Lidocaine Hydrochloride Injection, USP is a sterile, nonpyrogenic solution of Lidocaine Hydrochloride in water for injection for parenteral administration in various concentrations.

Lidocaine Hydrochloride injection, for infiltration and nerve block, should only be used by clinicians who are well versed in diagnosis and management of dose-related toxicity and other acute emergencies that might arise from the block to be employed. You must ensure that the immediate availability of oxygen, and other resuscitative drugs, cardiopulmonary equipment, and the personnel needed for proper management of toxic reactions and related emergencies are in place. Delay in proper management of dose-related toxicity, underventilation from any cause and/or altered sensitivity may lead to the developement of acidosis, cardiac arrest, and possibly death.

To avoid intravascular injection, aspiration should be performed before the local anesthetic solution is injected. The needle must be repositioned until no return of blood can be elicited by aspiration. Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided.

Local anesthetic solutions containing antimicrobial preservatives (e.g., methylparaben) should not be used for epidural or spinal anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental.

Lidocaine injection is given as an infusion into your veins to control your heart rate. Lidocaine may also be given as an injection into the skin or around your spine to numb the area before surgery or other procedures. It is usually given by a health-care professional in a hospital or clinic setting. Your prescriber or health care professional may instruct you on how to give yourself an injection if you get certain abnormal heart rhythms. In this case, you will be given a special self-injector unit with full instructions on how to use it.

Your healthcare provider needs to know if you have any of these conditions:

• heart disease or problems other than rhythm and heart rate problems
• infection
• myasthenia gravis
• liver disease
• an unusual or allergic reaction to lidocaine
• allergic reaction to medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Acute emergencies from local anesthetics are generally related to high plasma levels encountered during therapeutic use of local anesthetics or to unintended subarachnoid injection of local anesthetic solution.

The first consideration is prevention, best accomplished by careful monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered.

Side Effects

Depending upon what condition is being treated with lidocaine, you may experience different side effects. Discuss the possible side effects due to your treatment with your prescriber or health care professional.

Side effects that you should report to your prescriber or health care professional as soon as possible:

• chest pain, continued irregular heartbeats
• difficulty breathing, wheezing
• headache
• seizures (convulsions)
• swelling of the legs or feet
• trembling, shaking
• unusual weakness or tiredness

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

• anxiety, nervousness
• dizziness, drowsiness
• feelings of coldness, heat, or numbness
• pain at the site of the injection
• nausea, vomiting

Drugs that interact with lidocaine injection:

• beta-blockers
• bosentan
• certain medicines for fungal infection
• cimetidine
• bromocriptine
• digoxin
• medicines for high blood pressure
• medicine for chest pain or angina
• medicines for mental depression
• medicines for mental problems and psychotic disturbances
• medicines for migraine
• medicines to control heart rhythm
• phenytoin

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.