II. Indications
-
Amiodarone has replaced Lidocaine as first line agent in ACLS and PALS protocols
- However Lidocaine may have higher rate of ROSC and lower morbidity and mortality than Amiodarone
- Wagner (2023) Chest 163(5):1109-1119 +PMID: 36332663 [PubMed]
- 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
III. Contraindications
- Wide-complex Ventricular Escape Rhythm
- Associated with Bradycardia
IV. Mechanism
- See Lidocaine Local Skin Anesthesia
- Class Ib Antiarrhythmic Drug
- Increases conduction velocity in the AV Node, His Bundle and Purkinje Fibers
- Shortens QT Interval
- Suppresses ventricular Arrhythmias
- Terminates reentrant ventricular Arrhythmia
- Increases Ventricular Fibrillation threshold
- Requires high plasma Lidocaine levels (e.g. 6 mcg/ml)
- Suppresses ventricular ectopy (decreases automaticity)
- Post Myocardial Infarction, routine prophylactic Lidocaine use not recommended
V. Dosing: Pediatric
- Dose: 1 mg/kg IV/IO every 10 to 15 min up to 3 to 5 mg/kg in 1 hour
- ET Dose: Use 2 to 2.5 times the IV dose
- May continue with infusion dosing as below
VI. Dosing: Adult
-
Ventricular Fibrillation
- Dose: 1.0-1.5 mg/kg IV/IO push
- ET Dose: Use 2 to 2.5 times the IV dose in 10 ml Normal Saline
- May repeat in 3-5 min to max dose 3 mg/kg
- May continue with infusion dosing as below
-
Ventricular Tachycardia (with a pulse)
- First: 1.0-1.5 mg/kg IV/IO push
- Next: 0.5-0.75 mg/kg IV/IO push every 5 to 10 minutes
- Maximum total, cumulative dose: 3 mg/kg
- May continue with infusion dosing as below
VII. Dosing: Infusion (Pediatric and Adult)
- Preparation
- Lidocaine 4 g in 500 ml D5W (8 mg/ml)
- Precede infusion with 1 mg/kg bolus loading dose
- Then 20-50 mcg/kg/min up to 1 to 4 mg/min infusion
- If hepatic Blood Flow is compromised (e.g. CHF, liver disease, elderly)
- Decrease dose to under 20 mcg/kg/min
VIII. Adverse Effects
- Myocardial depression of conduction and contractility
- Concurrent Antiarrhythmic therapy
- Sick Sinus Syndrome
- Left Ventricular Dysfunction
- Circulatory depression
- May occur with rapid bolus dosing
- Neurologic changes (esp. with prolonged infusion)
- Drowsiness or Disorientation
- Decreased Hearing acuity
- Paresthesias
- Muscle Twitching (Fasciculations)
- Seizures (high dose)
- Overdosage
- Third degree AV Heart Block
- Altered AV conduction
- Sinus node automaticity depressed
IX. Safety
- Unknown safety in Lactation
- Pregnancy Category B
X. Metabolism
- Rapid hepatic metabolism (to 2 active metabolites)
- Renal excretion
XI. Drug Interactions
- Lidocaine serum levels increased by other medications
- Cimetidine
- Medications that reduce hepatic perfusion (e.g. Beta Blockers)
XII. Resources
- Lidocaine Injection Solution (DailyMed)
XIII. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Panchal (2018) Circulation 138(23):e740-e749 +PMID: 30571262 [PubMed]
Images: Related links to external sites (from Bing)
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 2%-EPI 1:100,000 | Generic | $0.13 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% 50 MG/5 ML VL | Generic | $0.55 per ml |
| LIDOCAINE HCL 1% VIAL | Generic | $0.07 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 | $0.06 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 |
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 |
