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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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