Drug reference

Lidocaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1444, 1445, 1446

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Infiltration anaesthesia ▶BY LOCAL INFILTRATION ▶Adult: Dose to be given according to patient’s weight and nature of procedure; max. 200 mg, maximum dose 500 mg if given in solutions containing adrenaline DOSES AT EXTREMES OF BODY-WEIGHT ▶When used by local infiltration To avoid excessive dosage in obese patients, weight-based doses for non-emergency indications may need to be calculated on the basis of ideal body-weight. Intravenous regional anaesthesia and nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: Seek expert advice Pain relief (in anal fissures, haemorrhoids, pruritus ani, pruritus vulvae, herpes zoster, or herpes labialis) | Lubricant in cystoscopy | Lubricant in proctoscopy ▶TO THE SKIN USING OINTMENT ▶Adult: Apply 1–2 mL as required, avoid long-term use Sore nipples from breast-feeding ▶TO THE SKIN USING OINTMENT ▶Adult: Apply using gauze and wash off immediately before next feed LMX 4 ® Anaesthesia before venous cannulation or venepuncture ▶TO THE SKIN ▶Child 1–2 months: Apply up to 1 g, apply thick layer to small area (2.5 cm 6 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 60 minutes, remove cream with gauze and perform procedure after approximately 5 minutes ▶Child 3–11 months: Apply up to 1 g, apply thick layer to small area (2.5 cm 6 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 4 hours, remove cream with gauze and perform procedure after approximately 5 minutes ▶Child 1–17 years: Apply 1–2.5 g, apply thick layer to small area (2.5 cm 6 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 5 hours, remove cream with gauze and perform procedure after approximately 5 minutes ▶Adult: Apply 1–2.5 g, apply thick layer to small area (2.5 cm 6 2.5 cm) of non-irritated skin at least 30 minutes before procedure; may be applied under an occlusive dressing; max. application time 5 hours, remove cream with gauze and perform procedure after approximately 5 minutes VERSATIS ® Postherpetic neuralgia ▶TO THE SKIN ▶Adult: Apply once daily for up to 12 hours, followed by a 12-hour plaster-free period; discontinue if no response after 4 weeks, to be applied to intact, dry, non-hairy, non-irritated skin, up to 3 plasters may be used to cover large areas; plasters may be cut XYLOCAINE ® During delivery in obstetrics ▶TO THE SKIN ▶Adult: Up to 20 doses

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Contra Indications

▶When used by regional administration Avoid injection into infected tissues. avoid injection into inﬂamed tissues. complete heart block. preparations containing preservatives should not be used for caudal, epidural, or spinal block, or for intravenous regional anaesthesia (Bier’s block) ▶With topical use Application to the middle ear (can cause ototoxicity). should not be applied to damaged skin CONTRA-INDICATIONS, FURTHER INFORMATION ▶With topical use or when used by regional administration Manufacturer advises local anaesthetics should not be injected into inﬂamed or infected tissues nor should they be applied to damaged skin. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

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Cautions

▶When used by regional administration Acute porphyrias p. 1120 (consider infusion with glucose for its anti- porphyrinogenic effects). congestive cardiac failure (consider lower dose). debilitated patients (consider dose Anaesthesia reduction). elderly (consider dose reduction). epilepsy. hypovolaemia. impaired cardiac conduction. impaired respiratory function. myasthenia gravis. post cardiac surgery (consider lower dose). shock

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Allergy And Cross Sensitivity

▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

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National Funding Access Decisions

VERSATIS ® Scottish Medicines Consortium (SMC) decisions ▶With transdermal use The Scottish Medicines Consortium has advised (August 2008) that Versatis ® is accepted for restricted use within NHS Scotland for the treatment of postherpetic neuralgia in patients who are intolerant of ﬁrst-line systemic therapies or when they have been ineffective.

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Safety

Important Safety Information

▶When used by local infiltration The licensed doses stated may not be appropriate in some settings and expert advice should be sought. Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

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Interactions

→Appendix 1: antiarrhythmics

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Side Effects

▶With parenteral use Anxiety. arrhythmias. atrioventricular block. cardiac arrest. circulatory collapse. confusion. dizziness. drowsiness. euphoric mood. headache. hypotension (may lead to cardiac arrest). loss of consciousness. methaemoglobinaemia. muscle twitching. myocardial contractility decreased. nausea. neurological effects. nystagmus. pain. psychosis. respiratory disorders . seizure. sensation abnormal. temperature sensation altered. tinnitus. tremor. vision blurred. vomiting SIDE-EFFECTS, FURTHER INFORMATION Toxic effects The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. Methaemoglobinaemia Methylthioninium chloride is licensed for the acute symptomatic treatment of drug- induced methaemoglobinaemia.

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Pregnancy

Crosses the placenta but not known to be harmful in animal studies—use if beneﬁt outweighs risk. When used as a local anaesthetic, large doses can cause fetal bradycardia; if given during delivery can also cause neonatal respiratory depression, hypotonia, or bradycardia after paracervical or epidural block.

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Breast Feeding

Present in milk but amount too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution (risk of increased exposure).

