II. Mechanism

  1. Suppresses ventricular arrhythmias
    1. Decreases automaticity
    2. Increases Ventricular Fibrillation threshold
      1. Requires high plasma Lidocaine levels (6 ug/ml)
  2. Suppresses ventricular ectopy
    1. Local Anesthetic effect
    2. Post Myocardial Infarction
      1. Routine prophylactic Lidocaine use not recommended
  3. Terminates reentrant ventricular arrhythmia

III. Indications

  1. Ventricular Fibrillation
  2. Ventricular Tachycardia (Wide Complex Tachycardia)
    1. Use Lidocaine only if unknown etiology
    2. Not indicated for drug induced arrhythmia
    3. Not indicated for metabolic induced arrhythmia
  3. Post-Resuscitation for ventricular arrhythmia
    1. Myocarditis
    2. Structural heart disease

IV. Contraindications

  1. Wide-complex ventricular escape rhythm
  2. Associated with Bradycardia

V. Pediatric Dosing

  1. Dose: 1 mg/kg IV/IO/ET

VI. Adult Dosing

  1. Ventricular Fibrillation
    1. Dose: 1.0-1.5 mg/kg IV push
    2. May repeat in 3-5 min to max dose 3 mg/kg
  2. Ventricular Tachycardia (with a pulse)
    1. First: 1.0-1.5 mg/kg IV push
    2. Next: 0.5-0.75 mg/kg IV push (max total 3 mg/kg)

VII. Infusion Dosing (Pediatric and Adult)

  1. Lidocaine 120 mg in 100 ml D5W
    1. Precede infusion with 1 mg/kg bolus loading dose
    2. Then 20-50 ug/kg/min (1-2.5 ml/kg/h) Infusion
  2. If hepatic blood flow is compromised (e.g. CHF)
    1. Decrease dose to under 20 ug/kg/min

VIII. Adverse Effects

  1. Myocardial depression of conduction and contractility
    1. Concurrent Antiarrhythmic therapy
    2. Sick Sinus Syndrome
    3. Left Ventricular Dysfunction
  2. Circulatory depression
  3. Neurologic changes
    1. Drowsiness or Disorientation
    2. Decreased hearing acuity
    3. Paresthesia and muscle twitching
    4. Seizures
  4. Overdosage
    1. Third degree AV Heart Block
    2. Altered AV conduction
    3. Sinus node automaticity depressed

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Cost: Medications

LIDOCAINE VISCOUS (on 2/19/2015 at Target.com)
LIDOCAINE VISCOUS 2% Solution #90 for $10.00 $0.11 each
lidocaine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
LIDOCAINE 2% VISCOUS SOLN Generic $0.02 per ml
LIDOCAINE 3% CREAM Generic $1.45 per gram
LIDOCAINE 4% CREAM Generic OTC $0.85 per gram
LIDOCAINE 5% OINTMENT Generic $3.08 per gram
LIDOCAINE 5% PATCH Generic $3.65 each
LIDOCAINE ANORECTAL 5% CREAM Generic OTC $1.31 per gram
LIDOCAINE HCL 1% AMPUL Generic $0.25 per ml
LIDOCAINE HCL 1% VIAL Generic $0.06 per ml
LIDOCAINE HCL 2% JELLY Generic $0.26 per ml
LIDOCAINE HCL 2% VIAL Generic $0.06 per ml
LIDOCAINE HCL 4% SOLUTION Generic $0.08 per ml
LIDOCAINE-HC 3-0.5% CREAM Generic $1.37 per gram
LIDOCAINE-HC 3-0.5% CREAM KIT Generic $0.68 per gram
LIDOCAINE-HC 3-1% CREAM KIT Generic $120.60 each
LIDOCAINE-HC 3-2.5% GEL KIT Generic $240.49 each
LIDOCAINE-PRILOCAINE CREAM Generic $0.75 per gram

Ontology: Lidocaine (C0023660)

Definition (MSH) A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of PROCAINE but its duration of action is shorter than that of BUPIVACAINE or PRILOCAINE.
Definition (NCI) A synthetic aminoethylamide with local anesthetic and antiarrhythmic properties. Lidocaine stabilizes the neuronal membrane by binding to and inhibiting voltage-gated sodium channels, thereby inhibiting the ionic fluxes required for the initiation and conduction of impulses and effecting local anesthesia.
Definition (NCI_NCI-GLOSS) A substance used to relieve pain by blocking signals at the nerve endings in skin. It can also be given intravenously to stop heart arrhythmias. It is a type of local anesthetic and antiarrhythmic.
Definition (CSP) drug having anesthetic, sedative, analgesic, anticonvulsant and cardiac depressant activities, used as a local anesthetic; applied topically to the skin and mucous membranes.
Definition (PDQ) A synthetic aminoethylamide with local anesthetic and antiarrhythmic properties. Lidocaine stabilizes the neuronal membrane by binding to and inhibiting voltage-gated sodium channels, thereby inhibiting the ionic fluxes required for the initiation and conduction of impulses and effecting local anesthesia. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39607&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39607&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C614" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008012
SnomedCT 387480006, 82573000
LNC LP16174-2, MTHU005009
English Lidocaine, Lignocaine, Acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl)-, Lidocaine (Obsolete), 2-(Diethylamino)-N-(2,6-dimethylphenyl)acetamide, 2-Diethylamino-2',6'-acetoxylidide, Omega-diethylamino-2,6-dimethylacetanilide, lidocaine, local anesthetics lidocaine, lidocaine (medication), LIDOCAINE, Lidocaine [Chemical/Ingredient], lidocaine substances, lignocaine, .omega.-Diethylamino-2,6-dimethylacetanilide, 2-(Diethylamino)-2',6'-acetoxylidide, Lidocaine (product), Lidocaine (substance), 2-2EtN-2MePhAcN, 2-(Diethylamino)-N-(2,6-Dimethylphenyl)Acetamide
Swedish Lidokain
Czech lidokain
Finnish Lidokaiini
Russian LIGNOKAIN, KSIKAIN, LIDOKAIN, КСИКАИН, ЛИГНОКАИН, ЛИДОКАИН
Japanese キシロカイン, リグノカイン, 塩酸リドカイン, ペンレス, アネトカイン, ユーパッチ, オリベス, リドカイン, リドクイック
Croatian LIDOKAIN
Polish Ksylokaina, Lidokaina, Lignokaina
Spanish lidocaína (producto), lidocaína (sustancia), lidocaína, lignocaína, Lignocaína, Lidocaína
French Lidocaïne
German Lidocain, Lignocain
Italian Lidocaina
Portuguese Lidocaína, Lignocaína