Lidocaine injection for 20 mg ml ampoules 2 ml 10 pcs
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Active ingredients
Lidocaine
Release form
Solution
Composition
1 ml of solution contains lidocaine hydrochloride 20 mg; excipients: sodium chloride - 6.0 g, 1 M solution of sodium hydroxide - to pH 5.0-7.0, water for injection - up to 1 l.
Pharmacological effect
As an antiarrhythmic agent in adults with the introduction of a loading dose in / in - 1-2 mg / kg for 3-4 minutes; The average single dose of 80 mg. Then, they immediately switch to drip infusion at a rate of 20–55 mcg / kg / min. Drip infusion can be performed within 24-36 hours. If necessary, on the background of drip infusion, you can repeat the IV injection of 40 mg of lidocaine 10 minutes after the first loading dose. V / m is administered at 2-4 mg / kg, if necessary, repeated administration is possible after 60-90 minutes. Children with a / in the introduction of a loading dose - 1 mg / kg, if necessary, you can re-enter after 5 minutes. For continuous intravenous infusion (usually after the administration of a loading dose) - 20-30 mg / kg / min. For use in surgical and obstetric practice, dentistry, ENT-practice, the dosing regimen is set individually, depending on the indications, the clinical situation and the dosage form used. Maximum doses: adults with on / in the introduction of a loading dose of 100 mg, with subsequent drip infusion - 2 mg / min; with i / m administration - 300 mg (about 4.5 mg / kg) for 1 hour. For children, in the case of repeated administration of the loading dose with an interval of 5 min, the total dose is 3 mg / kg; with continuous i / v infusion (usually after administration of a loading dose) - 50 mcg / kg / min
Pharmacokinetics
Lidocaine is a local anesthetic that also has antiarrhythmic activity. Assign with all types of local anesthesia: infiltration, conductive and superficial. The anesthetic effect of lidocaine hydrochloride is 2-6 times stronger than novocaine. The drug blocks the flow of sodium ions in myocardial cells and suppresses the automatism of ectopic foci, acts faster and longer. Reduces the effective refractory period, significantly reduces the amplitude of the action potential of myocardial cells. It has a weak effect on the electrophysiological properties of the atria and therefore is ineffective with atrial forms of cardiac arrhythmias. The drug has little effect on hemodynamics, only in large doses inhibits myocardial contractility and intracardiac conduction
Indications
In cardiology practice: treatment and prevention of ventricular arrhythmias (extrasystole, tachycardia, flutter, fibrillation), incl.in the acute period of myocardial infarction, with the implantation of an artificial pacemaker, with glycosidic intoxication, anesthesia. For anesthesia: terminal, infiltration, conduction, spinal (epidural) anesthesia in surgery, obstetrics and gynecology, urology, ophthalmology, dentistry, otorhinolaryngology; peripheral nerve and nerve block
Contraindications
Heavy bleeding. Shock. Hypotension. Infection site of the alleged injection. Severe bradycardia. Cardiogenic shock. Severe forms of chronic heart failure. SSSU in elderly patients. AV block II and III degree (except when a probe is inserted to stimulate the ventricles). Severe abnormal liver function. Hypersensitivity to lidocaine and other local amide type anesthetics. For subarachnoid anesthesia: Complete heart block. Bleeding. Hypotension. Shock. Infection of the site of lumbar puncture. Septicemia. With caution: Conditions accompanied by a decrease in hepatic blood flow, incl. with: chronic heart failure, liver disease. Progressive cardiovascular insufficiency (usually due to the development of heart block and shock). Severe and weakened patients. Older age (over 65). For epidural anesthesia: Neurological diseases. Septicemia. The impossibility of puncture due to spinal deformity. For subarachnoid anesthesia: Back pain. Brain Infection. Benign and malignant neoplasms of the brain. Coagulopathy of various origins. Migraine. Subarachnoid hemorrhage. Arterial hypertension. Hypotension. Paresthesia. Psychosis. Hysteria. Non-contact patients. Impossibility of puncture due to spinal deformity
Precautionary measures
Caution should be used in conditions involving a decrease in hepatic blood flow (including chronic heart failure, liver disease), progressive cardiovascular insufficiency (usually due to the development of heart block and shock), in severe and debilitated patients, in elderly patients. age (over 65); for epidural anesthesia - for neurological diseases, septicemia,inability to carry out puncture due to spinal deformity; for subarachnoid anesthesia - with back pain, brain infections, benign and malignant brain tumors, with coagulopathies various origins, migraine, subarachnoid hemorrhage, hypertension, hypotension, paresthesia, psychosis, hysteria, in uncooperative patients, the inability of the puncture of - due to spinal deformity. It is necessary to carefully introduce lidocaine solutions into tissues with abundant vascularization (for example, in the neck area during operations on the thyroid gland), in such cases lidocaine is used in smaller doses.
