Lidocaine is a local anesthetic.
Release form and composition
Lidocaine Dosage Forms:
- Solution for injection (1% - 2 ml in ampoules, 10 ampoules with an ampoule knife in a cardboard bundle; 3.5 ml in ampoules, 10 ampoules with an ampule knife in a cardboard bundle; 5 ml in ampoules, 10 ampoules with an ampoule knife in a cardboard bundle; 5 ml in ampoules, 5 ampoules in blisters, 1 or 2 packs with an ampoule knife in a cardboard bundle; 10 ml in ampoules, 10 ampoules with an ampule knife in a cardboard bundle; 10 ml in ampoules, 10 ampoules in blister packs, 1 pack each with an ampoule knife in a carton box; 10 ml each in ampoules, 5 ampoules per contour x cell packs, 1 or 2 packs with an ampoule knife in a carton box, 2% - 2 ml in ampoules, 5 ampoules in a blister pack, 20 packs in a carton; 2 ml in ampoules, 10 ampoules ampoule knife in a cardboard bundle; 2 ml in ampoules, 5 ampoules in blister packs (pallets), 1 or 2 pallets with an ampule knife in a cardboard bundle; 2 ml in ampoules, 10 ampoules in blister packs, 1 each or 2 packs with an ampule knife in a carton box; 5 ml ampoules, 10 ampoules with an ampoule knife in a carton box; 5 ml in ampoules, 5 ampoules in blisters, 1 or 2 packs with an ampoule knife in a carton box; 10 ml each in ampoules, 10 ampoules with an ampoule knife in a carton box; 10 ml in ampoules, 5 ampoules in blisters, 1 or 2 packs with an ampoule knife in a carton box; 10% - 2 ml in ampoules, 10 ampoules with an ampoule knife in a package; 2 ml in ampoules, 5 or 10 ampoules in blister packs, 1 or 2 packs with an ampoule knife in a carton box; 2 ml in ampoules, 5 ampoules in blister packs (pallets), 1 or 2 pallets with an ampoule knife in a cardboard box);
- Eye drops (2% - 1.5 or 2.5 ml in a tube-droppers, 1, 2, 4, 5 or 10 tubes in a carton box; 5 or 10 ml in dropper bottles, 1 or 2 bottles in a cardboard bundle; 5 ml in plastic dropper bottles, 1 or 50 bottles in a cardboard bundle; 4% - 1.3 or 1.5 ml in a dropper tube, 5 tubes in a cardboard bundle);
- Gel for topical use of 5% (15 or 30 g in aluminum tubes, in a cardboard bundle 1 tube; 25 g in cans of dark glass, in a cardboard bundle 1 bank);
- Spray for topical use 10% dosed (38 g each in dark glass bottles with a spray bottle, 1 bottle per carton pack; 38 g each in aerosol or polypropylene cartridges with a dental cap and spray bottle for oral administration).
The active ingredient of the drug is anhydrous lidocaine hydrochloride. Its content is:
- 1 ml of solution - 10, 20 or 100 mg;
- 1 ml of eye drops - 20 or 40 mg;
- 1 g of gel - 50 mg;
- 1 dose of spray - 4.8 mg.
Indications for use
- Infiltration, spinal, epidural and conduction anesthesia;
- Terminal anesthesia (including in ophthalmology);
- Ventricular arrhythmias due to glycosidic intoxication;
- Relief and prevention of recurrent paroxysms of ventricular tachycardia, recurrent ventricular fibrillation in acute coronary syndrome (usually within 12-24 hours).
For eye drops - local anesthesia during the following procedures:
- Contact methods of examination (diagnostic corneal scraping, gonioscopy, tonometry);
- Preparation for ophthalmologic operations;
- Short-term surgical interventions on the cornea and conjunctiva, including the removal of suture material or foreign body.
For the gel - surface anesthesia of the mucous membranes:
- Dentistry: removal of mobile milk teeth and tartar, suturing of the mucous membrane, anesthesia of the injection area in front of local anesthesia;
- Otolaryngology: electrocoagulation, surgery on the nasal septum, etc .;
- Obstetrics and gynecology: removal of sutures, incision treatment and episiotomy, interventions on the vagina and cervix, etc .;
- Instrumental and endoscopic examinations (intubation, rectoscopy, insertion of the probe) and X-ray examination (to eliminate the pharyngeal reflex and nausea).
