Lidocaine hydrochloride Dosage Form: Medically reviewed on August 1, Lidocaine HCl Injection, USP is a sterile, nonpyrogenic, aqueous solution that contains a local anesthetic agent and is administered parenterally by injection.
Lidocaine HCl Injection, USP solution contains Lidocaine HCl, which is chemically designated as acetamide, 2- diethylamino -N- 2,6-dimethylphenyl - monohydrochloride and has the lidocaine liver affects wt. The pH of this solution is adjusted to approximately 6. Lidocaine HCl stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses thereby effecting local anesthetic action, lidocaine liver affects.
Excessive blood levels may cause changes in cardiac output, total peripheral resistance, lidocaine liver affects, and mean arterial pressure. With central neural blockade these changes may be attributable to block of autonomic fibers, a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system.
The net effect is normally a modest hypotension when the recommended dosages lidocaine liver affects not exceeded.
Information derived from diverse formulations, website for advantage protection plan and usages reveals that Lidocaine HCl is completely absorbed following parenteral adverse seroquel, its rate of absorption depending, for example, upon various factors such as the site of administration and the presence or absence of a vasoconstrictor agent.
Except for intravascular administration, the highest blood levels are obtained following intercostal nerve block and the lowest after subcutaneous administration. The plasma binding of Lidocaine HCl is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 mcg of free base per mL 60 to 80 percent of Lidocaine HCl is protein bound. Binding is also dependent on the plasma concentration of the alphaacid glycoprotein.
Lidocaine HCl is metabolized rapidly by the liver, and metabolites and unchanged drug are excreted by the kidneys. Biotransformation includes oxidative N-dealkylation, ring hydroxylation, cleavage pregnant after provera the amide linkage, and conjugation.
N-dealkylation, a major pathway of biotransformation, yields the metabolites monoethylglycinexylidide and glycinexylidide. The primary metabolite in urine is a conjugate of 4-hydroxy-2,6-dimethylaniline. The elimination half-life of Lidocaine HCl following an intravenous bolus lidocaine liver affects is typically 1. Because of the rapid rate at which Lidocaine HCl is metabolized, any condition that affects liver function may alter Lidocaine HCl kinetics.
The half-life may be prolonged two-fold or more in patients with liver dysfunction. Renal dysfunction does not affect Lidocaine HCl kinetics but may increase the accumulation of metabolites. Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6 mcg free base per mL. Lidocaine HCl Injection, USP is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed.
Lidocaine HCl is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. Intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have been post-marketing reports of chondrolysis in patients receiving such infusions, lidocaine liver affects.
The majority of reported cases of chondrolysis have involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intra-articular infusions of local anesthetics for periods of 48 to 72 hours. There is insufficient information to determine whether shorter infusion periods are not associated with these findings. The time of onset of symptoms, such as joint pain, stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery.
Currently, there is no effective treatment for chondrolysis; patients who experienced chondrolysis have required additional diagnostic and therapeutic procedures and some required arthroplasty or shoulder replacement. To avoid intravascular injection, aspiration should be performed before the local anesthetic solution is injected.
The needle must be repositioned until no return of blood can be elicited by aspiration. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Local anesthetic solutions containing antimicrobial preservatives eg, methylparaben should not be used for epidural or spinal anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental, lidocaine liver affects.
In the case of severe reaction, discontinue the use of the drug. The safety and effectiveness of Lidocaine HCl depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies.
Standard textbooks should be consulted for specific techniques and precautions for various regional anesthetic procedures. The lowest dosage that results in effective anesthesia should be used to avoid high plasma lidocaine liver affects and serious adverse effects. Syringe aspirations should also be performed before and during each supplemental injection when using indwelling lidocaine liver affects techniques.
During the administration of epidural anesthesia, it is recommended that a test dose be administered initially and that the patient be monitored for central nervous system toxicity and cardiovascular toxicity, as well as for signs of unintended intrathecal administration, before proceeding. When clinical conditions permit, consideration should be given to employing local anesthetic solutions that contain epinephrine for the test dose because circulatory changes compatible with epinephrine may also serve as a warning sign of unintended intravascular injection.
An intravascular injection is still possible even if aspirations for blood are negative. Repeated doses of Lidocaine HCl may cause significant increases in blood levels with each repeated dose because of slow accumulation of the drug or its metabolites.
Tolerance to elevated blood levels varies with the status of the patient. Debilitated, elderly patients, acutely ill patients, and children should be given reduced doses commensurate with their age and physical condition, lidocaine liver affects. Lidocaine HCl should also be used with caution in patients with severe shock or heart block, lidocaine liver affects.
Lumbar and caudal epidural anesthesia should be used with extreme caution in lidocaine liver affects with the following conditions: Local anesthetic solutions containing a vasoconstrictor should be used cautiously and in carefully circumscribed quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply.
Patients with peripheral vascular disease and those with hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Ischemic injury or necrosis may result. Preparations containing a vasoconstrictor should be used with caution in patients during or following the administration of potent general anesthetic agents, since cardiac arrhythmias may occur under such conditions. It should be kept in mind at such times that restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness may be early warning signs of central nervous system toxicity.
Since amide-type local anesthetics are metabolized by the liver, Lidocaine HCl Injection, USP should be used with caution in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations.
