Lidocaine toxicity

Propranolol may increase procainamide plasma levels. Additive cholinergic effects may occur when procainamide is administered with other drugp with anticholinergic effects. There is the potential of additive cardiodepressant effects when procainamide is administered with lidocaine. When a beta blocker, such as Inderal, is administered with lidocaine, there is an increased risk of lidocaine toxicity. 

MEXILETINE LIDOCAINE Mexiletine t lidocaine levels (with cases of toxicity when lidocaine is given intravenously) Mexiletine displaces lidocaine from its tissue-binding sites it also seems to l its clearance but the exact mechanism is uncertain at present Watch for the early symptoms and signs of lidocaine toxicity (perioral paraesthesia, T muscle tone)... 

BETA-BLOCKERS LIDOCAINE 1. Risk of bradycardia (occasionally severe), 1 BP and heart failure with intravenous lidocaine 2. Risk of lidocaine toxicity due to t plasma concentrations of lidocaine, particularly with propranolol and nadolol 3. t plasma concentrations of propranolol and possibly some other beta-blockers 1. Additive negative inotropic and chronotropic effects 2. Uncertain, but possibly a combination of beta-blocker-induced reduction in hepatic blood flow (due to 1 cardiac output) and inhibition of metabolism of lidocaine 3. Attributed to inhibition of metabolism by lidocaine 1. Monitor PR, BP and ECG closely watch for development of heart failure when intravenous lidocaine is administered to patients on beta-blockers 2. Watch for lidocaine toxicity 3. Be aware. Regional anaesthetics should be used cautiously in patients with bradycardia. Beta-blockers could cause dangerous hypertension due to stimulation of alpha-receptors if epinephrine is used with focal anaesthetic... 

Temporary blindness, an unusual feature of lidocaine toxicity, has been reported in an otherwise healthy young woman (34). 

Lee DL, Ayoub C, Shaw RK, Fontes ML. Grand mal seizure during cardiopulmonary bypass probable lidocaine toxicity. J Cardiothorac Vase Anesth 1999 13(2) 200-2. 

Yamashita S, Sato S, Kakiuchi Y, Miyabe M, Yamaguchi H. Lidocaine toxicity during frequent viscous hdocaine use for painful tongue ulcer. J Pain Symptom Manage 2002 24(5) 543-5. 

Zuberi BF, Shaikh MR, Jatoi NU, Shaikh WM. Lidocaine toxicity in a student undergoing upper gastrointestinal endoscopy. Gut 2000 46(3) 435. 

Mofenson HC, Caraccio TR, Miller H, Greensher J. Lidocaine toxicity from topical mucosal application. With a review of the clinical pharmacology of lidocaine. CUn Pediatr (Phila) 1983 22(3) 190-2. 

Gold MS, Reichling DB, Hampl KF, Drasner K, Levine JD 1998 Lidocaine toxicity in primary afferent neurons from the rat. J Pharmacol Exp Ther 285 413-421... 

IV. Diagnosis is based on a history of local anesthetic use and typical clinical features. Abrupt onset of confusion, slurred speech, or convulsions in a patient receiving lidocaine infusion for arrhythmias should suggest lidocaine toxicity. 

Klein JA, KassarjdianN. Lidocaine toxicity with tumescent Uposuction a case report of probable drug interactions. Dermatol Surg (1997) 23,1169-74. 

A study in 6 healthy subjects receiving 30-hour infusions of lidocaine at a rate of 2 mg/minute found that pretreatment with propranolol 80 mg every 8 hours for 3 days raised the steady-state plasma lidocaine levels by 19% (from 2.1 to 2.5 micrograms/mL) and reduced the plasma clearance by 16%. Other similar studies have found a 22.5 to 30% increase in steady-state serum lidocaine levels and a 14.7 to 46% fall in plasma clearance due to the concurrent use of propranolol. Two cases of lidocaine toxicity attributed to a lidocaine-propranolol interaction were revealed by a search of the FDA adverse drug reaction file in 1981. A further case of lidocaine toxicity (seizures) has been described in a man on propranolol after accidental oral ingestion of lidocaine for oesophageal anaesthesia. High serum levels of lidocaine were detected. ... 

Nervous system Systemic lidocaine toxicity has been described from the simultaneous use of transdermal patches and a heating pad [69 ]. 

A 76-year-old man developed neuro-otologi-cal signs of central lidocaine toxicity, which occurred after he fell asleep on a heating pad with his lidocaine patch attached. The symptoms were present for about 48 hours and then spontaneously resolved. 

Oba H. Large-volume tumescent anesthesia for extensive liposuction in oriental patients lidocaine toxicity and its safe dose level. Plast Reconstr Surg 2003 111(2) 945-6. 

Each Lidoderm patch may be used only once for up to 12 hours/day. Lidoderm patches should be applied to the most painful area, only if the skin is intact. No more than three patches are to be apphed at a time. Average blood concentration achieved with this dosing is between 0.13 and 0.25 pg/mL of lidocaine, depending on the site of application (Table 69.2). Lidocaine toxicity coincides with a lidocaine blood level at or above 5 pg/mL. 

Treatment of overdose life support and symptomatic treatment for acute lidocaine toxicity. Most of the cases present with mild symptoms that respond to temporary discontinuation of treatment and decreasing the dosage. Dialysis was found to play no role in the treatment of lidocaine overdose. 

The authors conclude that despite both lidocaine and flecainide being in the therapeutic range, an interaction with flecainide could potentially be contributing to the lidocaine toxicity caution should be exercised with the combination of these two drugs. 

R. J. Sawyer and H. von Schroeder, Temporary blindness after acute lidocaine toxicity, Anesth. Analg., 2002, 95, 224-226. 

D. Bishop and R. E. Johnstone, Lidocaine toxicity treated with low-dose propofol. Anesthesiology, 1993, 78, 788-789. 

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