lidocaine hydrochloride: clinical use

Prescribing considerations

• Use only where resuscitation equipment, emergency medicines and appropriately skilled personnel are immediately available.
• Reduce systemic-toxicity risk through individual assessment, careful injection technique and vigilance for early neurological or cardiovascular symptoms.
• Use additional caution with hepatic or severe renal impairment, cardiac failure, impaired conduction, bradycardia, respiratory impairment, epilepsy, myasthenia gravis, shock, pregnancy and frailty.
• Inflamed or infected tissue can increase systemic absorption while reducing local anaesthetic effectiveness.

Contraindications and cautions

• Hypersensitivity to lidocaine, another amide local anaesthetic or a formulation excipient.
• For spinal or epidural anaesthesia: uncorrected hypovolaemia, coagulopathy, increased intracranial pressure, or intracranial or intraspinal haemorrhage.
• For antiarrhythmic use: severe conduction disorders; recent myocardial infarction or markedly reduced cardiac output unless a life-threatening ventricular arrhythmia is present.

Monitoring

• During systemic antiarrhythmic administration, continuously monitor ECG, blood pressure, consciousness and respiration.
• During prolonged parenteral treatment, monitor fluid balance, electrolytes and acid–base status.
• Monitor closely for early toxicity, particularly with impaired hepatic perfusion, severe renal impairment, interacting medicines or administration near highly vascular tissue.

Clinical pharmacology

Lidocaine reversibly blocks sodium channels in excitable membranes. It is extensively metabolised in the liver. Reduced hepatic blood flow or function can prolong exposure, while active metabolites may accumulate in severe renal impairment or during prolonged administration.

Formulation and product differences

• The selected product is a clear, colourless, single-use solution for injection.
• It contains sodium chloride, sodium hydroxide and water for injections, without a vasoconstrictor.
• Injectable lidocaine is not interchangeable in administration or licensed use with skin creams, gels, sprays or medicated plasters.
• It must not be mixed with sodium bicarbonate, specified incompatible injectable medicines or other alkaline solutions.

Injection

Route: Parenteral

Strengths: 0.5% w/v, 1.0% w/v, 1% w/v, 2.0% w/v, 2% w/v