HEALTHY LIFESTYLE




Lidocaine
Lidocaine.JPG

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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