Additionally for gel:
- Surface anesthesia of the skin with minor surgical interventions;
- Anesthesia for burns (including solar), small wounds and scratches, contact dermatitis, insect bites.
- Local anesthesia of mucous membranes in dental practice and oral surgery: removal of mobile milk teeth and bone fragments, opening of superficial abscesses, suturing of wounds of mucous membranes, fixation of the crown or bridge-like prosthesis (only when using an elastic impression material), excision of superficial benign tumors of the mucous oral cavity, manual or instrumental excision of the enlarged papilla of the tongue, reduction or suppression of the increased pharyngeal reflex in the preparation of the patient to X-ray examination in children - frenuloektomiya autopsy cysts of the salivary glands;
- ENT practice: anesthesia before washing the sinuses, septektomiey, electrocoagulation, resection of nasal polyps, tonsillectomy pain management injection site and decrease the gag reflex (except adenektomii and tonsillectomy in children aged up to 8 years), as well as to the puncture of the maxillary sinus or opening peritonsillar abscess (as an additional anesthetic);
- Endoscopy and instrumental examinations: anesthesia before insertion of various probes through the mouth or nose, before rectoscopy and in the case of catheter replacement;
- Obstetrics and gynecology: anesthesia of the perineum to treat and / or perform an episiotomy, when suturing with abscesses, for excision and in the treatment of rupture of the hymen, surgical field in vaginal surgery and cervical surgery;
- Dermatology: anesthesia of the mucous membranes during minor surgical interventions.
All dosage forms of lidocaine are not prescribed for hypersensitivity to the drug.
There are also additional contraindications.
- Cardiogenic shock;
- Acute and chronic heart failure (III-IV FC);
- A pronounced decrease in blood pressure;
- Sinoatrial blockade;
- WPW syndrome;
- AV-blockade II-III degree (except in cases where the probe is inserted to stimulate the ventricles);
- Adams-Stokes Syndrome;
- Severe bradycardia;
- Violation of intraventricular conduction;
- Sick sinus syndrome;
- Lactation period;
- Retrobulbar injection to patients with glaucoma.
- Significant reduction in left ventricular function;
- Severe bradycardia;
- Morgagni-Adams-Stokes Syndrome;
- Sick sinus syndrome;
- AV block II and III and intraventricular conduction disorders (except when a probe is inserted to stimulate the ventricles);
- Cardiogenic shock;
- Instructions in the history of convulsions associated with the use of the drug;
- The use of gypsum in dentistry as an impression material.
With caution, Lidocaine injections are made in the following cases:
- Reduced hepatic blood flow;
- Severe hepatic / renal failure;
- Hypotension, hypovolemia;
- Sinus bradycardia;
- AV block I degree;
- Chronic heart failure II-III degree;
- Epileptiform convulsions (including history);
- Severe myasthenia gravis;
- Age up to 18 years;
- Weakened condition and age over 65;
- Hypersensitivity to other amide local anesthetics in history.
Eye drops are carefully prescribed to children, pregnant and lactating women.
Spray with care should be applied in the following cases:
- Impaired liver function;
- Circulatory failure;
- Renal failure;
- Injuries to the mucous membranes;
- Mental retardation;
- Old age and a weakened condition in patients who are already receiving a drug with a similar effect on cardiac disease.
The gel is used with caution in such cases:
- Hemorrhoidal bleeding (in the case of a rectal examination);
- Trauma to the skin or mucous membrane in the application;
- Local infection in the area of use;
- Accompanying acute illness;
- Junior children and old age;
- Weakened condition;
Dosing and Administration
The method of administration and dose of Lidocaine solution are determined individually depending on the evidence:
- Infiltration anesthesia: subcutaneously, intracutaneously, intramuscularly; apply a solution of 5 mg / ml, the maximum allowable dose - 400 mg;
- Blockade of the nerve plexus and peripheral nerves: perineurally 10-20 ml of 1% solution or 5-10 ml of 2% solution, but not more than 400 mg;
- Conductive anesthesia: perineural 1% or 2% solution, maximum dose - 300 mg;
- Epidural anesthesia: epidural 1% or 2% solution, maximum dose - 300 mg;
- Spinal anesthesia: subarachnoid in 3-4 ml (60-80 mg) 2% solution;
- In ophthalmology: 2 drops of a 2% solution are instilled into the conjunctival sac 2-3 times with an interval of 30-60 seconds immediately before the examination or surgical intervention.