Lidocaine HCl Injection, USP should also be used with caution in patients with impaired cardiovascular function since they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs. Many drugs used during the conduct of anesthesia are considered potential triggering agents for familial malignant hyperthermia.
Since it is not known whether amide-type local anesthetics may trigger this reaction and since the need for supplemental general anesthesia cannot be predicted in advance, it is suggested that a standard protocol for the management of malignant hyperthermia should be available. Early unexplained signs of tachycardia, lidocaine liver affects, tachypnea, labile blood pressure and metabolic acidosis may precede temperature elevation.
Successful outcome is dependent on early diagnosis, albuterol shelflife discontinuance of the suspect triggering agent s and institution of treatment, including oxygen therapy, indicated supportive measures and dantrolene consult dantrolene sodium intravenous package insert before using.
Proper tourniquet technique, as described in publications and standard textbooks, is essential in the performance of intravenous regional anesthesia. Solutions containing epinephrine or other vasoconstrictors should not be used for this technique.
Lidocaine HCl should be used with caution in persons with known drug sensitivities. Patients allergic to para-aminobenzoic acid derivatives procaine, tetracaine, lidocaine liver affects, benzocaine, etc. Small doses of local anesthetics injected into the lidocaine liver affects and neck area, including retrobulbar, dental and stellate ganglion blocks, may produce adverse reactions similar to systemic toxicity seen with unintentional intravascular injections of larger doses.
These reactions may be due to intra-arterial injection of the local anesthetic with retrograde flow to the lidocaine liver affects circulation. Patients receiving these blocks should have their circulation and respiration monitored and be constantly observed. Resuscitative equipment and personnel for treating adverse reactions should be immediately available.
When appropriate, lidocaine liver affects should be informed in advance that they may experience temporary loss of sensation and motor activity, usually in the lower half of the body, following proper administration of epidural anesthesia.
Concurrent administration of vasopressor drugs for the treatment of hypotension related to obstetric blocks and ergot-type oxytocic drugs may cause severe, persistent hypertension or cerebrovascular accidents. The intramuscular injection of Lidocaine HCl may result in an increase in creatine phosphokinase levels.
Thus, the use of this enzyme determination, lidocaine liver affects isoenzyme separation, as a diagnostic test for the presence of acute myocardial infarction may be compromised by the intramuscular injection of Lidocaine HCl. Studies of Lidocaine HCl in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility have not been conducted.
Reproduction studies have been performed in rats at doses up to 6. There are, however, no adequate and well-controlled studies in pregnant women. Animal reproduction studies are not always predictive of human response. General consideration should be given lidocaine liver affects this fact before administering Lidocaine HCl to women of childbearing potential, especially during early pregnancy when maximum organogenesis takes place, lidocaine liver affects.
The potential for toxicity depends upon lidocaine liver affects procedure performed, the type and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus and neonate involve alterations of the central nervous system, peripheral vascular tone and cardiac function. Maternal hypotension lidocaine liver affects resulted from regional anesthesia.
Local lidocaine liver affects produce vasodilation by blocking sympathetic nerves. The fetal heart rate also should be monitored continuously, and electronic fetal monitoring is highly advisable. Epidural, lidocaine liver affects, spinal, paracervical, or pudendal anesthesia may alter the forces of parturition through changes in uterine contractility or maternal expulsive efforts. In one study, paracervical block anesthesia was associated with a decrease in the mean duration of first stage labor and facilitation of cervical dilation.
The use of obstetrical lidocaine liver affects may increase the need for forceps assistance, lidocaine liver affects. The use of some local anesthetic drug products during labor and delivery may be followed by diminished muscle strength and tone for the first day or two of life, lidocaine liver affects.
The lidocaine liver affects significance of these observations is unknown. Fetal bradycardia may occur in 20 to 30 percent of patients receiving paracervical nerve block anesthesia with the amide-type local anesthetics and may be associated with fetal acidosis. Fetal heart rate should always be monitored during paracervical anesthesia. The physician should weigh the possible advantages against risks when considering a paracervical block in prematurity, lidocaine liver affects, toxemia of pregnancy, and fetal distress.
Careful adherence to recommended dosage lidocaine liver affects of the utmost importance in obstetrical paracervical block. Failure to albuterol sulfate inhale before sports adequate analgesia with recommended doses should arouse suspicion of lidocaine liver affects or fetal intracranial injection.
Cases compatible with unintended fetal intracranial injection of local anesthetic solution have been reported following intended paracervical or pudendal block or both. Babies so affected present with unexplained neonatal depression at birth, which correlates with high local anesthetic serum levels, lidocaine liver affects, and often manifest seizures within six hours, lidocaine liver affects.
Prompt use of supportive measures combined with forced urinary excretion of the local anesthetic has been used successfully to manage this complication. Case reports of maternal convulsions and cardiovascular collapse following use of some local anesthetics for paracervical block in early pregnancy as anesthesia for elective abortion suggest that systemic absorption under these circumstances may be rapid. The stomach cancer and age maximum dose of each drug should not be exceeded.
Injection should be made slowly and with frequent aspiration. Allow a 5-minute interval lidocaine liver affects sides. It is not known whether this drug is excreted in human milk.