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What is the best-known trade name for lidocaine?
Xylocaine
Lidocaine was first marketed in 1949, it has also been called "lignocaine".
What is the functional class of lidocaine?
Class Ib antidysrhythmic (sodium channel blocker)
Other Ib antidysrhythmics include phenytoin (Dilantin) and mexiletine (Mexitil).
What is the mechanism of action of lidocaine?
Suppresses depolarization and automaticity in the His-Purkinje system. Also suppresses ventricular ectopy and increases the ventricular threshold for dysrhythmias; however it decreases the ventricular threshold for defibrillation.
Lidocaine blocks the fast voltage gated sodium (Na⁺) channels.
What are the listed indications for lidocaine?
- VF
- Pulseless VT
- VT with a pulse
- Malignant PVCs:
-- More than six unifocal PVCs a minute
-- Multifocal PVCs
-- Couplets
-- R-on-T phenomena
Lidocaine also has significant use as a local anesthetic, including during IO insertion. It is also used as an inhaled antitussive.
What are the listed contraindications for lidocaine?
- Hypersensitivity
- Supraventricular dysrhythmias
- Untreated sinus bradycardia
- 2nd Degree Mobitz II AV Block
- 3rd Degree AV Block
- Stokes-Adams syndrome
Some sources also include AIVR, the presence of an artificial pacemaker and the use of class I antidysrhythmics.
What are the listed precautions for lidocaine?
CNS depression may occur in doses greater than 300mg/hour
- Liver or renal disease
- CHF
- Hypovolemia
- Shock
- Myasthenia gravis.
Some sources state that lidocaine should not be used in patients with congenital or idiopathic methemoglobinemia or with pseudocholinesterase deficiency.
What are the listed side effects for lidocaine?
- Altered mental status including confusion
- Bradycardias,
- Hypotension
- Seizures
Prolonged use may produce permanent corneal opacification and ulceration with accompanying loss of vision.
What are the listed interactions for lidocaine?
Use caution when administered with beta blockers or procainamide as drug toxicity may result.
Cimetidine may increase serum levels of lidocaine due to reduced hepatic circulation.
What is the dosage and route of lidocaine for cardiac arrest?
Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 minutes up to a maximum of 3mg/kg

Note: a single dose of 1.5 mg/kg IVP in cardiac arrest is acceptable if moving on to amiodarone

- 2 - 4mg/kg ETT q 3 - 5 minutes

Pedi:
- 1 mg/kg IVP/IO/ETT
Interestingly, lidocaine has no proven short-term or long-term efficacy in cardiac arrest.
What is the dosage and route of lidocaine for a patient with a pulse?
Adult:
- 1 - 1.5mg/kg IVP, repeat at half the initial dose (0.5 - 0.75mg/kg IVP) q 5 - 10 minutes up to a maximum of 3mg/kg

- Infusion: 1 - 4 mg/minute using the "+1 Rule"
The infusion and bolus should be administered together so no lag occurs.
What are the pharmacokinetics of lidocaine?
Absorption = 3 minutes
Duration = 10 - 20 minutes
Half-Life = 1.5 - 2 hours
The elimination half-life of lidocaine is approximately 90-120 minutes in most patients. This may be prolonged in patients with hepatic impairment (average 343 minutes) or congestive heart failure (average 136 minutes). - Ann. Intern. Med. 1973 Apr; 78(4):499-508.