Neonatal Drug Therapy Manual

Lidocaine

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

Updated January 24, 2019 - 4:22pm

Alternate Name(s): 
Xylocaine
Classification: 
Antiarrhythmic Agent, Class I-B; Local Anesthetic
Original Date: 
May 2016
Indications: 
  • Treatment of ventricular tachycardia, ventricular fibrillation
  • Treatment of Phenobarbital resistant seizures (third-line treatment)
Administration: 
  • Antiarrhythmic
    • Loading dose
    • IV continuous infusion
  • Anticonvulsant
    • Loading dose: over 10 minutes followed by a continuous infusion
    • IV continuous infusion
Dosage: 
  • Antiarrhythmic
    • Loading dose: 0.5 - 1 mg/kg IV once. May repeat q10min as necessary to control arrhythmia
    • Maintenance: 10 - 50 mcg/kg/min IV

**Neonates with reduced hepatic function and decreased hepatic blood flow (eg. shock, CHF, cardiac arrest or postcardiac surgery) should receive 1/2 the usual arrhythmia loading dose and lower maintenance

  • Anticonvulsant
    • Loading dose: 2 mg/kg/dose IV over 10 minutes (may be given if patient in status epilepticus)
    • Maintenance: 2 - 8 mg/kg/hr IV
      • After 24 h of seizures cessation, the infusion rate should be lowered stepwise to minimize accumulation of metabolites with the goal of treatment termination within an additional 1-3 days.

** Lidocaine should be avoided in patients who have severe liver disease and should be used with precaution if severe renal impairment because of accumulation of metabolites.

Side Effects: 
  • CNS: recurrent seizure activity due to accumulation of lidocaine metabolites
  • CVS: cardiac arrhythmia primarily in the form of bradycardia, heart block,hypotension
  • Miscellaneous: pupillary mydriasis, thrombophlebitis
Parameters to Monitor: 
  • Continuous cardiac monitoring
  • Therapeutic drug levels: 6-21 micromol/L (1.5 - 5 mcg/mL)
  • Continuous EEG monitoring (if anticonvulsant)
Reconstitution and Stability: 

CHEO:

  • Use Lidocaine 8 mg/mL prefilled syringe prepared by pharmacy

TOH:

  • Lidocaine 1% (10 mg/mL)
    • Take 16 mL (160 mg) and add to 4 mL of D5W
    • Final concentration: 8 mg/mL
Compatibility: 

- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose/saline combinations

- Y-site Compatible: dobutamine, dopamine, heparin, KCl (up to 40mmol/L), morphine

Notes: 
  • Lidocaine should not be administered to patients who have congenital heart disease and should be used with precaution in infants who already have been treated with Fosphenytoin or Phenytoin.
  • Decreased lidocaine clearance is expected in the presence of therapeutic hypothermia.
References: 

- Taketomo CK, Hoding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook 22nd Edition. Hudson: lexi-Comp; 2015

- Lau, E (Editor). Drug Handbook and Formulary - The Hospital for Sick Children 2016. Toronto; 2016

- Lundqvist M, Agren J, Hellstrom-Westas L, et al. Efficacy and Safety of Lidocaine for Treatment of Neonatal Seizure.  Acta Paediatrica 2013, 102, pp.863-867

- Rademaker CM, de Vries LS.  Lidocaine for Neonatal Seizure Management.NeoReviews 2008. vol 9, No 12; 585-589

- Malingre MM,  Van Rooij LGM, Rademaker CMA, et al. Development of an optimal lidocaine infusion strategy for neonatal seizures.  Eur J Pediatr (2006) 165: 598-604

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.