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Back to Drug index
Name: Lidocaine Hydrochloride
Pregnancy Category B
Drug classes
- Antiarrhythmic
- Local anesthetic
Mechanisms of actions
Type 1 antiarrhythmic: decreases diastolic depolarization,
decreasing automaticity of ventricular cells; increases ventricular
fibrillation threshold.
Local anesthetic: blocks the generation and conduction of
action potentials in sensory nerves by reducing sodium permeability,
reducing height and rate of rise of the action potential, increasing
excitation threshold,
and slowing conduction velocity.
Indications
As antiarrhythmic: Management of acute ventricular arrhythmias
during cardiac surgery and MI (IV use). Use IM when IV administration
is not possible or when ECG monitoring is not available and
the danger of ventricular arrhythmias isgreat (single-dose IM
use, for example, by paramedics in a mobile coronary care unit).
As anesthetic: Infiltration anesthesia, peripheral and sympathetic
nerve blocks, central nerve blocks, spinal and caudal anesthesia,
retrobulbar and transtracheal injection; topical anesthetic
for skin disorders and accessible mucous membranes
Contraindications/cautions
Contraindicated in the presence of allergy to lidocaine or
amide-type local anesthetics, CHF, cardiogenic shock, second-
or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White
syndrome, Stokes-Adams syndrome.
Use caution in the presence of hepatic or renal disease,
inflammation or sepsis in the region of injection (local anesthetic),
labor and delivery (epidural anesthesia may prolong the second
stage of labor; monitor for fetal and neonatal CVS and CNS toxicity),
and lactation.
Adverse effects
Lidocaine as Antiarrhythmic-Systemic Administration
- CNS: Dizziness/lightheadedness,
fatigue, drowsiness, unconsciousness, tremors, twitching,
vision changes, may progress to seizures, convulsions
- GI: Nausea, vomiting
- CV: Cardiac arrhythmias,
cardiac arrest, vasodilation, hypotension
- Respiratory: Respiratory
depression and arrest
- Hypersensitivity:
Rash, anaphylactoid reactions
- Other: Malignant
hyperthermia
Lidocaine as Injectable Local Anesthetic for Epidural or
Caudal Anesthesia
- CNS: Headache, backache,
septic meningitis, persistent sensory, motor, or autonomic
deficit of lower spinal segments, sometimes with incomplete
recovery
- CV: Hypotension
due to sympathetic block
- GU: Urinary retention,
urinary or fecal incontinence
Lidocaine as Topical Local Anesthetic
- Dermatologic: Contact
dermatitis, urticaria, cutaneous lesions
- Hypersensitivity:
Anaphylactoid reactions
- Local: Burning,
stinging, tenderness, swelling, tissue irritation, tissue
sloughing and necrosis
- Other: Methemoglobinemia,
seizures
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