LidoPen

Topical:

Lidocaine is a prescription medication used to prevent pain before procedures or to relieve pain due to certain conditions.  Lidocaine patches may be used to treat pain due to post-herpetic neuralgia. Lidocaine ointment, gel, and cream are used to prevent and control pain during procedures, such as intubation and eye surgery, and relieve pain due to conditions such as inflammation of the urethra and sore throat. Lidocaine oral solution is used to treat pain in the mouth.

Injectable:

Injectable lidocaine is used as an anesthetic during surgical procedures.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Topical:

Serious side effects have been reported with topical lidocaine including the following:

Allergic reactions. Tell your healthcare provider right away if you have some or all of the following symptoms of an allergic reaction.

• Difficulty breathing or swallowing
• Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• Hives or skin rash
• Fast heartbeat
• Fast breathing
• Nausea or vomiting
• Confusion
• Weakness
• Fainting
• Seizures or convulsions

Injectable:

Serious side effects have been reported with injectable lidocaine including the following:

Allergic reactions. Tell your healthcare provider right away if you have some or all of the following symptoms of an allergic reaction.

• Difficulty breathing or swallowing
• Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• Hives or skin rash
• Fast pulse
• Fast breathing
• Nausea or vomiting
• Confusion
• Weakness
• Fainting
• Seizures or convulsions

Injectable lidocaine may also affect the central nervous system, including lightheadedness, nervousness, blurred or double vision, altered sensations, and changes in respiration.

Injectable lidocaine may also affect the cardiovascular system, including changes in heartbeat, decreased blood pressure, and cardiac arrest.

Lidocaine can cause drowsiness and dizziness. Do not drive or operate heavy machinery until you know how lidocaine affects you.

Do not take lidocaine if you:

• are allergic to lidocaine or to any of its ingredients
• are allergic to other local anesthetics, including bupivacaine (Marcaine), etidocaine (Duranest), mepivacaine (Carbocaine, Prolocaine), or prilocaine (Citanest)

Additionally, do not take injectable lidocaine if you:

• have Stokes-Adams syndrome or Wolff-Parkinson-White syndrome
• have sinoatrial, atrioventricular, or intraventricular block

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Lidocaine falls into category B.

There are no well-done studies that have been done in humans with lidocaine. In animal studies, pregnant animals were given this medication, and the babies did not show any medical issues related to this medication.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if lidocaine crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using lidocaine.

Lidocaine hydrochloride is reported to increase the electrical stimulation threshold of the ventricle during diastole and, thereby, exert an antiarrhythmic effect. In the dosage recommended, lidocaine hydrochloride produces no change in systolic arterial blood pressure, absolute refractory period, or myocardial contractility.

Clinical studies in which cardiac arrhythmias were monitored indicated that the onset and duration of antiarrhythmic activity of intramuscular lidocaine hydrochloride are correlated with the attained blood levels of lidocaine hydrochloride.

The relative blood levels in normal volunteers obtained by a “conventional” intravenous infusion and following the LidoPen® Auto-Injector can be determined by reference to the accompanying chart.

Approximately 90% of an administered dose of lidocaine hydrochloride is metabolized in the liver. Less than 10% of the drug is excreted unchanged via the kidneys.

Lidocaine hydrochloride is contraindicated in patients with known hypersensitivity to local anesthetics of the amide type, in patients with STOKES-ADAMS Syndrome, Wolff-Parkinson-White Syndrome, or severe degrees of sinoatrial, atrio-ventricular, or intraventricular block.

EVERY EFFORT SHOULD BE MADE TO AVOID POSSIBLE INADVERTENT INTRAVASCULAR ADMINISTRATION THROUGH APPROPRIATE SELECTION OF INJECTION SITE SUCH AS THIGH OR DELTOID. DO NOT INJECT INTO BUTTOCK. Monitoring with an electrocardiograph is recommended when lidocaine hydrochloride is administered by the intramuscular route. In emergency situations when a ventricular rhythm disorder is suspected and electrocardiographic equipment is not available, a single dose may be administered when the physician in attendance has determined that the potential benefits outweigh the possible risks. If possible, emergency resuscitative equipment and drugs should be immediately available to manage potential adverse reactions involving the cardiovascular, respiratory, or central nervous system.

