Pulmonology Book

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Nebulized Lidocaine

Aka: Nebulized Lidocaine
  1. Indications
    1. Refractory, constant cough
    2. Obstructive Lung Disease (e.g. Asthma, COPD) exacerbation with refractory cough
      1. Standard measures (Bronchodilators) are preferred
  2. Precautions
    1. Off-label use (not recommended in most cases, except when other measures fail)
    2. Dosing is not standardized, and although appears safe and effective, there is a paucity of literature
    3. Lidocaine can have serious toxicity (light headedness, myoclonic jerks)
      1. Intralipid (Lipid emulsion) is the antidote
  3. Dosing
    1. General
      1. Use Lidocaine Solution (2% or 4%)
      2. Dilute in 5 cc Normal Saline
      3. Maximum: 1-3 mg/kg Lidocaine
    2. Adults
      1. Lidocaine 4%, 3 ml in Normal Saline nebulized up to 3-4 times daily
      2. Hunt (2004) J Allergy Clin Immunol 113(5):853-9. [PubMed]
    3. Children
      1. Lidocaine 2%, 0.8 mg/kg/dose to 2.5 mg/kg/dose in Normal Saline nebulized 3-4 times daily
      2. Decco (1999) Ann Allergy Asthma Immunol 82(1):29-32. [PubMed]
  4. References
    1. Chong (2005) Emerg Med J 22(6): 429-32 +PMID: 15911951 [PubMed]

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