adrenaline tartrate + lidocaine hydrochloride: clinical use

Prescribing considerations

• Administer only in an appropriately staffed and equipped setting with monitoring and resuscitation facilities immediately available.
• Avoid intravascular administration; aspirate appropriately and maintain verbal contact where possible to identify early toxicity.
• Use particular caution with epilepsy, impaired respiration, cardiac conduction disease, advanced liver disease, severe renal dysfunction, acute porphyria, frailty or older age.
• Adrenaline requires caution in hypertension, cardiac or cerebrovascular disease, hyperthyroidism and advanced diabetes.
• Sodium metabisulphite can cause severe hypersensitivity or bronchospasm; sulphite sensitivity is more frequent in people with asthma.

Contraindications and cautions

• Hypersensitivity to lidocaine, adrenaline, another amide local anaesthetic or a formulation excipient.
• Use of the vasoconstrictor-containing solution for anaesthesia of fingers, toes, the tip of the nose, ears or penis.

Monitoring

• Observe for early central nervous system toxicity.
• Monitor cardiovascular and respiratory status during significant blocks and treat toxicity promptly.
• Consider ECG monitoring with class III antiarrhythmics.
• Monitor fetal heart rate when performing a paracervical block.

Clinical pharmacology

Lidocaine blocks voltage-gated sodium channels and prevents nerve impulse propagation. Adrenaline causes local vasoconstriction, reducing systemic absorption and increasing lidocaine's local onset and duration.

Formulation and product differences

• The selected product is a clear, colourless solution in single-use glass ampoules.
• It contains sodium metabisulphite and sodium.
• Do not mix with other medicines without established compatibility.
• Use immediately after opening and discard unused solution; inspect for particles or discolouration before use.
• The selected presentation is licensed for adults and children older than 1 year; age restrictions may differ between presentations.