Lidocaine, 20 mg/ml, solution for injection, 2 ml, 10 pcs.
When used simultaneously with barbiturates (including phenobarbital), it is possible to increase the metabolism of lidocaine in the liver, reduce the concentration in the blood plasma and, as a result, reduce its therapeutic effectiveness.
When used simultaneously with beta-blockers (including propranolol, nadolol), the effects of lidocaine (including toxic ones) may be enhanced, apparently due to a slowdown in its metabolism in the liver.
When used simultaneously with MAO inhibitors, the local anesthetic effect of lidocaine may be enhanced.
When used simultaneously with drugs that block neuromuscular transmission (including suxamethonium chloride), the effect of drugs that block neuromuscular transmission may be enhanced.
When used simultaneously with hypnotics and sedatives, the inhibitory effect on the central nervous system may be enhanced; with ajmaline, quinidine - possible increased cardiodepressive effect; with amiodarone - cases of seizures and SSSS have been described.
When used simultaneously with hexenal, sodium thiopental (iv), respiratory depression is possible.
When used simultaneously with mexiletine, the toxicity of lidocaine increases; with midazolam - a moderate decrease in the concentration of lidocaine in the blood plasma; with morphine - enhances the analgesic effect of morphine.
When used simultaneously with prenylamine, there is a risk of developing ventricular arrhythmias.
Cases of agitation and hallucinations have been described when used simultaneously with procainamide.
When used simultaneously with propafenone, the duration and severity of side effects from the central nervous system may increase.
It is believed that under the influence of rifampicin, a decrease in the concentration of lidocaine in the blood plasma is possible.
With simultaneous intravenous infusion of lidocaine and phenytoin, side effects of central origin may increase; a case of sinoatrial block due to the additive cardiodepressive effect of lidocaine and phenytoin is described.
In patients receiving phenytoin as an anticonvulsant, a decrease in the concentration of lidocaine in the blood plasma is possible, which is due to the induction of microsomal liver enzymes under the influence of phenytoin.
When used simultaneously with cimetidine, the clearance of lidocaine moderately decreases and its concentration in the blood plasma increases, and there is a risk of increased side effects of lidocaine.
LIDOCAINE
Directions for use and doses
The amount of solution and the total dose of lidocaine depends on the type of anesthesia, the nature and duration of the surgical intervention.
Method of diluting 20 mg/ml (2%) lidocaine solution to obtain a solution of the required concentration:
To prepare a 10 mg/ml (1%) lidocaine solution, you need to take 1 part of a 20 mg/ml lidocaine solution and 1 part of water for injection, i.e. mix 2 ml of 20 mg/ml lidocaine solution with 2 ml of water for injection (for a 2 ml ampoule), or mix 5 ml of 20 mg/ml lidocaine solution with 5 ml of water for injection (for a 5 ml ampoule).
To prepare a 5 mg/ml (0.5%) lidocaine solution, you need to take 1 part of a 20 mg/ml lidocaine solution and 3 parts of water for injection, i.e. mix 2 ml of 20 mg/ml lidocaine solution with 6 ml of water for injection (for a 2 ml ampoule), or mix 5 ml of 20 mg/ml lidocaine solution with 15 ml of water for injection (for a 5 ml ampoule).
To prepare a 2.5 mg/ml (0.25%) lidocaine solution, you need to take 1 part of a 20 mg/ml lidocaine solution and 7 parts of water for injection, i.e. mix 2 ml of a 20 mg/ml lidocaine solution with 14 ml of water for injection (for a 2 ml ampoule), or mix 5 ml of 20 mg/ml lidocaine solution with 35 ml of water for injection (for a 5 ml ampoule).
To prepare a 1.25 mg/ml (0.125%) lidocaine solution, you need to take 1 part of a 20 mg/ml lidocaine solution and 15 parts of water for injection, i.e. mix 2 ml of a 20 mg/ml lidocaine solution with 30 ml of water for injection (for a 2 ml ampoule), or mix 5 ml of 20 mg/ml lidocaine solution with 75 ml of water for injection (for a 5 ml ampoule).
