Swirl the applicator tip prior to removing the swab from the pouch. Apply to the area 3 to 5 minutes prior to the procedure not more than 4 times daily. Do not use in large quantities over raw or blistered skin. Instruct patient on proper application of ophthalmic gel. Do not to touch the tip of the dropper to the eye, fingertips, or other surface.
Consider ET administration only when other access is not available. If CPR is in progress, stop chest compressions briefly and administer the medication. Adults: Dilute the dose in 5 to 10 mL of saline or sterile water. Studies suggest dilution with sterile water may achieve better drug absorption compared to saline. Pediatrics: Dilute the dose in 1 to 5 mL of saline or follow drug administration with a saline flush 5 mL or more and 5 consecutive positive-pressure ventilations.
Do not store for later use. Lidocaine application to oral mucosa can interfere with swallowing and increase the risk of aspiration. Patients should not ingest food for at least 1 hour after the use of anesthetic agents in the mouth or throat. Local anesthetics, like lidocaine, should only be administered by a clinician trained in the diagnosis and management of drug-related toxicity and other acute emergencies that might arise from the administration of a regional anesthetic block.
The immediate availability of oxygen, cardiopulmonary resuscitative equipment and drugs and the appropriate support personnel for the management of toxic reactions or emergencies must be ensured. Any delay in appropriate management may lead to the development of acidosis, cardiac arrest, and possibly death.
Lidocaine is contraindicated in patients with amide local anesthetic hypersensitivity. Parenteral preparations containing preservatives should not be used for spinal or epidural anesthesia. Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products. There have been no reports of cross-sensitivity between lidocaine and either procainamide or quinidine.
Lidocaine does not provide adequate anesthesia in patients with collagen-vascular disease, such as Ehlers Danlos Type III. Lidocaine is relatively contraindicated in these conditions. Methemoglobinemia has been reported with local anesthetic use.
Although all patients are at risk for methemoglobinemia, patients with glucosephosphate dehydrogenase deficiency G6PD deficiency , preexisting congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise cardiac disease or pulmonary disease , those younger than 6 months, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing methemoglobinemia. Monitor such patients closely for signs and symptoms of methemoglobinemia if a local anesthetic must be used.
Signs of methemoglobinemia may occur immediately or may be delayed hours after exposure. Immediately discontinue the local anesthetic to avoid serious central nervous system and cardiovascular adverse events, as methemoglobin concentrations may continue to rise.
Patients may require supportive care such as oxygen therapy and hydration. More severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Use lidocaine with caution in patients at increased risk of adverse events.
Conditions that reduce hepatic blood flow such as hepatic disease and congestive heart failure may reduce hepatic metabolism and lead to drug accumulation, increasing the risk of developing systemic toxicity, particularly with parenteral, prescription topical jelly, or transdermal patch use. Repeated doses of parenteral lidocaine may cause a significant increase in blood concentrations with each successive dose; these increases may be poorly tolerated, particularly by those who are debilitated, pediatric patients, geriatric patients, or the acutely ill.
Excessive dosing by applying lidocaine transdermal patches to larger areas or for longer than the recommended wearing time could result in increased absorption of lidocaine and high blood concentrations, leading to serious systemic adverse effects. The blood concentration of lidocaine is determined by the rate of systemic absorption and elimination.
Longer duration of transdermal application, application of more than the recommended number of patches, smaller patients, or impaired elimination may all contribute to increasing the blood concentration of lidocaine. The OBRA guidelines caution that antiarrhythmics can have serious adverse effects e. Lidocaine is classified as FDA pregnancy category B. Reproductive studies conducted in rats have not demonstrated lidocaine-induced fetal harm; however, animal studies are not always predictive of human response.
There are no adequate or well controlled studies of lidocaine in pregnant women. Local anesthetics are known to cross the placenta rapidly and, when administered for epidural, paracervical, pudendal, or caudal block anesthesia, and to cause fetal toxicity. The frequency and extent of toxicity are dependent on the procedure performed.
Maternal hypotension can result from regional anesthesia, and elevating the feet and positioning the patient on her left side may alleviate this effect. Topical ocular application of lidocaine is not expected to result in systemic exposure. When lidocaine is used for dental anesthesia, no fetal harm has been observed; lidocaine is generally the dental anesthetic of choice during pregnancy and guidelines suggest the second trimester is the best time for dental procedures if they are necessary.
