Lidocaine - wikipedia Lidocaine Lidocaine Clinical data Pronunciation Lidocaine / ˈlaɪdəˌkeɪn / lignocaine / ˈlɪɡnəˌkeɪn / Trade names Xylocaine, others Synonyms N - ( 2, 6 - dimethylphenyl ) - N, N - diethylglycinamide, lignocaine ( AAN AU ) AHFS / Drugs.com Local Monograph Injectable Monograph License data EU EMA : by INN Pregnancy category AU : A US : B ( No risk in non-human studies ) Routes of administration intravenous, subcutaneous, topical, oral ATC code C01BB01 ( WHO ) C05AD01 ( WHO ) D04AB01 ( WHO ) N01BB02 ( WHO ) R02AD02 ( WHO ) S01HA07 ( WHO ) S02DA01 ( WHO ) Legal status Legal status AU : S4 ( Prescription only ) US : ℞ - only ( OTC for ≤ 4 % for topical application for skin numbing use or ≤ 5 % for anorectal hemorroidal pain and to prevent premature ejaculation ) Above 5 % or other routes of administration : RX only. Pharmacokinetic data Bioavailability 35 % ( by mouth ) 3 % ( topical ) Metabolism Liver, 90 % CYP3A4 - mediated Onset of action within 1.5 min ( IV ) Biological half - life 1.5 h to 2 h Duration of action 10 min to 20 min ( IV ), 0.5 h to 3 h ( injection ) Excretion Kidney Identifiers IUPAC name 2 - ( diethylamino ) - N - ( 2, 6 - dimethylphenyl ) acetamide CAS Number 137 - 58 - 6 73 - 78 - 9 ( hydrochloride ) PubChem CID 3676 IUPHAR / BPS 2623 DrugBank DB00281 ChemSpider 3548 UNII 98PI200987 KEGG D00358 ChEBI CHEBI : 6456 ChEMBL CHEMBL79 ECHA InfoCard 100.004. 821 Chemical and physical data Formula Molar mass 234.34 g / mol 3D model ( JSmol ) Interactive image Melting point 68 ° C ( 154 ° F ) SMILES O = C ( Nc1c ( cccc1C ) C ) CN ( CC ) CC InChI InChI = 1S / C14H22N2O / c1 - 5 - 16 ( 6 - 2 ) 10 - 13 ( 17 ) 15 - 14 - 11 ( 3 ) 8 - 7 - 9 - 12 ( 14 ) 4 / h7 - 9H, 5 - 6, 10H2, 1 - 4H3, ( H, 15, 17 ) Key : NNJVILVZKWQKPM - UHFFFAOYSA - N ( verify ) Lidocaine, also known as xylocaine and lignocaine, is a medication used to numb tissue in a specific area. It is also used to treat ventricular tachycardia and to perform nerve blocks. Lidocaine mixed with a small amount of adrenaline ( epinephrine ) is available to allow larger doses for numbing, to decrease bleeding, and to make the numbing effect last longer. When used as an injectable, it typically begins working within four minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. Common side effects with intravenous use include sleepiness, muscle twitching, confusion, changes in vision, numbness, tingling, and vomiting. It can cause low blood pressure and an irregular heart rate. There are concerns that injecting it into a joint can cause problems with the cartilage. It appears to be generally safe for use in pregnancy. A lower dose may be required in those with liver problems. It is generally safe to use in those allergic to tetracaine or benzocaine. Lidocaine is an antiarrhythmic medication of the class Ib type. Lidocaine works by blocking sodium channels and thus decreasing the rate of contractions of the heart. When used locally as a numbing agent, local neurons can not signal the brain. Lidocaine was discovered in 1946 and went on sale in 1948. It is on the World Health Organization 's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication and is not very expensive. The wholesale cost in the developing world in 2014 was US $0.45 to $1.05 wholesale per 20ml vial of medication. Contents 1 Medical uses 1.1 Local numbing agent 1.2 Heart arrhythmia 1.3 Epilepsy 1.4 Other 1.5 Insensitivity 1.6 Dosage forms 2 Adverse effects 2.1 Interactions 2.2 Contraindications 2.3 Overdosage 3 Pharmacology 3.1 Mechanism of action 3.2 Pharmacokinetics 4 History 5 Society and culture 5.1 Names 5.2 Recreational use 5.3 Adulterant in cocaine 5.4 Compendial status 6 Veterinary use 7 See also 8 References 9 External links Medical Uses Local numbing agent The efficacy profile of lidocaine as a local anaesthetic is characterized by a rapid onset of action and intermediate duration of efficacy. Therefore, lidocaine is suitable for infiltration, block, and surface anaesthesia. Longer - acting substances such as bupivacaine are sometimes given preference for spinal and epidural anaesthesias ; lidocaine, though, has the advantage of a rapid onset of action. Adrenaline