LIDOCAINE HYDROCHLORIDE 0.2% IN DEXTROSE 5%
Clinical safety rating: safe
Beta-blockers may increase the risk of lidocaine toxicity Can cause CNS toxicity (seizures) and cardiovascular collapse.
Lidocaine is a local anesthetic that stabilizes neuronal membranes by inhibiting sodium ion influx, thereby blocking initiation and conduction of nerve impulses.
| Metabolism | Primarily hepatic via CYP1A2 and CYP3A4; also undergoes deethylation to monoethylglycinexylidide (MEGX) and further to glycinexylidide (GX). |
| Excretion | Renal: ~90% as metabolites and <10% unchanged. Biliary/fecal: minor (<1%). |
| Half-life | Terminal elimination half-life: 1.5-2 hours (adults); prolonged in heart failure (up to 4-6 hours) or hepatic impairment (up to 5-7 hours). |
| Protein binding | 60-80% bound to alpha-1-acid glycoprotein (AAG); varies with AAG concentration. |
| Volume of Distribution | Vd: 1.1-2.0 L/kg; increased to 2-4 L/kg in heart failure or hepatic disease. |
| Bioavailability | Intravenous: 100%; Intraosseous: ~100%; Oral: <35% due to extensive first-pass metabolism. |
| Onset of Action | Intravenous: 1-2 minutes; Intraosseous: similar to IV. |
| Duration of Action | Intravenous: 10-20 minutes (antiarrhythmic); continuous infusion required for sustained effect. |
1-1.5 mg/kg IV bolus over 2-3 minutes, followed by continuous IV infusion of 1-4 mg/min for ventricular arrhythmias; maximum 3 mg/kg (or 200-300 mg) over 1 hour.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required; lidocaine clearance minimally affected by renal function. |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: reduce dose by 50%; Class C: avoid use or reduce dose by 75% with monitoring. |
| Pediatric use | Loading dose: 1-1.5 mg/kg IV/IO over 2-3 minutes; may repeat 0.5-0.75 mg/kg after 5-10 minutes (max 3 mg/kg). Maintenance infusion: 20-50 mcg/kg/min IV. |
| Geriatric use | Reduce infusion rate by 50% in elderly due to age-related decreased hepatic clearance; monitor for CNS toxicity and hypotension. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Beta-blockers may increase the risk of lidocaine toxicity Can cause CNS toxicity (seizures) and cardiovascular collapse.
| FDA category | Animal |
| Breastfeeding | Lidocaine enters breast milk in small amounts. Milk-to-plasma ratio is approximately 0.4. The relative infant dose is less than 1% of maternal weight-adjusted dose. Compatible with breastfeeding; observe infant for signs of toxicity (e.g., irritability) if high maternal doses used. |
| Teratogenic Risk |
■ FDA Black Box Warning
None.
| Common Effects | ventricular arrhythmias |
| Serious Effects |
["Hypersensitivity to lidocaine or amide-type local anesthetics","Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, or severe degrees of sinoatrial, atrioventricular, or intraventricular block without a pacemaker","Severe hypotension or cardiogenic shock"]
| Precautions | ["Risk of CNS toxicity (e.g., seizures, respiratory depression) and cardiotoxicity (e.g., bradycardia, hypotension) especially with high doses or rapid IV administration","Use with caution in patients with hepatic impairment, heart failure, or hypovolemia","Monitor ECG and vital signs during IV administration","May cause methemoglobinemia in neonates with repeated doses"] |
Loading safety data…
| Lidocaine crosses the placenta. For epidural use during labor, fetal heart rate changes may occur but it is not teratogenic at standard doses. FDA pregnancy category B. First trimester: No increased risk of major malformations. Second and third trimesters: No teratogenic effects reported; avoid high doses near delivery due to potential neonatal CNS depression. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, and ECG for arrhythmias or CNS toxicity. For epidural use: fetal heart rate monitoring, maternal blood pressure (hypotension risk). Observe neonate for respiratory depression, bradycardia, and seizures if high doses given near delivery. |
| Fertility Effects | Lidocaine has no known effects on fertility in humans. Animal studies show no impairment of fertility at relevant doses. |