DOSAGE AND ADMINISTRATION
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 |
|---|
0.2% Lidocaine Hydrochloride and
5% Dextrose Injection USP
(2 mg lidocaine hydrochloride/mL) | 1–4 | 30–120 | 0.5–2.0 |
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).
Pharmacokinetic data indicate reduced elimination of lidocaine after prolonged infusion (24 hours) with resultant prolongation of the half-life to approximately three times that seen following a single administration. Failure to adjust the rate of infusion in keeping with this altered ability to eliminate lidocaine may result in toxic accumulation of the drug in the patient's serum.LeLorier J, Grenon D, Latour Y, et al.: Pharmacokinetics of lidocaine after prolonged intravenous infusions in uncomplicated myocardial infarction. Ann Int Med 87:700–702, 1977.
Intravenous infusions of lidocaine hydrochloride must be administered under constant ECG monitoring to avoid potential overdosage and toxicity. Intravenous infusion should be terminated as soon as the patient's basic cardiac rhythm appears to be stable or at the earliest signs of toxicity. It should rarely be necessary to continue intravenous infusions beyond 24 hours. As soon as possible and when indicated, patients should be changed to an oral antiarrhythmic agent for maintenance therapy.
Caution: Concentrated solutions of lidocaine hydrochloride (greater than 0.2%) should be administered by carefully calibrated infusion devices.
Pediatric Use
Therapy should be initiated with a single IV bolus of 1 mg/kg of Lidocaine Hydrochloride Injection USP. A maintenance intravenous infusion of Lidocaine Hydrochloride and 5% Dextrose Injection USP administered at a recommended infusion rate of 30 mcg/kg/min may be given.
Geriatric Use
Patients with reduced hepatic function or diminished hepatic blood flow (as in heart failure and after cardiac surgery), or those over 70 years of age should receive half the usual loading dose and also should be given lower maintenance levels of intravenous lidocaine. Patients over 65 years may benefit from dosing based upon body weight (see CLINICAL PHARMACOLOGY and PRECAUTIONS, Geriatric Use).
Lidocaine hydrochloride should not be added to blood transfusion assemblies.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
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