Lidocaine

CLINICAL USE

Local anaesthetic Ventricular arrhythmias

DOSE IN NORMAL RENAL FUNCTION

Local anaesthetic: usually 1 or 2% solutions used, according to patient’s weight and procedureVentricular arrhythmias; 100 mg as a bolus in patients without gross circulatory impairment (50 mg in lighter patients or in severely impaired circulation), followed by an infusion of 4 mg/min for 30 minutes, 2 mg/min for 2 hours, then 1 mg/min or according to local policy

PHARMACOKINETICS

Molecular weight :288.8

%Protein binding :66

%Excreted unchanged in urine :

<10 :

Volume of distribution (L/kg) :1.3

half-life – normal/ESRD (hrs) :1–2/1.3–3

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anti-arrhythmics: increased risk of myocardial depression

Antibacterials: increased risk of ventricular arrhythmias with quinupristin/dalfopristin

Antipsychotics: increased risk of ventricular arrhythmias with antipsychotics that prolong the QT interval

Antivirals: concentration possibly increased by amprenavir, atazanavir, darunavir and lopinavir – avoid concomitant use with amprenavir and darunavir

Beta-blockers: increased risk of myocardial depression; increased risk of lidocaine toxicity with propranolol

Diuretics: effects antagonised by hypokalaemiaDolasetron and tropisetron: increased risk of ventricular arrhythmias – avoid concomitant use

Ulcer-healing drugs: concentration increased by cimetidine, increased toxicity

ADMINISTRATION

Reconstition

–

Route

IV, SC, topical

Rate of Administration

According to dose

Comments

Usually 1–2 mg/mL in glucose 5% Minimum volume 8–20 mg/mL but watch for extravasation. (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006

OTHER INFORMATION

IV injection lasts for only 15–20 minutes

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