vasoconstricts arteries, reducing bleeding and also delays the resorption of lidocaine, almost doubling the duration of anaesthesia. For surface anaesthesia, several formulations can be used for endoscopies, before intubations, etc. Buffering the pH of lidocaine makes local numbing less painful. Lidocaine drops can be used on the eyes for short ophthalmic procedures. There is tentative evidence for topical lidocaine for neuropathic pain and skin graft donor site pain. As a local numbing agent, it is used for the treatment of premature ejaculation. Heart arrhythmia Lidocaine is also the most important class - 1b antiarrhythmic drug ; it is used intravenously for the treatment of ventricular arrhythmias ( for acute myocardial infarction, digoxin poisoning, cardioversion, or cardiac catheterization ) if amiodarone is not available or contraindicated. Lidocaine should be given for this indication after defibrillation, CPR, and vasopressors have been initiated. A routine preventative dose is no longer recommended after a myocardial infarction as the overall benefit is not convincing. Epilepsy A 2013 review on treatment for neonatal seizures recommended intravenous lidocaine as a second line treatment, if phenobarbital fails to stop seizures. Other Inhaled lidocaine can be used as a cough suppressor acting peripherally to reduce the cough reflex. This application can be implemented as a safety and comfort measure for patients who have to be intubated, as it reduces the incidence of coughing and any tracheal damage it might cause when emerging from anaesthesia. Lidocaine, along with ethanol, ammonia, and acetic acid, may also help in treating jellyfish stings, both numbing the affected area and preventing further nematocyst discharge. For gastritis, drinking viscous lidocaine may help with the pain. Insensitivity Relative insensitivity to lidocaine is genetic. In hypokalemic sensory overstimulation, relative insensitivity to lidocaine has been described in people who also have attention deficit hyperactivity disorder. In dental anaesthesia, a relative insensitivity to lidocaine can occur for anatomical reasons due to unexpected positions of nerves. Some people with Ehlers - Danlos syndrome are insensitive to lidocaine. Dosage forms Lidocaine, usually in the form of lignocaine hydrochloride, is available in various forms including many topical formulations and solutions for injection or infusion. Lidocaine hydrochloride 2 % epinephrine 1 : 80,000 solution for injection in a cartridge Lidocaine hydrochloride 1 % solution for injection Topical lidocaine spray 2 % viscous lidocaine Adverse effects Adverse drug reactions ( ADRs ) are rare when lidocaine is used as a local anesthetic and is administered correctly. Most ADRs associated with lidocaine for anesthesia relate to administration technique ( resulting in systemic exposure ) or pharmacological effects of anesthesia, and allergic reactions only rarely occur. Systemic exposure to excessive quantities of lidocaine mainly result in central nervous system ( CNS ) and cardiovascular effects -- CNS effects usually occur at lower blood plasma concentrations and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. ADRs by system are : CNS excitation : nervousness, agitation, anxiety, apprehension, tingling around the mouth ( circumoral paraesthesia ), headache, hyperesthesia, tremor, dizziness, pupillary changes, psychosis, euphoria, hallucinations, and seizures CNS depression with increasingly heavier exposure : drowsiness, lethargy, slurred speech, hypoesthesia, confusion, disorientation, loss of consciousness, respiratory depression and apnoea. Cardiovascular : hypotension, bradycardia, arrhythmias, flushing, venous insufficiency, increased defibrillator threshold, edema, and / or cardiac arrest -- some of which may be due to hypoxemia secondary to respiratory depression. Respiratory : bronchospasm, dyspnea, respiratory depression or arrest Gastrointestinal : metallic taste, nausea, vomiting Ears : tinnitus Eyes : local burning, conjunctival hyperemia, corneal epithelial changes / ulceration, diplopia, visual changes ( opacification ) Skin : itching, depigmentation, rash, urticaria, edema, angioedema, bruising, inflammation