A study by the American Dental Association provides some evidence that, when needed, the use of dental local or topical anesthetics at 13 weeks to 21 weeks of pregnancy or later is likely safe and does not raise incidences of adverse pregnancy outcomes or other adverse events; the study analyzed data from the Obstetrics and Periodontal Therapy OPT trial, a multicenter study of over pregnant patients in the early to mid second trimester who received required dental procedures.
According to the manufacturers, caution should be exercised when lidocaine is administered to breast-feeding women regardless of dosage formulation. Lidocaine is excreted in breast milk with a milk:plasma ratio of 0. Many specific dosage forms, including Lidoderm brand lidocaine transdermal patches, have not been studied in breast-feeding women.
The American Academy of Pediatrics lists lidocaine as usually compatible with breast-feeding. When lidocaine is used for dental or short-term, limited local anesthesia, the healthy term infant can generally safely nurse as soon as the mother is awake and alert.
Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternal drug exposure, healthcare providers are encouraged to report the adverse effect to the FDA.
Although specific forms of parenteral lidocaine are indicated for the treatment of some cardiac arrhythmias, it can worsen others. Intravenous IV lidocaine for the treatment of ventricular arrhythmias is contraindicated in patients with Adams-Stokes syndrome, Wolff-Parkinson-White syndrome, or with severe SA block, AV block, or intraventricular heart block. The administration of IV lidocaine for the elimination of ventricular ectopic beats to patients with bradycardia or incomplete heart block without prior acceleration of heart rate may cause a more serious ventricular arrhythmia or complete heart block.
Lidocaine can increase the ventricular rate in patients with atrial fibrillation or atrial flutter. Use lidocaine with caution in patients with hypovolemia. Monitor blood pressure and the electrocardiogram during IV lidocaine administration. Promptly discontinue the infusion if signs of excessive depression of cardiac conductivity occur, such as prolongation of the PR interval, widening of the QRS interval, or appearance or aggravation of arrhythmias.
Use both parenteral and topical formulations of lidocaine with caution in patients with severe shock including cardiogenic shock and hemorrhagic shock and heart block.
Patients with impaired cardiac function, particularly AV block, may be less able to compensate for functional changes associated with prolonged AV conduction i. No lidocaine dosage adjustment needed in patients with renal impairment. However, the elimination of glycine xylidide major active metabolite is eliminated renally, and accumulation of the metabolite in severe renal failure renal disease theoretically could result in neurotoxicity.
Applying dermal, transdermal, or oromucosal lidocaine preparations to severely traumatized skin e. Also, applying large amounts of lidocaine or using an occlusive dressing skin wraps can increase absorption. Topical burn pads may be applied over burns and covered with tape or gauze while avoiding application of large quantities, particularly over raw surfaces or blistered areas.
Patches and administration via Zingo injection system should only be used on intact skin, and transoral delivery systems should only be applied to intact mucosa.
Excessive dosing by applying patches to larger areas or for longer than the recommended wearing time could result in increased absorption of lidocaine. Application of one additional Zingo at a new location is acceptable after a failed attempt at venous access. However, multiple administrations of Zingo at the same location are not recommended. Multiple Zingo applications could result in plasma concentrations that could produce systemic toxicity.
At least 2 reports of deaths exist after application of topical anesthetics prior to cosmetic procedures. In both instances, women, aged 22 and 25 years, applied topical anesthetics to their legs and wrapped the treated area, as directed, in plastic wrap to enhance the numbing effect of the cream.
Both women died from toxic effects of the topical anesthetic. The preparations used in both cases were compounded in pharmacies and contained high amounts of lidocaine and tetracaine. In order to reduce the risk of toxicity due to increased absorption of topical anesthetic, the FDA recommends patients use a topical anesthetic containing the lowest amount of medication needed to relieve pain, apply the medication sparingly, and only treat known or anticipated areas of pain.
Further, do not apply the anesthetic to broken or irritated skin, be aware of potential adverse reactions, and do not cover or apply heat to the treated area.
