Hormonal Lidocaine

Lozenges and troehes are solid preparations designed to dissolve or disintegrate slowly in the mouth their base is usually flavored and sweetened. Examples of eom-pounded troehes include anesthetic (lidocaine), hormonal (testosterone), analgesie (ketamine), and antifungal (nystatin) preparations (Table 2). 

Cardiac failure may also affect metabolism by altering hepatic blood flow. However, even after heart attack without hypotension or cardiac failure, metabolism may be affected. For example, the plasma clearance of lidocaine is reduced in this situation. Other diseases such as those, which affect hormone levels hyper-or hypothyroidism, lack of or excess growth hormone, and diabetes can alter the metabolism of foreign compounds. 

There are many types of steroid hormones in the body, such as the sex/gonadal hormones testosterone and estrogen, thyroid hormones, growth hormones, and stress hormones, which serve various normal functions. One type of steroid— corticosteroids or glucocorticoids—is secreted by the adrenal glands (located just above the kidneys). These steroids, particularly synthetic versions of them, have powerful antiinflammatory actions that help to relieve pain. They are often given as an epidural injection to relieve neck or back pain that results from a compressed or pinched nerve. They can also be injected directly into a joint to relieve pain caused by inflammation in conditions such as tendonitis (inflammation of the tendons), carpal tunnel syndrome, tennis elbow, bursitis (inflammation of sac-like cavities in tendons or muscles that allow them to slide easily over bone), or other joint pain. Professional athletes, who routinely experience one or more of these conditions, are often given local steroid injections. Frequently, the steroid is combined with a local anesthetic such as lidocaine. 

Hormone receptors are heat-labile proteins. Immediately after surgical removal of the specimen, the tissue should be chilled and kept at 4°C to ensure receptor stability during pathology review. At room temperature the half-life of receptors is about 2 hr. Special care must be taken to avoid direct contact with saline or formalin and direct injection of the tumor with lidocaine, since this may falsely decrease estrogen and progesterone receptor values (Mil). 

In the same way that a number of disease processes can impair lidocaine s hepatic metabolism by the cytochrome P450 enzymes, siuprisingly so can hormone replacement therapy. Gawronska-Sldarz and colleagues in 2006 studied in a randomized controlled trial 18 women who received hormone replacement therapy for 6 months [5]. They followed their pharmacokinetic response 360 minutes after an intravenous injection of lidocaine 1 mg/kg before initiation of hormone therapy, at 3 months and at 6 months. They found that the patients showed accelerated drug elimination after 3 months of oral (not transdermal) hormone replacement therapy, which resolved at the 6-month mark. Further studies with larger patient populations are needed to further elucidate this interaction between hormone replacement therapy and lidocaine s hepatic metabolism. 

Gawronska-Szklarz B, Zarzycki M, Musial HD, Pudlo A, Loniewski 1, Drozdzik M. Lidocaine pharmacokinetics in postmenopausal women on hormone therapy. Menopause 2006 13(5) 793-798. 

Corticosteroids in shampoos and other cosmetics are determined by LC-UVA IS or LC with mass spectrometry (MS) detection. Thin layer chromatography (TLC) has also been proposed. Dmgs such as lidocaine are determined by TLC. Hormones are determined by LC procedures. 

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