of the vein at the injection site, irritation of the skin when applied topically Blood : methemoglobinemia Allergy ADRs associated with the use of intravenous lidocaine are similar to toxic effects from systemic exposure above. These are dose - related and more frequent at high infusion rates ( ≥ 3 mg / min ). Common ADRs include : headache, dizziness, drowsiness, confusion, visual disturbances, tinnitus, tremor, and / or paraesthesia. Infrequent ADRs associated with the use of lidocaine include : hypotension, bradycardia, arrhythmias, cardiac arrest, muscle twitching, seizures, coma, and / or respiratory depression. It is generally safe to use lidocaine with vasoconstrictor such as epinephrine including in regions such as the nose, ears, fingers and toes. While concerns of tissue death if used in these areas have been raised evidence does not support these concerns. Interactions Any drugs that are also ligands of CYP3A4 and CYP1A2 can potentially increase serum levels and potential for toxicity or decrease serum levels and the efficacy, depending on whether they induce or inhibit the enzymes, respectively. Drugs that may increase the chance of methemoglobinemia should also be considered carefully. Dronedarone and liposomal morphine are both absolutely contraindicated, as they may increase the serum levels, but hundreds of other drugs require monitoring for interaction. Contraindications Absolute contraindications for the use of lidocaine include : Heart block, second or third degree ( without pacemaker ) Severe sinoatrial block ( without pacemaker ) Serious adverse drug reaction to lidocaine or amide local anesthetics Hypersensitivity to corn and corn - related products ( corn - derived dextrose is used in the mixed injections ) Concurrent treatment with quinidine, flecainide, disopyramide, procainamide ( class I antiarrhythmic agents ) Prior use of amiodarone hydrochloride Adams - Stokes syndrome Wolff - Parkinson - White syndrome Lidocaine viscous is not recommended by the FDA to treat teething pain in children and infants. Exercise caution in patients with any of these : Hypotension not due to arrhythmia Bradycardia Accelerated idioventricular rhythm Elderly patients Pseudocholinesterase deficiency Intra-articular infusion ( this is not an approved indication and can cause chondrolysis ) Porphyria, especially acute intermittent porphyria ; lidocaine has been classified as porphyrogenic because of the hepatic enzymes it induces, although clinical evidence suggests it is not. Bupivacaine is a safe alternative in this case. Impaired liver function - people with lowered hepatic function may have an adverse reaction with repeated administration of lidocaine because the drug is metabolized by the liver. Adverse reactions may include neurological symptoms ( e.g. dizziness, nausea, muscle twitches, vomiting, or seizures ). Overdosage Overdoses with lidocaine can be a result of excessive administration by topical or parenteral routes, accidental oral ingestion of topical preparations by children who are more susceptible to overdose, accidental intravenous ( rather than subcutaneous, intrathecal, or paracervical ) injection, or prolonged use of subcutaneous infiltration anesthesia during cosmetic surgical procedures. These occurrences have often led to severe toxicity or death in both children and adults. Lidocaine and its two major metabolites may be quantified in blood, plasma, or serum to confirm the diagnosis in potential poisoning victims or to assist in the forensic investigation in a case of fatal overdose. It is important in the interpretation of analytical results to recognize that lidocaine is often routinely administered intravenously as an antiarrhythmic agent in critical cardiac - care situations. Treatment with intravenous lipid emulsions ( used for parental feeding ) to reverse the effects of local anaesthetic toxicity is becoming more commonplace than it was in the past. Pharmacology Mechanism of action Lidocaine alters signal conduction in neurons by blocking the fast voltage - gated Na channels in the neuronal cell membrane responsible for signal propagation. With sufficient