Avoid unintended ocular exposure of lidocaine dermal, oromucosal, and transdermal products. Severe eye irritation has been reported in animals treated with similar products. If eye contact occurs, immediately wash the eye with water or saline and protect the eye until sensation returns.
Lidocaine ophthalmic gel is intended for application to the eye surface; however, prolonged use may produce permanent corneal opacification and ulceration with accompanying visual loss. Use with caution in patients with pre-existing cataracts or ocular trauma or ulceration. It is important to note that whether new or used, lidocaine patches contain a large amount of lidocaine at least mg post-use. The potential exists for small kids or pets to suffer serious adverse reactions from unintended lidocaine exposure including chewing or ingesting a new or used lidocaine patch.
When parenteral lidocaine is intended as a local anesthetic, avoid intravenous administration, intraarterial administration, or intrathecal administration. Unintended intravenous or intraarterial administration may result in cardiac arrest and may require prolonged resuscitation.
Further, do not administer preservative-containing parenteral lidocaine via intrathecal routes. To avoid intravascular administration of lidocaine during local anesthetic procedures, aspiration should be performed before the local anesthetic is injected and after repositioning of the needle. During epidural administration, a test dose should be administered initially and the patient should be monitored for CNS and cardiovascular toxicity, as well as signs of inadvertent intrathecal administration see Adverse Reactions.
Syringe aspiration should also be performed before and during each supplemental injection in continuous catheter techniques. Clinicians should be aware that the absence of blood return does not guarantee that intravascular injection has been avoided. Patients receiving local head and neck anesthesia including retrobulbar, stellate ganglion, and dental blocks, are at increased risk of CNS toxicity similar to the systemic toxicity seen with unintentional intravascular injections of large doses of lidocaine.
These reactions may be due to potential intraarterial injection of the local anesthetic with retrograde flow to the cerebral circulation. Patients receiving these blocks should have their ventilatory and circulatory systems monitored closely.
Recommended doses should not be exceeded in these patients. When local anesthetics, like lidocaine, are used for retrobulbar block during ocular surgery, lack of corneal sensation should not be relied upon to determine whether or not the patient is ready for surgery. Lack of corneal sensation usually precedes clinically acceptable external ocular muscle akinesia. Parenteral use of lidocaine requires an experienced clinician and requires a specialized care setting.
Lidocaine preparations containing preservatives should not be used for epidural or spinal anesthesia. Patients with the following conditions should receive spinal anesthesia with caution: pre-existing CNS disorders such as poliomyelitis, pernicious anemia, paralysis from nerve injuries or syphilis; pediatric patients younger than 16 years, or elderly patients; chronic backache; preoperative headache; hypotension; hypertension; arthritis or spinal deformity; technical problems persistent paresthesias, persistent bloody tap ; psychotic or uncooperative patients.
Consult standard textbooks for specific techniques and precautions for spinal anesthetic procedures. Lumbar and caudal epidural anesthesia should be used with extreme caution in patients with existing neurological disease, spinal deformities, sepsis, and severe hypertension.
Use caution when applying topical lidocaine to mucous membranes in the presence of sepsis due to the potential for rapid systemic absorption. Patients with platelet disorders or those with bleeding tendencies may be at risk for superficial dermal bleeding when lidocaine is administered intradermally for topical anesthesia.
During labor and obstetric delivery, local anesthetics, like lidocaine, can cause varying degrees of maternal, fetal, and neonatal toxicities. The potential for toxicity is related to the procedure performed, the type and amount of drug used, and the technique of administration. Appropriate patient positioning during obstetric delivery may decrease maternal hypotension that can result from regional anesthesia. Injection of the local anesthetic should be performed with the patient in the left lateral decubitus position to displace the gravid uterus, thereby minimizing aortocaval compression.
Epidural, spinal, paracervical, or pudendal nerve block may alter the forces of parturition. The use of obstetrical anesthesia may alter the duration of various phases of labor and increase the need for forceps assistance. Electronic fetal monitoring for signs of fetal distress is highly recommended. Lidocaine is not approved for continuous intraarticular infusion administration. Infusion of local anesthetics into a joint space may have caused chondrolysis. Local anesthetics are not indicated for continuous intraarticular postoperative infusions or for use with infusion devices such as elastomeric pumps.