If it is necessary to prolong the action of Lidocaine, a 0.1% solution of adrenaline is added to it (1 drop for every 5-10 ml of lidocaine solution, but not more than 5 drops for the entire volume of the solution).
Older people, patients with reduced hepatic blood flow (chronic heart failure) and liver disease (hepatitis, cirrhosis) are advised to reduce the dose by 40-50%
When using Lidocaine as an antiarrhythmic agent, the solution is administered intravenously. For these purposes, use a 10% solution (100 mg / ml) after dilution: 25 ml in 100 ml of saline (the concentration of lidocaine should be 20 mg / ml). The resulting solution is administered as a loading dose. The initial dose is 1 mg / kg, injected at a rate of 25-50 mg / minute, for 2-4 minutes, after which a constant infusion is immediately switched on at a rate of 1-4 mg / minute. 10-20 minutes after the first dose, there is a decrease in the concentration of lidocaine in the blood plasma, which may require repeated bolus administration (simultaneously with a constant infusion) in a dose of 1 / 2-1 / 3 of the initial load, with an interval of 8 -10 minutes. Within 1 hour you can enter no more than 300 mg of lidocaine, the maximum allowable daily dose is 2000 mg.
Intravenous infusion is usually carried out for 12-24 hours under constant monitoring of the electrocardiogram. The infusion is then stopped to assess the condition of the patient and the need for a change in antiarrhythmic therapy.
Older people, patients with impaired liver function (hepatitis, cirrhosis) and heart failure reduce the dose and rate of drug administration by 25-50%.
Eye drops Lidocaine drip into the conjunctival sac 1-2 drops 3 times with an interval of 30-60 seconds immediately before surgery or study.
Spray Lidocaine sprayed on the mucous membranes, holding the balloon in an upright position. The doctor determines the dose individually, depending on the evidence and the area of the anesthetized surface.
Approximate number of sprays (doses) for various indications:
- Dermatology - 1-3;
- Dentistry - 1-3;
- Oral cavity and otorhinolaryngology surgery - 1-4;
- Endoscopy - 2-3;
- Gynecology - 4-5;
- Obstetrics - 15-20.
Children under the age of 2 use the drug preferably by applying a cotton swab: this avoids the burning sensation and reduces the feeling of fear in the child.
Patients with hepatic or / heart failure dose is reduced by 40%.
Lidocaine Gel is intended for topical use.
- Before infiltration anesthesia - put on the mucous membrane with an interval of 2-3 minutes in the area of subsequent infiltration anesthesia;
- Removal of tartar - rubbed into the gingival margin and neck of the teeth for 2-3 minutes before the procedure;
- After curettage or removal of tartar - applied to the gum pocket and fixed;
- Treatment of aft and erosion - applied several times a day to the mucous membrane.
For anesthesia, the mucous membrane of the larynx, trachea, esophagus lubricates the surface of the instruments intended for the study. For surface anesthesia of the oral mucosa, the gel is applied with a sterile glass rod or the mucous membranes are treated with a sterile cotton swab moistened with gel. The dose of the drug - 200-2000 mg. With insufficient severity of analgesic action after 2-3 minutes, the treatment is repeated. Within 12 hours a dose of not more than 300 mg of lidocaine (6 g of gel) can be applied to adults.
In other cases, the dose is set individually.
Children should be prescribed up to 4.5 mg / kg.
When using Lidocaine Solution:
- Central nervous system: euphoria, drowsiness, headache, dizziness, general weakness, disorientation, diplopia, photophobia, nystagmus, tinnitus, confusion or loss of consciousness, tremor, paresthesia, facial muscles, anxiety, neurotic reactions, convulsions;
- Cardiovascular system: lowering blood pressure, chest pain, peripheral vasodilation, collapse, bradycardia (up to cardiac arrest);
- Digestive system: nausea, vomiting;
- Allergic reactions: rash, pruritus, urticaria, anaphylactic shock, angioedema;
- Other: sensation of cold or heat, persistent anesthesia, methemoglobinemia, hypothermia, erectile dysfunction.
