Lidocaine drug monitoring

Survival Prophylactic single dose lidocaine administered in a monitored environment does not appear to affect mortality in the earliest phase of acute Ml, and may harm some patients who are later shown not to have suffered an acute Ml. Constant ECG monitoring Constant ECG monitoring is essential for proper administration. Have emergency resuscitative equipment and drugs immediately available. 

Drug interactions Serious and/or life-threatening drug interactions could occur between amprenavir and amiodarone, lidocaine (systemic), tricyclic antidepressants, and quinidine. Concentration monitoring of these agents is recommended if these agents are used concomitantly with amprenavir. 

The cardiac arrhythmias are life-threatening, so the patient must be closely monitored, with facilities available for possible resuscitation. Drugs such as quinidine and procainamide are contraindicated, but lidocaine, propranolol, or phenytoin has been used safely and effectively. The arterial blood gas levels, pH, and electrolyte concentrations should be monitored so that metabolic acidosis or hypokalemia can be identified that would further aggravate the arrhythmias. Electrical pacing may be required if the antiarrhythmic drugs fail. Hyperpyrexia is treated by cooling. Seizures may be managed by intravenous doses of diazepam. 

Patients with severe decompensated liver disease usually have associated renal impairment, with obvious consequences for drugs eliminated predominantly by the kidney. Where facilities exist, dosing should be guided by plasma concentration monitoring, e.g. of theophylline, lidocaine and phen doin. 

Layton D, Pearce G, Shakir S. Safety profile of tolterodine as used in general practice in England results of prescription event monitoring 2001. Drug Safety 2001 24 703-13. Hine LK, Laird N, Hewitt P, Chalmers TC. Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Arch Intern Med 1989 149 ... 

Lidocaine is the drug of choice for ventricular dysrhythmias, but the client must be monitored by telemetry to determine the specific rhythm. 

Evidence of a pharmacokinetic interaction between lidocaine and amiodarone is conflicting. However, the two reports of adverse interactions and the study in patients with arrhythmias illustrate the importance of good monitoring if hoth drugs are used. 

The lidocaine/cimetidine interaction is well studied but controversial. It is confused by the differences between the studies (healthy subjects, patients with different diseases, different modes of drug administration, etc). A fall in the clearance of lidoeaine (15% or more) and a resultant rise in the serum levels should be looked for if eimetidine is used, but a clinically significant alteration may not occur in every patient. It may possibly be of less importance in patients following a myocardial infarction because of the increased amounts of alpha-l-acid glycoprotein, which alters the levels of bound and free lidoeaine. Monitor all patients closely for evidence of toxicity and, where possible, check serum lidoeaine levels regularly. A reduced infusion rate may be needed. Ranitidine would appear to be a suitable alternative to eimetidine. See also Anaesthetics, local -i- H2-receptor antagonists , p.l 11. 

TLC is useful for monitoring drugs used in the treatment of cardiac disorders. Drugs such as lidocaine and digitalis and its derivatives are used to regulate heartbeat, thus preventing cardiac arrhythmias. Malikin et al. (1984) have reported on the use of HPTLC to monitor the serum of patients treated with various drugs used to control cardiac arrhythmias. 

Dizziness. 4 Hallucinations. 4 Nervousness. Tachycardia. Tachypnea. Seizures. Lidocaine doesn t affect blood pressure, cardiac output or myocardial contractility. Lidocaine is ineffective against atrial arrhythmias. -0 Contraindicated in second- or third-degree AV block without pacing support Reduce drug dosage as ordered in patients with heart failure or liver disease. 0 Monitor patient closely for CNS changes. 

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