Parenteral Manual

Lidocaine hydrochloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Local anesthetic, antiarrythmic
Original Date: 
August 2005
Revised Date: 
December 2019
  • Local: For peridural infiltration and regional anesthesia
  • Antiarrhythmic: Treatment of ventricular tachycardia and runs of premature ventricular beats
  • Anticonvulsant: For status epilepticus (last resort)
  • Treatment of neuropathic or intractactable pain
Reconstitution and Stability: 
  • Stable at room temperature
  • Solutions diluted in D5W stable for 14-120 days depending on concentration - use diluted solutions within 24 hours to prevent bacterial contamination
  • Multiple concentrations and formulations exist therefore check vial carefully

- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: KCl (up to 40 mmol/L), glycopyrrolate, heparin, hydroxyzine

- Y-site Compatible: amiodarone, ciprofloxacin, morphine, dobutamine, dopamine, labetalol, nitroglycerin, nitroprusside sodium,  TPN (amino acids/dextrose)

- Incompatible: phenytoin,  thiopental


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct YES  Cardiac monitoring, continous BP monitoring
Usual dilution: 10-20 mg/mL
Infusion time: 2 minutes
Infusion rate: Max: 0.7 mg/kg/minute or 50 mg/minute, whichever is less      
IV Intermittent Infusion

YES   Cardiac monitoring, BP monitoring

 For intractable seizures

Infusion Time: 30 minutes

Usual Dilution: 8 mg/mL (for seizures, supplied as  250 mL bag for use on large volume pump)


IV Continuous Infusion

YES    Cardiac monitoring, BP monitoring

- Neuropathic or intractable pain - Continuous oxygen saturation and Cardio-Respiratory monitoring
Standard Drug Concentration: 8 mg/mL (supplied as 50 mL syringe for use on syringe pump)

- Seizures

Standard Drug Concentration: 8 mg/mL (supplied as 250 mL bag for use on large volume pump)

Intraosseous YES
Endotracheal YES
Usual dilution: dilute dose in 1-2 mL NS
Local Infiltration YES, for production for peridural infiltration and regional anesthesia

NOTE:  DO NOT administer lidocaine with preservative or epinephrine IV


(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Local infiltration:

  1. Dosage varies with the anesthetic procedure, degree of anesthesia, vascularity of tissue, duration of anesthesia and physical condition of patient.
  2. Lidocaine with epinephrine: DO NOT exceed 7 mg/kg.  Not to be administered at intervals of less than 2 hours
  3. Lidocaine without epinephrine: DO NOT exceed 4.5 mg/kg.  For continuous caudal and epidural anaesthesia the maximum recommended dose should not be administered at intervals of less than 2 hrs.


  • Loading dose: 1 mg/kg/dose by slow IV/IO/Endotracheal injection
    - May repeat 0.5-1 mg/kg Q 10-15 minutes till desired effect or up to a total maximum
    loading dose of 5 mg/kg.
  • Continuous IV Infusion: 10-50 mcg/kg/minute (supplied as 50 ml syringe for use on syringe pump)


  • Loading Dose: 1-1.5 mg/kg IV; may repeat doses of 0.5 - 0.75 mg/kg if refractory after 5-10 minutes
    Maximum total loading dose: 3 mg/kg
  • Continuous infusion: 1-4 mg/minute IV  

N.B. - moderate to severe CHF may require ½ loading doses and lower infusion rates

Intractable Seizures:

  • Loading dose: 2 mg/kg/dose IV over 30 minutes, then
  • Continuous infusion: 2 to 6 mg/kg/hour IV  (supplied as 250 mL bag for use on large volume pump)

Neuropathic or Intractable Pain:

  • 1 - 2 mg/kg/hour  - Maximum rate 200 mg/hour  - Adjust rate every 8 - 10 hours PRN to allow for steady state concentration. Supplied as 50 mL syringe for use on syringe pump.
    - Reassess after 72 hours

Intraosseous Line Infusion (to decrease pain associated with IO insertion):

  • Preservative free lidocaine 2%  (0.5 mg/kg/dose, MAX 40 mg) infused over 1 - 2 min into medullary space. Follow with NaCL 0.9% flush.
Potential hazards of parenteral administration: 
  • CNS effects - apprehension, tremors, seizures, respiratory arrest, drowsiness, anxiety, agitation, euphoria
  • With high doses: bradycardia, hypotension, heart block, cardiovascular collapse, arrhythmias
  • Thrombophlebitis
  • Paresthesias, blurred vision
  • Monitor EKG and serum lidocaine concentrations with continuous infusion    
  • Therapeutic plasma levels = 6-21 micromol/L (1.5-5 mcg/mL)           
  • Solutions containing preservatives should not be used for spinal or epidural block
  • Solutions containing epinephrine should not be used for the treatment of arrhythmias
  • Contraindicated in Adams-Stokes syndrome, severe sinoatrial, atrioventricular and intraventricular heart block                                                      
  • Cimetidine or beta-blockers (eg. propranolol) may interact and cause lidocaine toxicity
  • Solution containing epinephrine should not be used in anesthesia of digits, ears, nose or penis
  • For management of hemodynamic instability due to lidocaine toxicity: see Intralipid 20% (fat emulsion) monograph

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