Therapeutic Classification: anesthetics (topical/local), antiarrhythmics (class IB)
Absorption: IV administration results in complete bioavailability; some absorption follows local use.
Distribution: Widely distributed. Concentrates in adipose tissue. Crosses the blood-brain barrier.
Metabolism/Excretion: Mostly metabolized by the liver; <10% excreted in urine as unchanged drug.
Half-Life: Biphasic—initial phase, 7–30 min; terminal phase, 90–120 min; ↑ in HF and hepatic impairment.
(IV = antiarrhythmic effects; local = anesthetic effects)
| ROUTE | ONSET | PEAK | DURATION |
|---|
| IV | immediate | immediate | 10–20 min (up to several hr after continuous infusion) |
| Local | rapid | unknown | 1–3 hr |
Ventricular Tachycardia (with a Pulse) or Pulseless Ventricular Tachycardia/Ventricular Fibrillation
- IV (Adults ): 1–1.5 mg/kg bolus; may repeat doses of 0.5–0.75 mg/kg every 5–10 min up to a total dose of 3 mg/kg; may then start continuous infusion of 1–4 mg/min.
- Endotracheal(Adults ): Give 2–2.5 times the IV loading dose down the endotracheal tube, followed by a 10 mL saline flush.
- IV (Children ): 1 mg/kg bolus (not to exceed 100 mg), followed by 20–50 mcg/kg/min continuous infusion (range 20–50 mcg/kg/min); may administer 2nd bolus of 0.5–1 mg/kg if delay between bolus and continuous infusion.
- Endotracheal(Children ): Give 2–3 mg/kg down the endotracheal tube followed by a 5 mL saline flush.
Local
- Infiltration(Adults and Children ): Infiltrate affected area as needed (increased amount and frequency of use increases likelihood of systemic absorption and adverse reactions).
- (Adults ): Cream/ointment/gel/solution/jelly: Apply to affected area 2–3 times daily. Patch: Up to 3 patches may be applied once for up to 12 hr in any 24-hr period; consider smaller areas of application in geriatric or debilitated patients.
- Mucosal(Adults ): For anesthetizing oral surfaces: 20 mg as 2 sprays/quadrant (not to exceed 30 mg/quadrant) may be used. 15 mL of the viscous solution may be used every 3 hr for oral or pharyngeal pain. For anesthetizing the female urethra: 3–5 mL of the jelly or 20 mg as 2% solution may be used. For anesthetizing the male urethra: 5–10 mL of the jelly or 5–15 mL of 2% solution may be used before catheterization or 30 mL of jelly before cystoscopy or similar procedures. Topical solutions may be used to anesthetize mucous membranes of the larynx, trachea, or esophagus.
- Mucosal(Children ≥3 yr): Do not exceed 4.5 mg/kg/dose (or 300 mg/dose) of viscous solution; swish in the mouth and spit out no more frequently than every 3 hr (maximum: 4 doses per 12-hr period).
- Mucosal(Children <3 yr): ≤1.2 mL applied to area with a cotton-tipped applicator no more frequently than every 3 hr (maximum: 4 doses per 12-hr period); use only if the underlying condition requires treatment with product volume of ≤1.2 mL.
lidocaine (parenteral): Xylocaine,
lidocaine (local anesthetic): Xylocaine,
lidocaine (mucosal): Xylocaine Viscous,
lidocaine (topical): Glydo, Lidoderm, L-M-X 4, L-M-X 5, Xylocaine, ZTLido
lidocaine (parenteral): Xylocard,
lidocaine (mucosal): Jampocaine Viscous,
lidocaine (topical): Betacaine, Cathejell, Lidodan, Lyracaine, Maxilene, Stallion, Topicaine