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Renal Impairment

Possible accumulation of lidocaine and active metabolite; caution in severe impairment.

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Monitoring Requirements

▶With systemic use Monitor ECG and have resuscitation facilities available.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection, liquid, ointment Solution for injection ▶Lidocaine hydrochloride (Non-proprietary) Lidocaine hydrochloride 5 mg per 1 ml Lidocaine 50mg/10ml (0.5%) solution for injection ampoules | 10 ampoule P £7.00 Lidocaine hydrochloride 10 mg per 1 ml Lidocaine 100mg/10ml (1%) solution for injection Mini-Plasco ampoules | 20 ampoule P £1.15–£11.21 Lidocaine 100mg/10ml (1%) solution for injection ampoules | 10 ampoule P £5.00 DT = £5.00 Lidocaine 200mg/20ml (1%) solution for injection vials | 10 vial P Anaesthesia £22.00 DT = £22.00 Lidocaine 200mg/20ml (1%) solution for injection ampoules | 10 ampoule P £10.00–£11.00 DT = £11.00 Lidocaine 50mg/5ml (1%) solution for injection ampoules | 10 ampoule P £3.00–£12.00 DT = £3.00 Lidocaine 200mg/20ml (1%) solution for injection Mini-Plasco ampoules | 20 ampoule P s Lidocaine 20mg/2ml (1%) solution for injection ampoules | 10 ampoule P £12.00 DT = £2.50 Lidocaine 50mg/5ml (1%) solution for injection Mini-Plasco ampoules | 20 ampoule P £6.50 Lidocaine 50mg/5ml (1%) solution for injection Sure-Amp ampoules | 20 ampoule P £6.00 Lidocaine hydrochloride 20 mg per 1 ml Lidocaine 100mg/5ml (2%) solution for injection ampoules | 10 ampoule P £3.20– £12.00 DT = £3.20 Lidocaine 400mg/20ml (2%) solution for injection vials | 10 vial P £23.00 DT = £23.00 Lidocaine 200mg/10ml (2%) solution for injection Mini-Plasco ampoules | 20 ampoule P £14.95 DT = £14.95 Lidocaine 400mg/20ml (2%) solution for injection Mini-Plasco ampoules | 20 ampoule P s Lidocaine 40mg/2ml (2%) solution for injection ampoules | 10 ampoule P £12.00 DT = £2.70 Lidocaine 100mg/5ml (2%) solution for injection Mini-Plasco ampoules | 20 ampoule P £7.50 Lidocaine 400mg/20ml (2%) solution for injection ampoules | 10 ampoule P £11.00–£11.40 DT = £11.40 Medicated plaster EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene glycol ▶Ralvo (Grunenthal Ltd) Lidocaine 50 mg per 1 gram Ralvo 700mg medicated plasters | 30 plaster P £61.54 DT = £72.40 ▶Versatis (Grunenthal Ltd) Lidocaine 50 mg per 1 gram Versatis 700mg medicated plasters | 30 plaster P £72.40 DT = £72.40 Cream EXCIPIENTS: May contain Benzyl alcohol, propylene glycol ▶LMX 4 (Ferndale Pharmaceuticals Ltd) Lidocaine 40 mg per 1 gram LMX 4 cream | 5 gram p £2.98 DT = £2.98 | 30 gram p £14.90 DT = £14.90 ▶Vagisil medicated (Combe International Ltd) Lidocaine 20 mg per 1 gram Vagisil 2% medicated cream | 30 gram G £2.99 DT = £2.99 Ointment ▶Lidocaine hydrochloride (Non-proprietary) Lidocaine hydrochloride 50 mg per 1 gram Lidocaine 5% ointment | 15 gram p £9.00 DT = £8.28 Spray ▶Xylocaine (Aspen Pharma Trading Ltd) Lidocaine 10 mg per 1 actuation Xylocaine 10mg/dose spray sugar- free | 50 ml p £6.29 DT = £6.29

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Dose text by age group

Child 1–2 months

Apply up to 1 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Child 3–11 months

Apply up to 1 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Child 1–17 years

Apply 1–2.5 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Lidocaine hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1444, 1445, 1446

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 1444, 1445

Contra Indications

PDF page 1445

Cautions

PDF page 1445

Allergy And Cross Sensitivity

PDF page 1445

National Funding Access Decisions

PDF page 1446

Safety

Important Safety Information

PDF page 1445

Interactions

→Appendix 1: antiarrhythmics

PDF page 1445

Side Effects

PDF page 1445

Pregnancy

PDF page 1445

Breast Feeding

Present in milk but amount too small to be harmful.

PDF page 1445

Hepatic Impairment

Manufacturer advises caution (risk of increased exposure).

PDF page 1445

Renal Impairment

Possible accumulation of lidocaine and active metabolite; caution in severe impairment.

PDF page 1445

Monitoring Requirements

▶With systemic use Monitor ECG and have resuscitation facilities available.

PDF page 1445

Dose and formulations

Medicinal Forms

PDF page 1446

Dose text by age group

Child 1–2 months

Apply up to 1 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Child 3–11 months

Apply up to 1 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Child 1–17 years

Apply 1–2.5 g, apply thick layer to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1445

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.