Occasional acceleration of ventricular rate may occur when lidocaine hydrochloride is administered to patients with atrial fibrillation.

General:

Caution should be employed in the repeated use of lidocaine hydrochloride in patients with severe liver or renal disease because accumulation may occur and lead to toxic phenomena since lidocaine hydrochloride is metabolized mainly in the liver and excreted by the kidneys. This drug should also be used with caution in patients with hypovolemia and shock and all forms of heart block.

Half-life and clearance of lidocaine are reduced, when administered to patients on propranolol. A recent study indicates that half-life was prolonged from 65 to 101 minutes and clearance was reduced from 18.0 to 10.7 mL/min/kg after single administration of lidocaine. The clearance of lidocaine was further reduced during continuous infusion. These factors should be considered when the LidoPen® Auto-Injector is prescribed and during use of lidocaine in patients on propranolol. See CONTRAINDICATIONS and WARNINGS.

Information for Patient:

A separate booklet containing patient information and instructions for self-administration is provided. The full text of the booklet is reprinted in DETAILED INSTRUCTIONS section.

Under no circumstances should the LidoPen® Auto-Injector be used without specific instructions to do so by qualified medical personnel.

Unless absolutely necessary, do not attempt to operate a motor vehicle after use.

Drug Interactions:

Caution should be exercised in administration to patient with known or suspected digitalis toxicity accompanied by atrioventricular block. SeeCONTRAINDICATIONS.

Many potent anesthetic drugs, neuromuscular blocking agents and possible amide local anesthetics may serve as triggering agents for the fulminant hypermetabolic process termed malignant hyperthermia.

Drug/Laboratory Test Interactions:

The intramuscular use of lidocaine hydrochloride may result in an increase in creatine phosphokinase levels. Thus, the use of the enzyme determination without isoenzyme separation, as a diagnostic test for the presence of acute myocardial infarction, may be compromised by the use of intramuscular lidocaine hydrochloride.

Carcinogenesis, Mutagenesis, Impairment of Fertility:

Studies of lidocaine in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility have not been conducted.

Usage in Pregnancy:

Pregnancy Category B: Reproduction studies have been performed in rats at doses up to 6.6 times the human dose and have revealed no evidence of harm to the fetus due to lidocaine.

There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Pediatric Use:

Intramuscular lidocaine hydrochloride should not be used in children under 50 kg (110 lbs).

The following types of systemic reactions have been reported with lidocaine hydrochloride administration:

1. Central Nervous System: light-headedness; drowsiness; dizziness; apprehension; euphoria; tinnitus; blurred or double vision; vomiting; sensations of heat, cold or numbness; twitching; tremors; convulsions; unconsciousness; respiratory depression and arrest.
2. Cardiovascular System: hypotension; bradycardia; cardiovascular collapse and cardiac arrest.
3. Allergic reactions may occur but are infrequent. There have been no reports of cross-sensitivity between lidocaine hydrochloride and procainamide or between lidocaine hydrochloride and quinidine.

Soreness at the injection site following intramuscular injection has occasionally been reported.

MANAGEMENT OF ADVERSE REACTIONS

1. In the case of severe reaction, do not continue or repeat administration of the drug.
2. Institute emergency resuscitative procedures including maintenance of patent airway and cardiopulmonary resuscitation, if required.
3. For severe convulsions, parenteral administration of a rapidly acting anticonvulsant may be used by persons appropriately trained in the use of those drugs and the management of the cardiovascular and respiratory depression which may result. Resuscitative equipment should be available.