The use of eye drops may cause irritation of the conjunctiva, local allergic reactions, with long-term use - corneal epitheliopathy.
When applying the gel and spray:
- Local reactions: fast passing sensation of slight burning sensation (disappears within 1 minute as the anesthetic effect develops);
- Cardiovascular system: extremely rare - arterial hypotension, bradycardia;
- Central nervous system: extremely rare - anxiety, dizziness, headache, blurred vision, tremor, convulsions, depression;
- Allergic reactions: extremely rare - itching, skin rash, anaphylactic shock.
Special care must be taken when carrying out local anesthesia of tissues with high vascularization. To avoid intravascular injection of the drug, it is recommended to conduct an aspiration test.
Patients receiving monoamine oxidase inhibitors (MAO), you must cancel them at least 10 days before the scheduled use of lidocaine.
During the period of treatment with lidocaine in the form of an injection solution, care must be taken when driving and performing work that requires reaction speed and concentration.
When applying the spray and gel, contact with the eyes and ingestion should be avoided and the aerosol should be inhaled. Particular caution should be applied to the drug on the back of the pharynx.
It should be borne in mind that lidocaine:
- Strengthens muscle relaxation of curative drugs;
- Reduces the cardiotonic action of digitoxin;
- Reduces the effect of anti-myasthenic drugs;
- Strengthens and prolongs the action of muscle relaxants.
Cimetidine and beta-blockers increase the risk of toxic effects of lidocaine. Verapamil, amiodarone, quinidine and aymalin enhance its negative inotropic effect. Inductors of microsomal liver enzymes (rifampicin, phenytoin, barbiturates) reduce its effectiveness. Ethanol enhances its depressant effect on breathing. Adrenaline and other alpha adrenomimetics prolong its effect.
With simultaneous use of vasoconstrictors (phenylephrine, methoxamine, epinephrine) prolong the anesthetic effect of lidocaine, may cause an increase in blood pressure and tachycardia.
Mecamylamine, guanethidine, trimetafan, guanadrel increase the risk of marked reduction in blood pressure and the development of bradycardia.
When combined with procainamide, hallucinations and excitation of the central nervous system are possible.
Lidocaine should be used with caution in combination with phenytoin and defininin, as there is a possibility of reducing its resorptive action, as well as the development of an undesirable cardiodepressive effect.
MAO inhibitors can enhance the anesthetic effect of lidocaine and help lower blood pressure. Patients receiving MAO inhibitors, parenteral use of lidocaine is contraindicated.
With the combined use of lidocaine with thiopental sodium, hexenal, opioid analgesics, sedatives or hypnotics, it is possible to increase the inhibitory effect on respiration and the central nervous system.
In the case of Lidocaine, it is necessary to monitor the patient's respiratory function at the same time as polymicynase B
For treatment of the injection site is not recommended to use disinfectant solutions containing metals, because it increases the risk of local reactions in the form of edema and pain.
When lidocaine is administered intravenously to patients taking cimetidine, such undesirable effects as drowsiness, paresthesia, stupor and bradycardia are possible. If you need to use this combination, you must reduce the dose of lidocaine.
If Lidocaine is used simultaneously with class IA antiarrhythmic drugs (disopyramide, procainamide, quinidine), the QT interval is lengthened, in rare cases, ventricular fibrillation or AV blockade may develop.
Lidocaine may enhance the effects of drugs that cause a neuromuscular blockade.
When using the drug in patients with intoxication with digitalis glycosides, the severity of AV blockade may be aggravated.
The following drugs increase the concentration of lidocaine in the blood serum (in case of simultaneous use): bupivacaine, pethidine, quinidine, propranolol, disopyramide, nortriptyline, cimetidine, amitriptyline, aminazine, imipramine.
Terms and conditions of storage
Store in a dark place, out of reach of children.
- Solution - 5 years at a temperature of 15-25 ºС;
- Gel - 2 years at temperatures up to 20 ºС;
- Eye drops - 2 years at a temperature of 15-25 ºС, after opening the bottle - 1 month;
- Spray - 5 years at a temperature of 15-25 ºС.