For infiltration anesthesia
(intradermal, subcutaneous) 0.125%, 0.25%, 0.5% solutions are used; to achieve infiltration anesthesia, up to 60 ml (5-300 mg) of a 0.5% solution or up to 30 ml of a 1% solution is used.
For conduction anesthesia
(anaesthesia of peripheral nerves, including blockade of nerve plexuses) use 1 and 2% solutions; the maximum total dose is up to 400 mg (40 ml of a 1% solution or 20 ml of a 2% solution). For nerve plexus blockade, 10-20 ml of a 1% solution or 5-10 ml of a 2% solution.
For conduction anesthesia of peripheral nerves
: brachial - 15-20 ml (225-300 mg) 1.5% solution; in dental practice - 1-5 ml (20-100 mg) of 2% solution; blockade of intercostal nerves - 3 ml (30 mg) of 1% solution.
For paracervical anesthesia:
10 ml (100 mg) of 1% solution in each direction, if necessary, re-administration is possible after at least 1.5 hours.
For paravertebral anesthesia
: from 3 to 5 ml (30-50 mg) of 1% solution.
Retrobulbar anesthesia -
3.0-4.0 (60-80 mg) 2% solution.
Parabulbar anesthesia
- 1.0-2.0 (20-40 mg) 2% solution.
Vagosympathetic blockade:
cervical (stellate ganglion) - 5 ml (50 mg) of 1% solution, lumbar - 5-10 ml (50-100 mg) of 1% solution.
Spinal anesthesia
- 3.0-4.0 ml (60-80 mg) 2% solution.
Epidural anesthesia -
to obtain analgesia, 25-30 ml (250-300 mg) of a 1% solution is used; to obtain anesthesia, 15-20 ml (225-300 mg) of a 1.5% solution or 10-15 ml (200-300 mg) of a 2% solution; for thoracic epidural anesthesia - 20-30 ml (200-300 mg) of 1% solution. Continuous administration of anesthetic via a catheter is not recommended; administration of the maximum dose should not be repeated more often than after 90 minutes.
When using caudal anesthesia:
in surgical practice - 15-20 ml (225-300 mg) of a 1.5% solution. Continuous administration of anesthetic via a catheter is not recommended; administration of the maximum dose should not be repeated more often than after 90 minutes. Recommended doses for children with neuromuscular blockade are up to 4.5 mg/ml of a 0.25-1.0% solution.
The maximum dose for children is 4.5 mg/kg, but not more than 100 mg; the maximum dose for adults is no more than 4.5 mg/kg or 300 mg. These doses must be repeated within 24 hours.
The effect of lidocaine can be prolonged by adding a 0.1% epinephrine solution (0.1 ml per 20 ml of lidocaine). In this case, with regional anesthesia, the dose of lidocaine can be increased to 600 mg.
Procedure for working with a polymer ampoule:
1.Take the ampoule and shake it, holding it by the neck.
2. Squeeze the ampoule with your hand, without releasing the drug, and use a rotating motion to turn and separate the valve.
3. Immediately connect the syringe to the ampoule through the resulting hole.
4. Turn the ampoule over and slowly draw its contents into the syringe.
5. Place the needle on the syringe.
Publications in the media
(Lidocainum) INN
Synonyms. Xycaine, Xylocaine.
Composition and release form. 1% solution of lidocaine hydrochloride in ampoules of 10 ml; 2% solution in ampoules of 2 and 10 ml; 10% solution in ampoules of 2 ml; an aerosol can containing 790 doses of lidocaine hydrochloride, 4.8 mg each.
Indications. Infiltration, conduction, epidural, spinal anesthesia; local anesthesia in dentistry, otorhinolaryngology, surgery (tracheal intubation, bronchoesophagoscopy, removal of polyps, etc.); arrhythmia, prevention of ventricular fibrillation.
