Systemic reactions of the following types have been reported:
- Central Nervous System: Light-headedness; drowsiness; dizziness; apprehension; euphoria; tinnitus; blurred or double vision; vomiting; sensation of heat, cold or numbness; twitching; tremors; convulsions; unconsciousness; respiratory depression and arrest.
- Cardiovascular System: Hypotension; cardiovascular arrest; and bradycardia which may lead to cardiac arrest.
- Allergic reactions may occur but are infrequent. There have been no reports of cross-sensitivity between lidocaine hydrochloride and procainamide or between lidocaine hydrochloride and quinidine.
Management of Adverse Reactions
- In the case of severe reaction, discontinue the use of the drug. Institute emergency resuscitative procedures and administer the emergency drugs necessary to manage the severe reaction. For severe convulsions, small increments of diazepam or an ultrashort-acting barbiturate (thiopental or thiamylal) or if those are not available, a short-acting barbiturate (pentobarbital or secobarbital); or if the patient is under anesthesia, a short-acting muscle relaxant (succinylcholine) may be given intravenously. Muscle relaxants and intravenous medications should only be used by those familiar with their use.
Patency of the airway and adequacy of ventilation must be assured.
- Should circulatory depression occur, vasopressors such as ephedrine and intravenous fluids may be used. When necessary standard methods of cardiopulmonary resuscitation should be employed.
- Allergic reactions should be managed by conventional means.
- Key to successful outcome of the syndrome known as malignant hyperthermia is early recognition of the fulminant hypermetabolic process through premonitory signs such as tachycardia, hyperpnea with respiratory and/or metabolic acidosis. Treatment includes administration of oxygen, discontinuation of the lidocaine infusion, maintenance of renal output through adequate fluid therapy, control of temperature and administration of dantrolene sodium.
For additional information on management see prescribing information for dantrolene sodium.