Physicians should weigh the possible risks versus benefits when considering obstetrical paracervical nerve block with parenteral lidocaine in situations of fetal prematurity, toxemia of pregnancy, and fetal distress. Adherence to the recommended dosage is critical during obstetrical paracervical block.
Failure to achieve adequate analgesia with recommended doses should arouse suspicion of intravascular or fetal intracranial injection. Use of paracervical block in early pregnancy i. The recommended dose of the local anesthetic should not be exceeded.
Injections should be administered slowly with frequent aspirations. Allow a 5-minute interval between administration to each side. Use lidocaine with caution in patients with a genetic predisposition to malignant hyperthermia. Although it is unknown whether lidocaine triggers this reaction, it is recommended that a standard protocol for management be available when lidocaine is administered in hospital environments.
Acebutolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Also, opposing effects on conduction exist between lidocaine and beta-blockers while their effects to decrease automaticity may be additive. Propranolol has been shown to decrease lidocaine clearance and symptoms of lidocaine toxicity have been seen as a result of this interaction. This interaction is possible with other beta-blocking agents since most decrease hepatic blood flow.
Monitoring of lidocaine concentrations is recommended during concomitant therapy with beta-blockers. Acetaminophen: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any other oxidizing agents. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.
Acetaminophen; Aspirin, ASA; Caffeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Caffeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Caffeine; Dihydrocodeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Moderate The use of these drugs together must be approached with caution. Although commonly used together for additive analgesic effects, the patient must be monitored for respiratory depression, hypotension, and excessive sedation due to additive effects on the CNS and blood pressure.
In rare instances, serious morbidity and mortality has occurred. Limit the use of opiate pain medications with local anesthetics to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. The use of the local anesthetic may allow for the use a lower initial dose of the opiate and then the doses can be titrated to proper clinical response. Educate patients about the risks and symptoms of respiratory depression and sedation.
Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Chlorpheniramine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Chlorpheniramine; Dextromethorphan: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Codeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Dextromethorphan: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Dextromethorphan; Doxylamine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Dextromethorphan; Phenylephrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Dextromethorphan; Pseudoephedrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Dichloralphenazone; Isometheptene: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Diphenhydramine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Guaifenesin; Phenylephrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Hydrocodone: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. The use of the local anesthetic will allow for the use a lower initial dose of the opiate and then the doses can be titrated to proper clinical response. Acetaminophen; Oxycodone: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Pamabrom; Pyrilamine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Acetaminophen; Pentazocine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Propoxyphene: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Acetaminophen; Pseudoephedrine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Adapalene; Benzoyl Peroxide: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic. Investigators attributed the decreased anesthetic effect to a breakdown of the benzocaine molecule by either or both benzoyl peroxide or benzoyl peroxide-derived free radicals.
It is recommended that the skin area that is to be topically anesthetized have no previous treatment with benzoyl peroxide or that the skin is thoroughly washed prior to the application of the anesthetic. Aldesleukin, IL Moderate Concomitant use of systemic lidocaine and aldesleukin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Monitor for lidocaine toxicity if used together.
Alfentanil: Moderate The use of these drugs together must be approached with caution. Aliskiren; Amlodipine: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Ambenonium Chloride: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
In addition, inhibitors of CYP1A2, such as tacrine, could theoretically reduce lidocaine metabolism and increase the risk of toxicity when given concurrently.
Also, rivastigmine is an acetylcholinesterase inhibitor and therefore is likely to exaggerate muscle relaxation under general anesthetics. Aminosalicylate sodium, Aminosalicylic acid: Moderate Coadministration of lidocaine with oxidizing agents, such as aminosalicylic acid, may increase the risk of developing methemoglobinemia.
Amiodarone: Major Concomitant administration of lidocaine with amiodarone has been reported to cause sinus bradycardia and seizure.
Furthermore, DEA inhibits lidocaine metabolism in a concentration-dependent manner. Also, the metabolism of amiodarone to DEA appears to be competitively inhibited by lidocaine.
Close correlations between amiodarone N-monodesethylase activities and the amounts of CYP3A4 and the rates of lidocaine N-monodesethylation have been observed from analyses of in vitro data. Inhibition of lidocaine metabolism is supported by in vivo data from 6 adults.
