lidocaine hydrochloride monohydrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
lidocaine hydrochloride monohydrate: clinical details
Prescribing considerations
- Injection requires appropriate anaesthetic expertise, monitoring and immediate access to resuscitation facilities.
- Assess hepatic, renal and cardiovascular function, frailty, epilepsy, myasthenia gravis, respiratory depression and bleeding risk.
- Inflamed or infected tissue can increase systemic absorption while reducing local anaesthetic effectiveness.
- Consider total exposure from all lidocaine-containing products and other local anaesthetics.
Contraindications and cautions
- Hypersensitivity to lidocaine, another amide local anaesthetic or a formulation excipient.
- For the selected throat spray: asthma or bronchospasm and age under 12 years.
- For the selected injection: age and route restrictions vary by intended procedure.
Monitoring
- Observe cardiovascular and respiratory status and early neurological signs of systemic toxicity.
- Consider ECG and lidocaine concentration monitoring when clinically important metabolic or cardiac interactions are present.
- Monitor serum potassium when medicines causing substantial hypokalaemia are relevant.
- Monitor fetal heart rate when using paracervical or pudendal blockade.
Clinical pharmacology
Lidocaine blocks open voltage-gated sodium channels from within nerve cells, reducing membrane excitability and action-potential propagation. It is mainly metabolised hepatically through CYP1A2 and CYP3A4; impaired hepatic perfusion or function can prolong exposure, while active metabolites may accumulate in severe renal impairment.
Formulation and product differences
- The oromucosal spray acts locally at the back of the throat and contains ethanol, sorbitol, flavourings and colourants.
- The injection is a clear, sterile solution in a single-use pre-filled syringe containing sodium chloride and pH-adjusting agents.
- The pre-filled syringe is not intended for reuse, mixing with other medicines or administration through an electronic syringe pump.
lidocaine hydrochloride monohydrate preparations and strengths
Oromucosal preparation
Route: Oromucosal
Strengths: 2% w/v
Injection
Route: Parenteral
Strengths: 10 mg/mL, 1% w/v
lidocaine hydrochloride monohydrate interactions
The throat spray has no known clinically significant interactions. Injected lidocaine has important interactions, so clinicians should review all medicines before administration.
Class I antiarrhythmics
Concurrent use should generally be avoided because serious cardiac effects may be additive.
Beta blockers, calcium-channel blockers and amiodarone
They may increase conduction or contractility effects, and some can increase lidocaine exposure and toxicity.
Other local anaesthetics
Cardiovascular and central nervous system toxicity may be additive.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.