Lidocaine
Class
Antidysrhythmic (class Ib)
Description
Lidocaine decreases phase-4 diastolic depolarization and suppresses premature
ventricular contractions. In addition, it is used to treat ventricular
tachycardia and some cases of ventricular fibrillation. Lidocaine also raises
the ventricular fibrillation threshold.
Onset & Duration
Onset: 30-90 sec.
Duration: 2-4 hr.
Indications
Acute ventricular dysrhythmias
Contraindications
1. Hypersensitivity
2. Stokes-Adams syndrome
3. Second- or third-degree heart block in the absence of an artificial pacemaker
4. Hypotension
Adverse Reactions
1. Lightheadedness
2. Confusion
3. Blurred vision
4. Hypotension
5. Cardiovascular collapse
6. Bradycardia
7. CNS depression (altered level of consciousness, slurred speech, irritability,
muscle twitching, seizures) with high doses
8. Localized anesthetic effects
Drug Interactions
1. Metabolic clearance of lidocaine may be decreased in patients taking
beta-adrenergic blockers or in patients with liver dysfunction.
2. Apnea induced with succinylcholine may be prolonged with large doses of
lidocaine.
3. Cardiac depression may occur if lidocaine is given concomitantly with IV
phenytoin.
4. Additive neurological effects may occur with procainamide.
Special Considerations
1. Pregnancy safety: Category B.
2. Therapeutic plasma levels of lidocaine between 2-6 mcg/ml suppress
ventricular dysrhythmias. A 75- to 100-mg bolus maintains adequate blood levels
for only 20 min.
3. If bradycardia occurs in conjunction with PVCs, always treat the bradycardia
first with atropine, epinephrine, and/or dopamine.
4. Exceedingly high doses of lidocaine can result in coma or death.
5. Avoid lidocaine for reperfusion dysrhythmias after thrombolytic therapy.
**maybe given endotracheally
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