Names and pronunciation
(lye′doe-kane) LidoPen Auto-Injector, Xylocaine, Xylocard
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Drug reference
(lye′doe-kane) LidoPen Auto-Injector, Xylocaine, Xylocard
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Func. class.: Antidysrhythmic (Class Ib)
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Chem. class.: Aminoacyl amide
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ACTION: Increases electrical stimula- tion threshold of ventricle, His-Purkinje system, which stabilizes cardiac mem- brane, decreases automaticity
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USES: Ventricular tachycardia, ven- tricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac cathe- terization
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Unlabeled uses: Attenuation of intra- cranial pressure increased during intu- bation/endotracheal tube suctioning
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CONTRAINDICATIONS: Hyper- sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams- Stokes syndrome, Wolff-Parkinson-White syndrome Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal/hepatic disease, HF, respiratory depression, malignant hyperthermia, myasthenia gra- vis, weight <50 kg
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SIDE EFFECTS CNS: Headache, dizziness, involuntary movement, confusion, tremor, drowsi- ness, euphoria, seizures, shivering CV: Hypotension, bradycardia, heart block, CV collapse, arrest EENT: Tinnitus, blurred vision GI: Nausea, vomiting, anorexia HEMA: Methemoglobinemia INTEG: Rash, urticaria, edema, swelling, petechiae, pruritus MISC: Febrile response, phlebitis at inj site RESP: Dyspnea, respiratory depression L
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INTERACTIONS Increase: cardiac depression, toxicity— amiodarone, phenytoin, procainamide, propranolol, quiNIDine Increase: hypotensive effects—MAOIs, antihypertensives Increase: neuromuscular blockade— neuromuscular blockers, tubocurarine; monitor for adverse effects Increase: lidocaine effects, toxicity— cimetidine, β-blockers, protease inhibi- tors, ritonavir Increase: hypotension—ergots; avoid concurrent use Decrease: lidocaine effects—barbitu- rates, ciprofloxacin, voriconazole Decrease: effect of—cycloSPORINE
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TREATMENT OF OVERDOSE: O2, artificial ventilation, ECG; administer DOPamine for circulatory depression, diaz- epam or thiopental for seizures; decrease product if needed See Appendix B See Appendix B
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DOSAGE AND ROUTES Ventricular arrhythmias caused by MI, cardiac manipulation/ glycosides • Adult: IV BOL 50-100 mg (1-1.5 mg/ kg) 25-50 mg/min, repeat q5min until arrhythmias are controlled, max 300 mg in 1 hr; begin IV INFUSION; IV INFUSION 1-4 mg/min (20-50 mcg/kg/ min) • Child: IV/INTRAOSSEUS BOL 1 mg/ kg; start infusion at 30 mcg/kg/min Renal/hepatic dose with heart failure • Adult <50 kg: IV reduce dose
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Available forms: IV INFUSION 0.2% (2 mg/mL), 0.4% (4 mg/mL), 0.8% (8 mg/mL); IV 4% (40 mg/mL), 10% (100 mg/mL), 20% (200 mg/ mL); IV dir 1% (10 mg/mL), 2% (20 mg/mL); Inj (to IV admix) 20% (200 mg/mL)
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Administer: IV route • Bolus undiluted (1%, 2% only), give ≤50 mg/1 min or dilute 1 g/250-500 mL D5W; titrate to patient response; use infu- sion pump; pediatric infusion 120 mg lidocaine/100 mL D5W; 1-2.5 mL/kg/hr = 20-50 mcg/kg/min; use only 1%, 2% sol for IV bol • Use a cardiac monitor • Additive syringes/single-use vials are for infusions and must be diluted Y-site compatibilities: Acetaminophen, alemtuzumab, alfentanil, alteplase, amika- cin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid/lipo- some, anidulafungin, argatroban, ascorbic acid injection, atenolol, atropine, atracu- rium, azithromycin, aztreonam, benz tropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, ceFAZolin, cefotaxime, cefo- TEtan, cefOXitin, ceftaroline, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clarithromycin, clindamycin, cya- nocobalamin, cyclophosphamide, cyclo- SPORINE, cytarabine, DACTINomycin, DAP- TOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, EPI- NEPHrine, epirubicin, epoetin alfa, eptifiba- tide, ertapenem, erythromycin, esmolol, etomidate, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, flucon- azole, fludarabine, fluorouracil, folic acid, furosemide, gentamicin, granisetron, halo- peridol, heparin, hydrocortisone, imipe- nem/cilastatin, inamrinone, insulin, isopro- terenol, ketorolac, labetalol, levofloxacin, linezolid, LORazepam, magnesium sulfate, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, morphine, nafcillin, niCARdipine, nitroglyc- erin, nitroprusside, norepinephrine, ondansetron, palonosetron, penicillin G potassium, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chlo- ride, procainamide, prochlorperazine, pro- methazine, propofol, propranolol, protamine, quinupristin/dalfopristin, raniti- dine, remifentanil, sodium bicarbonate, streptokinase, tacrolimus, theophylline, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, vancomycin, vasopressin, vera- pamil, vitamin B complex with C, voricon- azole, warfarin
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Assess: • CV: B/P continuously for circulatory collapse decompensation; ECG continu ously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased ventricu lar ectopic beats, may have to rebolus; B/P • Drug levels: therapeutic level 1.5-5 mcg/mL • I&O ratio, electrolytes (potassium, so- dium, chlorine) • Toxicity: monitor for seizures, confu sion, tremors; if these occur, discontinue immediately, notify prescriber; keep emergency equipment nearby • Malignant hyperthermia: tachypnea, tachycardia, changes in B/P, increased temperature • Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur with HF; increased respira- tion, pulse; product should be discontin- ued • CNS effects: dizziness, confusion, psy- chosis, paresthesias, convulsions; prod- uct should be discontinued • Pregnancy/breastfeeding: use only if clearly needed; use caution in breast- feeding, excreted in breast milk
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Evaluate: • Therapeutic response: decreased dys- rhythmias
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the use of automatic lidocaine injection device if ordered for personal use • To report signs of toxicity immediately
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PHARMACOKINETICS Half-life 8 min, 1-2 hr (terminal); metab- olized in liver; excreted in urine; crosses placenta IV: Onset 2 min, duration 20 min
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• Child: IV/INTRAOSSEUS BOL 1 mg/ kg; start infusion at 30 mcg/kg/min Renal/hepatic dose with heart failure
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