Use during pregnancy and lactation
In pregnancy and lactation, use only for health reasons. Lidocaine is excreted in breast milk. In obstetric practice, apply with caution paracervical for violations of intrauterine development of the fetus, placental insufficiency, prematurity, postmaturity, preeclampsia
Dosage and administration
Adults: As an antiarrhythmic agent with the introduction of a loading dose in / in - 1-2 mg / kg for 3-4 minutes; The average single dose of 80 mg. Then, they immediately switch to drip infusion at a rate of 20–55 mcg / kg / min. Drip infusion can be performed within 24-36 hours. If necessary, on the background of drip infusion, you can repeat the IV injection of 40 mg of lidocaine 10 minutes after the first loading dose. V / m is administered at 2-4 mg / kg, if necessary, repeated administration is possible after 60-90 minutes. Maximum doses: with a / in the introduction of a loading dose of 100 mg, with subsequent drip infusion - 2 mg / min; with intramuscular administration, 300 mg (about 4.5 mg / kg) for 1 hour. For children: For intravenous administration of a loading dose, 1 mg / kg, if necessary, repeated administration is possible after 5 minutes. For continuous intravenous infusion (usually after the administration of a loading dose) - 20-30 mg / kg / min. Maximum doses: in case of repeated administration of a loading dose with an interval of 5 min, the total dose is 3 mg / kg; with continuous i / v infusion (usually after the administration of a loading dose) - 50 mg / kg / min. For use in surgical and obstetric practice, dentistry, ENT-practice, the dosing regimen is set individually, depending on the indications, the clinical situation and the dosage form used.
Side effects
On the part of the central nervous system and peripheral nervous system: dizziness, headache, weakness, motor restlessness, nystagmus, loss of consciousness, drowsiness, visual and auditory disturbances, tremor, trismus, convulsions (the risk of their development increases in the background of hypercapnia and acidosis), horsetail syndrome (paralysis of the legs, paresthesia), paralysis of the respiratory muscles, respiratory arrest, motor and sensory block, respiratory paralysis (most often develops with subarachnoid anesthesia), numbness of the tongue (when used in dentistry). Since the cardiovascular system: a decrease or increase in blood pressure, tachycardia - with the introduction of a vasoconstrictor, peripheral vasodilation, collapse, chest pain. On the part of the digestive system: nausea, vomiting, involuntary defecation. Allergic reactions: skin rash, urticaria (on the skin and mucous membranes), itchy skin, angioedema, anaphylactic shock. Local reactions: in spinal anesthesia, back pain; in epidural anesthesia, accidental entry into the subarachnoid space; with local use in urology - urethritis. Others: involuntary urination, methemoglobinemia, persistent anesthesia, decreased libido and / or potency, respiratory depression, even stopping, hypothermia; during anesthesia in dentistry: insensitivity and paresthesia of the lips and tongue, lengthening of anesthesia
Overdose
Symptoms: initial signs of intoxication - dizziness, nausea, vomiting, euphoria, asthenia, low blood pressure; then - convulsions of the facial muscles, tonic-clonic convulsions of skeletal muscles, psychomotor agitation, bradycardia, collapse; when used in childbirth in a newborn - bradycardia, depression of the respiratory center, respiratory arrest. Treatment: when the first signs of intoxication appear, the administration is stopped, the patient is transferred to the horizontal position; prescribe inhalation of oxygen. When convulsions - intravenous 10 mg of diazepam. In bradycardia, m-anticholinergics (atropine), vasoconstrictors (norepinephrine, phenylephrine). It is possible to conduct intubation, artificial ventilation, resuscitation. Dialysis is ineffective
Interaction with other drugs
With simultaneous use with beta-blockers, cimetidine requires a reduction in the dose of lidocaine; with polymyxin B - should monitor respiratory function. During treatment with MAO inhibitors, lidocaine should not be used parenterally. Injection solutions, which include epinephrine and norepinephrine, are not intended for intravenous administration. Lidocaine should not be added to transfused blood. Influence on the ability to drive vehicles and control mechanisms: after the use of lidocaine is not recommended to engage in activities that require high concentration of attention and quick psychomotor reactions
special instructions
It is used with caution in patients with impaired liver function, circulatory failure, arterial hypotension, renal failure, epilepsy. In these cases, a reduction in the dose of the drug is required. With rapid intravenous administration, a sharp decrease in blood pressure and the development of collapse can occur. In these cases, mezaton, ephedrine and other vasoconstrictor agents are used. Lidocaine solutions should be carefully introduced into highly vascularized tissues to prevent the drug from entering the vessel lumen (for example, in the neck area during operations on the thyroid gland) mental retardation, as well as very old and / or weakened patients who are already receiving drugs like lidocaine for cardiac problems. In dentistry and orthopedics, the drug should be used be only with elastic impression materials. Avoid getting the aerosol in or contact with eyes, it is important to prevent the aerosol from entering the respiratory tract (risk of aspiration). Applying the drug on the back of the pharynx requires special care. a reflex that can lead to aspiration, bronchopneumonia Use in pediatrics It should be borne in mind that in children the swallowing reflex occurs much more often than in adults. Lidocaine aerosol is not recommended for local anesthesia before tonsillectomy and adenotomy in children under the age of 8 years.Impact on the ability to drive vehicles and control mechanisms If the side effects after using the drug do not cause discomfort, there are no restrictions for driving vehicles and driving mechanisms