Pharmachologic effect. Lidocaine has a strong local anesthetic effect and antiarrhythmic activity. Lidocaine is used in different concentrations: for infiltration anesthesia - 0.025-0.5% solution; conductor - 1-2% solution, terminal - 10% solution. Compared to novocaine, it acts faster, stronger and longer. In low concentrations (0.5%) it does not differ significantly in toxicity from novocaine; with increasing concentration to 1-2%, toxicity increases by 40-50%. The drug blocks the occurrence and conduction of nerve impulses, reducing the permeability of neuronal membranes to sodium ions, which leads to stabilization of the membrane and inhibits depolarization. The antiarrhythmic effect of the drug is due to its stabilizing effect on the cell membranes of the myocardium. It blocks the slow flow of sodium ions into myocardial cells and is therefore capable of suppressing the automaticity of ectopic foci of impulse formation. In this case, the conductivity function is not inhibited. The drug promotes the release of potassium ions from myocardial cells and accelerates the process of repolarization of cell membranes, shortens the duration of the action potential and the effective refractory period.
Pharmacokinetics. The rate of absorption is affected by the site of administration and the rate of administration of the drug. With resorptive action from the surface of the mucous membranes, the maximum concentration of lidocaine in the blood is achieved after 10-30 minutes; with intravenous administration of the drug - after 5 minutes. 50% protein bound. Metabolized in the liver to form two pharmacologically active metabolites. T 1/2 is from 1 to 3 hours. A small part of the drug undergoes enterohepatic circulation and is excreted in the feces; 10% is excreted unchanged in urine.
Side effects. Headache, dizziness, drowsiness, anxiety, euphoria, ringing in the ears; bradycardia, conduction disturbances; decrease in blood pressure; collapse.
Contraindications. Increased individual sensitivity to lidocaine, weakness of the sinus node in elderly patients, AV block of II-III degree, severe bradycardia, cardiogenic shock; severe liver dysfunction.
Adverse reactions when interacting with other drugs. When beta-blockers are used together with lidocaine, the metabolism of lidocaine slows down due to a decrease in blood flow to the liver, which leads to an increased risk of lidocaine toxicity. Antagonism was noted in the effects of antimyasthenic drugs and lidocaine due to inhibition of neuronal transmission under the influence of the latter.
Information for the patient. When using an aerosol form of lidocaine, it should be remembered that the amount of the sprayed drug depends on the surface to be anesthetized. In adults, the dose should not exceed 200 mg. The aerosol should not come into contact with the eyes. Various types of local anesthesia are administered by medical staff.
Description of the drug LIDOCAINE HYDROCHLORIDE
When used simultaneously with barbiturates (including phenobarbital), it is possible to increase the metabolism of lidocaine in the liver, reduce the concentration in the blood plasma and, as a result, reduce its therapeutic effectiveness.
When used simultaneously with beta-blockers (including propranolol, nadolol), the effects of lidocaine (including toxic ones) may be enhanced, apparently due to a slowdown in its metabolism in the liver.
When used simultaneously with MAO inhibitors, the local anesthetic effect of lidocaine may be enhanced.
When used simultaneously with drugs that block neuromuscular transmission (including suxamethonium chloride), the effect of drugs that block neuromuscular transmission may be enhanced.
When used simultaneously with hypnotics and sedatives, the inhibitory effect on the central nervous system may be enhanced; with ajmaline, quinidine - possible increased cardiodepressive effect; with amiodarone - cases of seizures and SSSS have been described.
When used simultaneously with hexenal, sodium thiopental (iv), respiratory depression is possible.
When used simultaneously with mexiletine, the toxicity of lidocaine increases; with midazolam - a moderate decrease in the concentration of lidocaine in the blood plasma; with morphine - enhances the analgesic effect of morphine.
When used simultaneously with prenylamine, there is a risk of developing ventricular arrhythmias.
Cases of agitation and hallucinations have been described when used simultaneously with procainamide.
When used simultaneously with propafenone, the duration and severity of side effects from the central nervous system may increase.
It is believed that under the influence of rifampicin, a decrease in the concentration of lidocaine in the blood plasma is possible.
With simultaneous intravenous infusion of lidocaine and phenytoin, side effects of central origin may increase; a case of sinoatrial block due to the additive cardiodepressive effect of lidocaine and phenytoin is described.
In patients receiving phenytoin as an anticonvulsant, a decrease in the concentration of lidocaine in the blood plasma is possible, which is due to the induction of microsomal liver enzymes under the influence of phenytoin.
When used simultaneously with cimetidine, the clearance of lidocaine moderately decreases and its concentration in the blood plasma increases, and there is a risk of increased side effects of lidocaine.