In contrast, the mean systemic concentration of lidocaine over minutes after cumulative amiodarone doses of 3 g and 13 g is As expected, the systemic exposure of the lidocaine metabolite, monoethylglycinexylidide, decreases from In addition, the systemic clearance of lidocaine decreases from 7.
As compared with values before amiodarone administration, the lidocaine elimination half-life and the distribution volume at steady state remain relatively unchanged. Due to the long half-life of amiodarone, clinicians should use caution when administering lidocaine to patients who are receiving or who have recently discontinued amiodarone.
Amitriptyline: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension. In general, concurrent use of a local anesthetic solution containing epinephrine and a TCA should be avoided. If coadministration is necessary, careful patient monitoring is essential. Amlodipine: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Atorvastatin: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Benazepril: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amlodipine; Celecoxib: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Olmesartan: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amlodipine; Valsartan: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amoxicillin; Clarithromycin; Omeprazole: Moderate Concomitant use of systemic lidocaine and clarithromycin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amprenavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
The concurrent use of systemic lidocaine and anti-retroviral protease inhibitors should be carefully monitored due to the potential for serious toxicity. Amyl Nitrite: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. In theory, coadministration of anagrelide with substrates of CYP1A2, including lidocaine, could lead to increases in the serum concentrations of lidocaine and, thus, adverse effects.
Patients receiving anagrelide and lidocaine concomitantly should be monitored for increased toxicity of lidocaine. Apalutamide: Moderate Monitor for decreased efficacy of lidocaine if coadministration of systemic lidocaine with apalutamide is necessary; higher doses of lidocaine may be required. Aprepitant, Fosaprepitant: Major Use caution if lidocaine and aprepitant, fosaprepitant are used concurrently and monitor for an increase in lidocaine-related adverse effects, including QT prolongation and torsade de pointes TdP , for several days after administration of a multi-day aprepitant regimen.
This interaction is not expected with topical preparations of lidocaine. Lidocaine is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1.
After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1.
Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Articaine; Epinephrine: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias. Epinephrine may produce ventricular arrhythmias in patients who are on drugs that may sensitize the heart to arrhythmias.
Moderate Use articaine and lidocaine together with caution. Additionally, coadministration may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue local anesthetic use. Asciminib: Moderate Monitor for lidocaine toxicity if coadministration with asciminib is necessary as concurrent use may increase lidocaine exposure. Atazanavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
Atazanavir; Cobicistat: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine. Moderate Monitor for lidocaine-related adverse reactions if coadministration with cobicistat is necessary. Atenolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Atenolol; Chlorthalidone: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Atracurium: Moderate Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade.
The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration. Atropine; Edrophonium: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Avacopan: Moderate Monitor for lidocaine toxicity if coadministration with avacopan is necessary as concurrent use may increase lidocaine exposure. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Concomitant use of systemic lidocaine and phenobarbital may decrease lidocaine plasma concentrations.
Higher lidocaine doses may be required; titrate to effect. Additionally, coadministration of lidocaine with oxidizing agents, such as phenobarbital, may increase the risk of developing methemoglobinemia. Belladonna; Opium: Moderate The use of these drugs together must be approached with caution. Belumosudil: Moderate Monitor for lidocaine toxicity if coadministration with belumosudil is necessary as concurrent use may increase lidocaine exposure.
Bendroflumethiazide; Nadolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Benzalkonium Chloride; Benzocaine: Moderate Use lidocaine and benzocaine together with caution. Benzhydrocodone; Acetaminophen: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Benzocaine: Moderate Use lidocaine and benzocaine together with caution. Benzocaine; Butamben; Tetracaine: Moderate Use lidocaine and benzocaine together with caution. Benzonatate: Major Caution is advised if amide local anesthetics are used concurrently with benzonatate. The toxic effects of local anesthetics are additive. Benzoyl Peroxide: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic.
Benzoyl Peroxide; Clindamycin: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic. Benzoyl Peroxide; Erythromycin: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic.
Benzoyl Peroxide; Sulfur: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic. Berotralstat: Moderate Monitor for lidocaine toxicity if coadministration with berotralstat is necessary as concurrent use may increase lidocaine exposure.
