Lidocaine: Difference between revisions

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{{MedTemplate

| generic = Lidocaine

| generic = Lidocaine (hydrochloride)

| classes = Local anesthetic

| brand = Xylocaine (injectable, oral solution, topical), Lidoderm (patch), ZTLido (patch), Glydo (jelly), EMLA (with prilocaine, topical)

| mechanism = ~~Sodium~~ channel blocker

| structure =

| classes = [[:Category:Local anesthetics|Local anesthetic (amide class)]], [[:Category:Anesthetics|Anesthetic]], [[:Category:Antiarrhythmics|Antiarrhythmic (Vaughan Williams Class IB)]]

| uses = <vote slug="local-anesthesia-use">Local anesthesia for procedures and minor surgery (FDA; infiltration, nerve block, epidural, spinal)</vote>, <vote slug="ventricular-arrhythmias-use">Ventricular arrhythmias (FDA, IV)</vote>, <vote slug="postherpetic-neuralgia-use">Postherpetic neuralgia (FDA, Lidoderm 5% patch)</vote>, <vote slug="topical-pain-use">Topical analgesia for skin and mucosal pain (FDA)</vote>, <vote slug="pediatric-procedure-analgesia-use">Pediatric procedure analgesia (EMLA, LMX-4)</vote>

| starting_dose = Infiltration: 1-2% solution; '''4.5 mg/kg ceiling without epinephrine, 7 mg/kg with epinephrine'''. IV antiarrhythmic: 1-1.5 mg/kg bolus then infusion 1-4 mg/minute. Lidoderm patch: up to 3 patches per 12 hours

| preparations = Injection 0.5-4% solutions (with and without epinephrine); topical cream 4-5%; transdermal patch 5% (Lidoderm), 1.8% (ZTLido); oral 2% viscous solution; jelly 2%; ophthalmic

| fda_max = '''4.5 mg/kg (without epinephrine), 7 mg/kg (with epinephrine)''' for infiltration; serum level monitoring required for prolonged IV antiarrhythmic use

| pill_id =

| routes = Topical, infiltration, intravenous, regional anesthesia (spinal, epidural, nerve block), oral mucosal

| onset = <1 minute (IV); 1-2 minutes (infiltration); 30+ minutes (patch on adult skin, faster on thinner pediatric skin)

| duration = 30-90 minutes (infiltration without epinephrine); 90-200 minutes (with epinephrine); 12 hours (patch)

| halflife = 1.5-2 hours<ref name="xylocaine-label">FDA Prescribing Information, Xylocaine (lidocaine hydrochloride), Hospira/Pfizer, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/006488s092lbl.pdf</ref>

| bioavailability = ~35% (oral, extensive first-pass; not used orally for systemic effect); ~100% (IV)<ref name="xylocaine-label" />

| pregnancy = Extensive use experience in obstetric anesthesia; broadly considered safe<ref name="xylocaine-label" />

| legal = [[USLegal:Prescription only|Rx-only]] for most formulations; some low-concentration topical formulations are [[USLegal:Over-the-counter|OTC]] (4% cream)

| mechanism = <vote slug="lidocaine-mech-claim">Amide-class local anesthetic. Reversible voltage-gated sodium channel blocker, preferentially binding the inactivated and open states, producing '''use-dependent block''' that is more effective on rapidly firing nerves (pain fibers) than slowly firing ones (motor fibers at low concentrations, sensory fibers preferentially). The Vaughan Williams Class IB antiarrhythmic mechanism applies the same sodium channel blockade to ventricular cardiac tissue at therapeutic plasma levels.</vote> Dose-limited by '''systemic toxicity''': CNS toxicity progresses through perioral numbness, tinnitus, seizures, and coma; cardiac toxicity through bradyarrhythmia and asystole at higher concentrations. Hepatic metabolism via CYP1A2 and CYP3A4; accumulates in hepatic impairment and heart failure<ref name="xylocaine-label" />.

}}

== References ==

[[Category:Local anesthetics]]

[[Category:Anesthetics]]

[[Category:Antiarrhythmics]]

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