II. Indications

  1. Refractory, constant cough
  2. Obstructive Lung Disease (e.g. Asthma, COPD) exacerbation with refractory cough
    1. Standard measures (Bronchodilators) are preferred

III. 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

IV. 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]

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