribed for your patient?

2015 F.A. Davis Company