Name: LIDOCAINE(XylocaineR)
Classification: antiarrhythmic
  • useful in the treatment of ventricular arrhythmias
  • may be used to inhibit cough reflex during intubation or suctioning with raised intracranial pressure
Dose:
  • Loading Dose:
    • 1mg/kg, up to 1.5 mg/kg over 1 min, may repeat X 1 to a maximum total dose of 3.0 mg/kg
  • Maintenance Infusion:
    • 1 - 4 mg/min
  • Circulatory Failure:
    • 50 mg, then 1 mg/min as continuous infusion
  • Pre-suctioning with raised ICP:
    • 1.5 mg/kg (max 100 mg) 1 - 2 minutes prior to suctioning; maximum dose per hour 4.5 mg/kg

    •  
  • dose must be decreased in hepatic or renal failure.
  • infusion beyond 36 hours may necessitate a reduction in dose 
Administration:
  • Bolus dose:
    • rate 50 mg/min
  • IV Infusion:
    • 2 g/500 mL D5W, NS, RL
  • underlying causes for ventricular ectopy, such as low potassium or magnesium, hypoxemia, ischemia should be corrected concurrently with initation of therapy
Adverse Effects: Cardiac:
  • hypotension
  • bradyarrythmias
  • heart block
  • decreased cardiac output
  • reports of cardiac arrest ollowing IV administration
CNS:
  • disorientation
  • agitation
  • parasthesia
  • seizures
  • coma
Contraindication:
  • in complete heart block or type II second degree heart block unless functional pacemaker in place (can suppress a ventricular escape rhythm)
Drug Interactions:
  • lidocaine + cimetidine = increased lidocaine toxicity
  • lidocaine + propranolol = increased lidocaine toxicity
  • lidocaine + procainamide = increased lidocaine toxicity
  • lidocaine + amiodarone = severe sinus bradycardia (especially in sick sinus syndrome)
  • lidocaine + neuromuscular blockers = increased neuromuscular blockade
Monitoring Therapy:
  • HR and rhythm
  • BP
  • neurological status
  • cardiac index
  • electrolytes: potassium, magnesium, phosphate 
CCTC Protocol:
  • May be administered at a dose of 1 mg/kg IV direct followed by an infusion of 2 g/500 ml at 2 mg/min without a physician's order, by a certified nurse in the CCTC for symptomatic ventricular tachycardia or ventricular fibrillation.
  • May be administered IV direct by an approved nurse in CCTC.
  • May be titrated by an approved nurse in CCTC.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006

LHSCHealth Professionals

Last Updated March 24, 2009 | © 2007, LHSC, London Ontario Canada