Dextrose and Lidocaine

Lidocaine hydrochloride administered intravenously is specifically indicated in the acute management of ventricular arrhythmias occurring during cardiac manipulations, such as cardiac surgery and life-threatening arrhythmias which are ventricular in origin, such as occur during acute myocardial infarction.

Therapy of ventricular arrhythmias is often initiated with a single IV bolus of 1 mg/kg of Lidocaine Hydrochloride Injection USP. Following acute treatment by bolus in patients in whom arrhythmias tend to recur and who are incapable of receiving oral antiarrhythmic agents, intravenous infusion of Lidocaine Hydrochloride and 5% Dextrose Injection USP is administered continuously. Rate of Administration Adults (20 to 50 mcg/kg/min): Average 70 kg adult mg/min mL/hr mL/min 0.4% Lidocaine Hydrochloride and 5% Dextrose Injection USP (4 mg lidocaine hydrochloride/mL) 1–4 15–60 0.25–1.0 0.8% Lidocaine Hydrochloride and 5% Dextrose Injection USP (8 mg lidocaine hydrochloride/mL) 1–4 7.5–30 0.12–0.5 Pediatric Patients (30 mcg/kg/min). Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). American Heart Association, JAMA 244:453–509, 1980.

Lidocaine hydrochloride is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type. Lidocaine should not be used in patients with Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, or with severe degrees of sinoatrial, atrioventricular, or intraventricular block. Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.

Constant monitoring with an electrocardiograph is essential to the proper administration of lidocaine hydrochloride intravenously. Signs of excessive depression of cardiac conductivity, such as prolongation of the PR interval, widening of the QRS interval or the appearance or aggravation of arrhythmias, should be followed by prompt cessation of the intravenous infusion of this agent. It is mandatory to have emergency resuscitative equipment and drugs immediately available to manage adverse reactions involving cardiovascular, respiratory, or central nervous systems. Occasional acceleration of ventricular rate may occur when lidocaine hydrochloride is administered to patients with atrial fibrillation. Evidence for proper usage in pediatric patients is limited. Anaphylactic reactions may occur following administration of lidocaine hydrochloride.

Systemic reactions of the following types have been reported: Central Nervous System: Light-headedness, drowsiness, dizziness, apprehension, euphoria, tinnitus, blurred or double vision, nausea and vomiting, sensation of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. Cardiovascular System: Hypotension, cardiovascular arrest, and bradycardia which may lead to cardiac arrest. Hematologic Effects: methemoglobinemia Allergic reactions, including anaphylactic reactions, may occur but are infrequent. There have been no reports of cross-sensitivity between lidocaine hydrochloride and procainamide or between lidocaine hydrochloride and quinidine.

Lidocaine should be used with caution in patients with digitalis toxicity accompanied by atrioventricular block. Coadministration of propranolol or cimetidine with lidocaine has been reported to reduce clearance from the plasma and may result in toxic accumulation of the drug. When lidocaine is administered with other antiarrhythmic drugs such as phenytoin, procainamide, propranolol, amiodarone, or quinidine, the cardiac effects may be additive or antagonistic and toxic effects may be additive. Phenytoin may stimulate the hepatic metabolism of lidocaine, but the clinical significance of this effect is not known.

Storage in automated dispensing machines: Brief exposure up to 2 weeks to ultraviolet or fluorescent light does not adversely affect the product labeling legibility, prolonged exposure can cause fading of the red label.