PEDIATRIC LTA KIT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for PEDIATRIC LTA KIT (PEDIATRIC LTA KIT).
PEDIATRIC LTA KIT contains lidocaine, tetracaine, and epinephrine. Lidocaine and tetracaine are amide and ester local anesthetics, respectively, that block voltage-gated sodium channels, preventing nerve impulse propagation. Epinephrine is a sympathomimetic that causes vasoconstriction, prolonging local anesthetic effect and reducing systemic absorption.
| Metabolism | Lidocaine: primarily hepatic via CYP3A4 and CYP1A2 to active metabolites (MEGX, GX). Tetracaine: primarily hydrolyzed by plasma esterases (pseudocholinesterase) to para-aminobenzoic acid (PABA). Epinephrine: metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). |
| Excretion | Renal (95% as unchanged drug), fecal (5%) |
| Half-life | 2-3 hours (terminal) in children with normal renal function; prolonged in renal impairment |
| Protein binding | 20-30% bound to albumin |
| Volume of Distribution | 0.5-0.7 L/kg, indicating distribution into total body water |
| Bioavailability | Oral: 60-75% (first-pass effect); Intramuscular: 80-90% |
| Onset of Action | Intravenous: 5-10 minutes; Intramuscular: 15-30 minutes; Oral: 30-60 minutes |
| Duration of Action | Intravenous/Intramuscular: 2-4 hours; Oral: 4-6 hours; clinical effect correlates with serum concentrations |
| Molecular Weight | Lidocaine 234.34 Da, Prilocaine 220.31 Da, Epinephrine 183.2 Da, Tetracaine 264.36 Da |
Not applicable. Pediatric LTA Kit is a topical lidocaine/tetracaine patch for dermal anesthesia. Adult dose: apply one patch to intact skin for 20-30 minutes prior to procedure; remove prior to procedure. Maximum 3 patches per session. Not for systemic use.
| Dosage form | SOLUTION |
| Renal impairment | No dosage adjustment required. Lidocaine and tetracaine are extensively hepatically metabolized; renal excretion of metabolites is minor. Use caution in severe renal impairment due to potential accumulation of metabolites. |
| Liver impairment | Lidocaine and tetracaine are hepatically metabolized. In severe hepatic impairment (Child-Pugh C), risk of systemic toxicity increased; consider avoiding or using with extreme caution. No specific dose adjustment defined. |
| Pediatric use | Approved for pediatric patients weighing ≥10 kg. Apply one patch to intact skin for 20-30 minutes; maximum 3 patches. Do not apply to broken skin or mucous membranes. Avoid in infants <3 months due to risk of methemoglobinemia. |
| Geriatric use | No specific dose adjustment; elderly may have impaired hepatic or renal function. Use with caution due to thinner skin and increased systemic absorption risk. Monitor for local and systemic adverse effects. Maximum 3 patches per session. |
| 1st trimester | Lidocaine and epinephrine are widely used in local anesthesia during pregnancy; no teratogenic effects in humans. Prilocaine may cause methemoglobinemia; avoid large doses. Tetracaine is not recommended due to systemic toxicity risk. |
| 2nd trimester | Generally considered safe in standard doses. Avoid excessive epinephrine due to potential reduction in uterine blood flow. |
| 3rd trimester | Use with caution due to possible effects on uterine tone and fetal heart rate; lidocaine is preferred. Avoid near delivery if possible. |
Clinical note
Comprehensive clinical and safety monograph for PEDIATRIC LTA KIT (PEDIATRIC LTA KIT).
| Placental transfer | Lidocaine and prilocaine cross the placenta readily; epinephrine crosses to a lesser extent. Fetal/maternal ratios: lidocaine ~0.5-0.7, prilocaine ~0.5, epinephrine minimal. |
| Breastfeeding | Lidocaine and prilocaine are excreted into breast milk in low amounts; unlikely to cause adverse effects in infants. Avoid application to breast area to prevent infant ingestion. Epinephrine levels in milk are negligible. |
■ FDA Black Box Warning
None.
| Serious Effects |
Hypersensitivity to amide-type anesthetics or epinephrineSevere hypotensionShockSevere bradycardia or heart blockPorphyriaMethemoglobinemia
| Precautions | Risk of methemoglobinemia, especially in children younger than 6 months, with repeated doses, or with concurrent use of oxidizing agents., Use caution in patients with liver disease, renal impairment, or cardiac disease., Avoid use on infected or inflamed skin, in patients with allergies to ester-type anesthetics (tetracaine) or amide-type anesthetics (lidocaine), or with known hypersensitivity to epinephrine., Do not apply to large areas or use with occlusive dressing unless directed. |
| Food/Dietary | No specific food interactions. However, avoid excessive caffeine or stimulants as epinephrine may increase risk of cardiovascular side effects. No dietary restrictions. |
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| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | No known teratogenic risk in first trimester; lidocaine and epinephrine are not associated with major congenital malformations at standard doses. Second and third trimester: no fetal harm reported; high doses may cause fetal bradycardia due to systemic absorption. |
| Fetal Monitoring | Maternal: vital signs, ECG, oxygen saturation; monitor for signs of local anesthetic systemic toxicity (LAST). Fetal: heart rate monitoring during and after administration; assess for bradycardia if high doses used. |
| Fertility Effects | No evidence of adverse effects on fertility in animal studies; lidocaine and epinephrine at clinical doses do not impair reproductive function. |
| Clinical Pearls | This kit contains lidocaine, tetracaine, and epinephrine for topical anesthesia. Apply to intact skin only; avoid mucous membranes. Maximum combined dose of lidocaine and tetracaine should not exceed 20 mg/kg or 1000 mg total. Use with caution in patients with hepatic impairment, arrhythmias, or concurrent use of class III antiarrhythmics. Epinephrine may cause local ischemia; avoid use on digits, ears, nose, or penis. Monitor ECG for QT prolongation. |
| Patient Advice | Apply only to intact skin; do not use on cuts, scrapes, or inside mouth/nose. · Wash hands after application and avoid touching eyes. · Keep out of reach of children; accidental ingestion can cause serious side effects. · Do not use with other numbing medications without consulting doctor. · Seek immediate medical help if you experience difficulty breathing, swelling, or severe allergic reaction. · Inform your doctor if you have heart disease, liver problems, or are pregnant/breastfeeding. |