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Lidocaine (lignocaine) Intravenous for Adults
Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- See 'Monitoring requirements' opposite
- With regards to the unlicensed (systemic) use in acute pain management note that adjust dose for BMI greater than 30kg/m2. CAP dose for obese patients (see below).
Available preparations
Lidocaine 2% ampoule 100mg per 5mL (20mg per ml)
Lidocaine 2% ampoule 400mg per 20mL (20mg per ml)
Lidocaine 1% ampoule 50mg per 5ml (10mg per ml)
Lidocaine 1% ampoule 200mg per 20ml (10mg per ml)
Reconstitution
Already in solution
Infusion fluids
Glucose 5% or Sodium chloride 0.9%
Methods of intravenous administration
Bolus intravenous injection (FOR USE IN CARDIOLOGY)
- Administer required dose over a few minutes
- Maximum rate of 50mg/min
Continuous intravenous infusion (FOR USE IN CARDIOLOGY) (administer using an electronically controlled infusion device)
- To prepare an 0.2% infusion:
- Remove 50ml from a Glucose 5% or Sodium chloride 0.9% 500ml infusion bag, and add 50ml of the lidocaine 2% solution.
- This solution then contains 1000mg lidocaine in 500ml - 2mg/ml (0.2%)
- Adjust rate as per 'Dose'
Bolus intravenous injection (FOR USE IN PAIN MANAGEMENT)
- Refer to the GUH Guideline for Intravenous Lidocaine Infusion for Acute pain- available on QPulse CLN-NM-0541
- The guideline recommends a 1 to 1.5mg/kg slow IV injection to be administered over three to five minutes then see continuous infusion below
Continuous intravenous infusion (FOR USE IN PAIN MANAGEMENT) (administer using an electronically controlled infusion device)
- Refer to Guideline for Intravenous Lidocaine Infusion for Acute pain- available on QPulse CLN-NM-0541
- Prepare syringe by drawing up 50ml of 1% Lidocaine (10mg/ml) in a 50 ml syringe. This will be a lidocaine solution of 500mg in 50ml
- Administer via a syringe driver
Dose in adults
VENTRICULAR ARRYTHMIAS, especially after myocardial infarction in patients without gross circulatory collapse
- Give 100mg as a bolus injection over a few minutes (50mg in lighter patients, or those whose circulation is severely impaired)
Followed immediately by an intravenous infusion:
- Give 4mg per minute for thirty minutes (= 120ml/hour of 0.2% infusion),
- then 2mg per minute for two hours (= 60ml/hour of 0.2% infusion),
- then 1mg per minute (= 30ml/hour of 0.2% infusion);
- STOP as soon as cardiac rhythm normalises or toxicity is noticed (and inform team)
- Reduce concentration further if infusion continued beyond twenty four hours
- Important: ECG monitoring and specialist advice required for infusion
- If an intravenous infusion is not immediately available the initial intravenous injection can be repeated if necessary once or twice at intervals of not less than 10 minutes
PAIN CONTROL (unlicensed indication) (refer to Q pulse document CLN-NM-0541: Intravenous lidocaine infusion for acute pain management)
- May only be prescribed by Pain team or relevant anaesthetist
- Give a bolus dose of 1 to 1.5mg/kg over 3 to 5 minutes (cap dose for obese patients - see table 2) as a slow intravenous injection
- Follow with a continuous infusion. Start with 1mg/kg/hour CAP dose in obesity (speak to your anasthesia consultant, pain team or critical care pharmacist before exceeding 100mg/hour)
- Do not re-bolus
- Consult with the Pain team before making any increases (ref 3)
- Infusion rate can vary from 0.5mg/kg/hour to 1.5mg/kg/hour
- Duration: 48 to 72 hours usually, but longer durations have been used
| Table 1: Lidocaine STARTING doses for PAIN MANAGEMENT INDICATION ONLY | ||||
|---|---|---|---|---|
| 500mg Lidocaine 1% in 50ml (10mg/ml). Based on dose of 1mg/kg/hr with BMI < 30kg/m2 | ||||
| Weight (kg) | Rate of infusion | Weight (kg) | Rate of infusion | |
| 50kg | 50mg/hr (5ml/hr) | 80kg | 80mg/hr (8ml/hr) | |
| 55kg | 55mg/hr (5.5ml/hr) | 85kg | 85mg/hr (8.5ml/hr) | |
| 60kg | 60mg/hr (6ml/hr) | 90kg | 90mg/hr (9ml/hr) | |
| 65kg | 65mg/hr (6.5ml/hr) | 95kg | 95mg/hr (9.5ml/hr) | |
| 70kg | 70mg/hr (7ml/hr) | 100kg | 100mg/hr (10ml/hr) | |
| 75kg | 75mg/hr (7.5ml/hr) | |||
Renal impairment: Use with caution in patients with severe renal impairment as it may accumulate
Hepatic impairment: Use with caution due to increased risk of side-effects (ref 1). The manufacturer advise dose reduction in such cases.
Monitoring
- ECG monitoring required for infusion and resuscitation facilities should be available.
- Monitor for excessive dose: (drowsiness or dizziness)
- Common or very common side effects (may indicate serious toxicity): bradycardia and hypotension (may lead to cardiac arrest); dizziness, drowsiness and paraesthesia (particularly if injection is too rapid); confusion, convulsions. In all such circumstances contact a senior physician. (ref 2)
- Pain management: refer to lidocaine pain guidelines QPulse document CLN-NM-0541: Intravenous lidocaine infusion for acute pain management
Further information
- Following intravenous injection lidocaine has a short duration of action (lasting for 15 to 20 minutes)
Table 2: Dosing weight if BMI of 30kg/m2 or more
| Height | Dosing weight if BMI of 30kg/m2 or more, with 100kg cap | Maximum starting infusion rate (ml/hour) (1mg/kg/hour dose) |
|---|---|---|
| 140cm | 59kg | 5.9 |
| 145cm | 63kg | 6.3 |
| 150cm | 68kg | 6.8 |
| 155cm | 72kg | 7.2 |
| 160cm | 77kg | 7.7 |
| 165cm | 82kg | 8.2 |
| 170cm | 87kg | 8.7 |
| 175cm | 92kg | 9.2 |
| 180cm | 97kg | 9.7 |
| 185cm | 100kg | 10 |
| 190cm | 100kg | 10 |
| 195cm | 100kg | 10 |
| 200cm | 100kg | 10 |
Storage
Store below 250C
References
SPC 1% w/v Lidocaine April 2015
SPC 2% w/v Lidocaine April 2015
(1) BNF 76
(2) Injectable Medicines Guide Medusa - accessed online 14/11/18
(3) Email correspondence with Dr O Finnerty on 26/1/18
Therapeutic classification
Class 1 Antiarrhythmic agent