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 |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for PEDIATRIC LTA KIT (PEDIATRIC LTA KIT).
| Breastfeeding | Lidocaine excreted into breast milk in low concentrations (M/P ratio ~0.4). Epinephrine has minimal milk excretion. Considered compatible with breastfeeding; monitor infant for local anesthetic toxicity signs (e.g., drowsiness, apnea). |
| 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. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to lidocaine, tetracaine, epinephrine, or any component of the formulation.","Avoid use in patients with known history of malignant hyperthermia (related to lidocaine? no, but caution with epinephrine).","Do not use in patients with severe hypertension, thyrotoxicosis, or cardiovascular disease where vasoconstrictors are contraindicated.","Avoid use in patients with pseudocholinesterase deficiency (risk of prolonged tetracaine effect)."]
| 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."] |
Loading safety data…
| 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. |