- Treatment of ventricular tachycardia, ventricular fibrillation
- Treatment of Phenobarbital resistant seizures (third-line treatment)
- Loading dose
- IV continuous infusion
- Loading dose: over 10 minutes followed by a continuous infusion
- IV continuous infusion
- 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
- Loading dose: 2 mg/kg/dose IV over 10 minutes (may be given if patient in status epilepticus)LoLoading dLoaose: 2 mg/kg/dose (recommended if patient in status epilepticus)LoadinL
- 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.
- 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
- Continuous cardiac monitoring
- Therapeutic drug levels: 6-21 micromol/L (1.5 - 5 mcg/mL)
- Continuous EEG monitoring (if anticonvulsant)
- Use Lidocaine 8 mg/mL prefilled syringe prepared by pharmacy
- Lidocaine 1% (10 mg/mL)
- Take 16 mL (160 mg) and add to 4 mL of D5W
- Final concentration: 8 mg/mL
- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose/saline combinations
- Y-site Compatible: dobutamine, dopamine, heparin, KCl (up to 40mmol/L), morphine
- 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.
- 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