II. Mechanism
- Suppresses ventricular Arrhythmias
- Decreases automaticity
- Increases Ventricular Fibrillation threshold
- Requires high plasma Lidocaine levels (6 ug/ml)
- Suppresses ventricular ectopy
- Local Anesthetic effect
- Post Myocardial Infarction
- Routine prophylactic Lidocaine use not recommended
- Terminates reentrant ventricular Arrhythmia
III. Indications
- Ventricular Fibrillation
-
Ventricular Tachycardia (Wide Complex Tachycardia)
- Use Lidocaine only if unknown etiology
- Not indicated for drug induced Arrhythmia
- Not indicated for metabolic induced Arrhythmia
- Post-Resuscitation for ventricular Arrhythmia
- Myocarditis
- Structural heart disease
IV. Contraindications
- Wide-complex ventricular escape rhythm
- Associated with Bradycardia
V. Pediatric Dosing
- Dose: 1 mg/kg IV/IO/ET
VI. Adult Dosing
-
Ventricular Fibrillation
- Dose: 1.0-1.5 mg/kg IV push
- May repeat in 3-5 min to max dose 3 mg/kg
-
Ventricular Tachycardia (with a pulse)
- First: 1.0-1.5 mg/kg IV push
- Next: 0.5-0.75 mg/kg IV push (max total 3 mg/kg)
VII. Infusion Dosing (Pediatric and Adult)
- Lidocaine 120 mg in 100 ml D5W
- Precede infusion with 1 mg/kg bolus loading dose
- Then 20-50 ug/kg/min (1-2.5 ml/kg/h) Infusion
- If hepatic Blood Flow is compromised (e.g. CHF)
- Decrease dose to under 20 ug/kg/min
VIII. Adverse Effects
- Myocardial depression of conduction and contractility
- Concurrent Antiarrhythmic therapy
- Sick Sinus Syndrome
- Left Ventricular Dysfunction
- Circulatory depression
- Neurologic changes
- Drowsiness or Disorientation
- Decreased Hearing acuity
- Paresthesia and Muscle Twitching
- Seizures
- Overdosage
- Third degree AV Heart Block
- Altered AV conduction
- Sinus node automaticity depressed
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Related Studies
| lidocaine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| LIDOCAINE 2% VISCOUS SOLN | Generic | $0.07 per ml |
| LIDOCAINE 3% CREAM | Generic | $0.78 per gram |
| LIDOCAINE 4% CREAM | Generic OTC | $0.76 per gram |
| LIDOCAINE 4% PATCH | Generic OTC | $0.91 each |
| LIDOCAINE 5% OINTMENT | Generic | $0.17 per gram |
| LIDOCAINE 5% PATCH | Generic | $1.78 each |
| LIDOCAINE ANORECTAL 5% CREAM | Generic OTC | $0.43 per gram |
| LIDOCAINE HCL 1% 20 MG/2 ML VL | Generic | $0.75 per ml |
| LIDOCAINE HCL 1% 50 MG/5 ML VIAL | Generic | $0.41 per ml |
| LIDOCAINE HCL 1% VIAL | Generic | $0.21 per ml |
| LIDOCAINE HCL 2% 100 MG/5 ML | Generic | $0.34 per ml |
| LIDOCAINE HCL 2% JELLY | Generic | $2.99 per ml |
| LIDOCAINE HCL 2% VIAL | Generic | $0.34 per ml |
| LIDOCAINE HCL 4% CREAM | Generic OTC | $0.05 per gram |
| LIDOCAINE HCL 4% SOLUTION | Generic | $0.46 per ml |
| LIDOCAINE PAIN RELIEF 4% PATCH | Generic OTC | $0.91 each |
| LIDOCAINE-HC 3-0.5% CREAM | Generic | $1.16 per gram |
| LIDOCAINE-PRILOCAINE CREAM | Generic | $0.51 per gram |