Beta-adrenergic blockers: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Betaxolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Bexarotene: Moderate Concomitant use of systemic lidocaine and bexarotene may decrease lidocaine plasma concentrations. Bicalutamide: Moderate Monitor for lidocaine toxicity if coadministration with bicalutamide is necessary as concurrent use may increase lidocaine exposure.
Bisoprolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Bisoprolol; Hydrochlorothiazide, HCTZ: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. If lidocaine dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment.
Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathway of lidocaine. Lidocaine is partially metabolized by the hepatic isoenzyme CYP3A4; boceprevir inhibits this isoenzyme. Coadministration may result in elevated lidocaine plasma concentrations.
Bosentan: Moderate Bosentan is an inducer of CYP3A4 enzymes, and may decrease plasma concentrations of drugs metabolized by these enzymes. Caution is recommended when administering bosentan to patients receiving lidocaine as lidocaine is a CYP3A4 substrate.
However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. If you wear too many lidocaine transdermal patches or topical systems or wear them for too long, too much lidocaine may be absorbed into your blood. In that case, you may experience symptoms of an overdose. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Do not let anyone else use your medication.
Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Lidocaine Transdermal Patch pronounced as lye' doe kane. Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow?
What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication?
Brand names. Wash your hands after handling lidocaine patches or topical system. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
Other uses for this medicine. What special precautions should I follow? Before using lidocaine transdermal, tell your doctor and pharmacist if you are allergic to lidocaine; other medications such as benzocaine. Ask your pharmacist for a list of the ingredients. Each adhesive patch contains mg of lidocaine 50 mg per gram adhesive in an aqueous base.
It also contains the following inactive ingredients: dihydroxyaluminum aminoacetate, disodium edetate, gelatin, glycerin, kaolin, methylparaben, polyacrylic acid, polyvinyl alcohol, propylene glycol, propylparaben, sodium carboxymethylcellulose, sodium polyacrylate, D-sorbitol, tartaric acid, and urea.
Lidocaine is an amide-type local anesthetic agent and is suggested to stabilize neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses.
The penetration of lidocaine into intact skin after application of LIDODERM is sufficient to produce an analgesic effect, but less than the amount necessary to produce a complete sensory block.
Absorption The amount of lidocaine systemically absorbed from LIDODERM is directly related to both the duration of application and the surface area over which it is applied. Blood samples were withdrawn for determination of lidocaine concentration during the application and for 12 hours after removal of patches. The results are summarized in Table 1. Mean peak blood concentration of lidocaine is about 0. Repeated application of three patches simultaneously for 12 hours recommended maximum daily dose , once per day for three days, indicated that the lidocaine concentration does not increase with daily use.
The mean plasma pharmacokinetic profile for the 15 healthy volunteers is shown in Figure 1. Distribution When lidocaine is administered intravenously to healthy volunteers, the volume of distribution is 0.
Lidocaine crosses the placental and blood brain barriers, presumably by passive diffusion. Metabolism It is not known if lidocaine is metabolized in the skin.
Lidocaine is metabolized rapidly by the liver to a number of metabolites, including monoethylglycinexylidide MEGX and glycinexylidide GX , both of which have pharmacologic activity similar to, but less potent than that of lidocaine. A minor metabolite, 2,6-xylidine, has unknown pharmacologic activity but is carcinogenic in rats.
Excretion Lidocaine and its metabolites are excreted by the kidneys. The systemic clearance is 0. Single-dose treatment with LIDODERM was compared to treatment with vehicle patch without lidocaine , and to no treatment observation only in a double-blind, crossover clinical trial with 35 post-herpetic neuralgia patients. Pain intensity and pain relief scores were evaluated periodically for 12 hours.
The constant type of pain was evaluated but not the pain induced by sensory stimuli dysesthesia. About half of the patients also took oral medication commonly used in the treatment of post-herpetic neuralgia. The extent of use of concomitant medication was similar in the two treatment groups.
It should be applied only to intact skin. LIDODERM is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type, or to any other component of the product. Cases of methemoglobinemia have been reported in association with local anesthetic use. Although all patients are at risk for methemoglobinemia, patients with glucosephosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition.
If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended. Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Depending on the severity of the signs and symptoms, patients may respond to supportive care, i.
A more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.
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