blockage, the membrane of the postsynaptic neuron will not depolarize and will thus fail to transmit an action potential. This creates the anaesthetic effect by not merely preventing pain signals from propagating to the brain, but by stopping them before they begin. Careful titration allows for a high degree of selectivity in the blockage of sensory neurons, whereas higher concentrations also affect other modalities of neuron signaling. The same principle applies for this drug 's actions in the heart. Blocking sodium channels in the conduction system, as well as the muscle cells of the heart, raises the depolarization threshold, making the heart less likely to initiate or conduct early action potentials that may cause an arrhythmia. Pharmacokinetics When used as an injectable it typically begins working within four minutes and lasts for half an hour to three hours. Lidocaine is about 95 % metabolized ( dealkylated ) in the liver mainly by CYP3A4 to the pharmacologically active metabolites monoethylglycinexylidide ( MEGX ) and then subsequently to the inactive glycine xylidide. MEGX has a longer half - life than lidocaine, but also is a less potent sodium channel blocker. The volume of distribution is 1.1 L / kg to 2.1 L / kg, but congestive heart failure can decrease it. About 60 % to 80 % circulates bound to the protein alpha acid glycoprotein. The oral bioavailability is 35 % and the topical bioavailability is 3 %. The elimination half - life of lidocaine is biphasic and around 90 min to 120 min in most patients. This may be prolonged in patients with hepatic impairment ( average 343 min ) or congestive heart failure ( average 136 min ). Lidocaine is excreted in the urine ( 90 % as metabolites and 10 % as unchanged drug ). History Lidocaine, the first amino amide -- type local anesthetic, was first synthesized under the name ' xylocaine ' by Swedish chemist Nils Löfgren in 1943. His colleague Bengt Lundqvist performed the first injection anesthesia experiments on himself. It was first marketed in 1949. Society and culture Names Lidocaine is the INN and BAN while lignocaine is the AAN and former BAN. Xylocaine is a brandname. Recreational use Lidocaine is not currently listed by the World Anti-Doping Agency as an illegal substance. It is used as an adjuvant, adulterant, and diluent to street drugs such as cocaine and heroin. It is one of the three common ingredients in site enhancement oil used by bodybuilders. Adulterant in cocaine Lidocaine is often added to cocaine as a diluent. Cocaine numbs the gums when applied. Lidocaine causes a similar numbing sensation when applied to the gums and is sometimes used as an adulterant in cocaine. This gives the user the impression of high - quality cocaine when in actuality, the user is receiving a diluted product. Compendial status Japanese Pharmacopoeia 15 United States Pharmacopeia 31 Veterinary use It is a component of the veterinary drug Tributame along with embutramide and chloroquine used to carry out euthanasia on horses and dogs. See also Lidocaine / prilocaine Dimethocaine ( has some DRI activity ) Procaine References Jump up ^ `` Lidocaine ''. Merriam - Webster Dictionary. Jump up ^ `` Lidocaine ''. Dictionary.com Unabridged. Random House. ^ Jump up to : `` Lidocaine Hydrochloride ( Antiarrhythmic ) ''. The American Society of Health - System Pharmacists. Archived from the original on 2015 - 08 - 10. Retrieved Aug 26, 2015. ^ Jump up to : `` Lidocaine Hydrochloride ( Local ) ''. The American Society of Health - System Pharmacists. Archived from the original on 2015 - 09 - 06. Retrieved Aug 26, 2015. ^ Jump up to : J. P. Nolan & P. J. F. Baskett ( 1997 ). `` Analgesia and anaesthesia ''. In David Skinner, Andrew Swain, Rodney Peyton & Colin Robertson. Cambridge Textbook of Accident and Emergency Medicine. Project co-ordinator, Fiona Whinster. Cambridge, UK : Cambridge University Press. p. 194. ISBN 9780521433792. Archived from the original on 2017 - 09 - 08. CS1 maint : Uses authors parameter ( link ) CS1 maint : Uses editors parameter ( link ) Jump up ^ Scriabine, Alexander ( 1999 ). `` Discovery and development of major drugs currently in use ''. In Ralph Landau, Basil Achilladelis & Alexander Scriabine. Pharmaceutical Innovation : Revolutionizing Human Health. Philadelphia : Chemical Heritage Press. p. 211. ISBN 9780941901215. Archived from the original on 2017 - 09 - 08. CS1 maint : Uses editors parameter ( link ) Jump up ^ `` WHO Model List of Essential Medicines ( 19th List ) '' ( PDF ). World Health Organization. April 2015. Archived ( PDF ) from the original on 13 December 2016. Retrieved 8 December 2016. Jump up ^ Hamilton, Richart ( 2015 ). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab - Coat Edition. Jones & Bartlett Learning. p. 22. ISBN 9781284057560. Jump up ^ `` Lidocaine HCL ''. International Drug Price Indicator Guide. Retrieved 27 August 2015. Jump up ^ Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R ( 2010 ). `` Adjusting the pH of lidocaine for reducing pain on injection ''. Cochrane Database Syst Rev ( 12 ) : CD006581. PMID 21154371. doi : 10.1002 / 14651858. CD006581. pub2. Jump up ^ Derry, S ; Wiffen, PJ ; Moore, RA ; Quinlan, J ( 24 July 2014 ). `` Topical lidocaine for neuropathic pain in adults ''. The Cochrane database of systematic reviews. 7 : CD010958. PMID 25058164. doi : 10.1002 / 14651858. CD010958. pub2. Jump up ^ Sinha S, Schreiner AJ, Biernaskie J, Nickerson D, Gabriel VA ( June 2017 ). `` Treating pain on skin graft donor sites : review and clinical recommendations. ''. J Trauma Acute Care Surg. PMID 28598907. doi : 10.1097 / TA. 0000000000001615. Jump up ^ `` Lidocaine / prilocaine spray for premature ejaculation. ''. Drug and therapeutics bulletin. 55 ( 4 ) : 45 -- 48. April 2017. PMID 28408390. doi : 10.1136 / dtb. 2017.4. 0469. Jump up ^ Martí - Carvajal, AJ ; Simancas - Racines, D ; Anand, V ; Bangdiwala, S ( 21 August 2015 ). `` Prophylactic lidocaine for myocardial infarction ''. The Cochrane database of systematic reviews. 8 : CD008553. PMID 26295202. doi : 10.1002 / 14651858. CD008553. pub2. Jump up ^ Slaughter, LA ; Patel, AD ; Slaughter, JL ( March 2013 ). `` Pharmacological treatment of neonatal seizures : a systematic review. ''. Journal of child neurology. 28 ( 3 ) : 351 -- 64. PMC 3805825. PMID 23318696. doi : 10.1177 / 0883073812470734. Jump up ^ Biller JA ( 2007 ). `` Airway obstruction, bronchospasm, and cough ''. In Berger AM, Shuster JL, Von Roenn JH. Principles and practice of palliative care and supportive oncology. Hagerstwon, MD : Lippincott Williams & Wilkins. pp. 297 -- 307. ISBN 978 - 0 - 7817 - 9595 - 1. Inhaled lidocaine is used to suppress cough during bronchoscopy. Animal studies and a few human studies suggest that lidocaine has an antitussive effect... Jump up ^ Birsa LM, Verity PG, Lee RF ( May 2010 ). `` Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts ''. Comp. Biochem. Physiol. C Toxicol. Pharmacol. 151 ( 4 ) : 426 -- 30. PMID 20116454. doi : 10.1016 / j. cbpc. 2010.01. 007. Jump up ^ Morabito R, Marino A, Dossena S, La Spada G ( Jun 2014 ). `` Nematocyst discharge in Pelagia noctiluca ( Cnidaria, Scyphozoa ) oral arms can be affected by lidocaine, ethanol, ammonia and acetic acid ''. Toxicon. 83 : 52 -- 8. PMID 24637105. doi : 10.1016 / j. toxicon. 2014.03. 002. Jump up ^ James G. Adams ( 2012 ). `` 32 ''. Emergency Medicine : Clinical Essentials. Elsevier Health Sciences. ISBN 9781455733941. Archived from the original on 2017 - 09 - 08. Jump up ^ Segal MM, Rogers GF, Needleman HL, Chapman CA ( Dec 2007 ). `` Hypokalemic sensory overstimulation ''. Journal of child neurology. 22 ( 12 ) : 1408 -- 10. PMID 18174562. doi : 10.1177 / 0883073807307095. Jump up ^ Hakim AJ, Grahame R, Norris P, Hopper C ( February 2005 ). `` Local anaesthetic failure in joint hypermobility syndrome ''. JR Soc Med. 98 ( 2 ) : 84 -- 5. PMC 1079398. PMID 15684369. doi : 10.1258 / jrsm. 98.2. 84. Jump up ^ `` Lidocaine international forms and names ''. Drugs.com. Retrieved 29 October 2017. Jump up ^ Jackson D, Chen AH, Bennett CR ( October 1994 ). `` Identifying true lidocaine allergy ''. J Am Dent Assoc. 125 ( 10 ) : 1362 -- 6. PMID 7844301. ^ Jump up to : Australian Medicines Handbook. Adelaide, S. Aust : Australian Medicines Handbook Pty Ltd. 2006. ISBN 0 - 9757919 - 2 - 3. ^ Jump up to : Nielsen, LJ ; Lumholt, P ; Hölmich, LR ( 27 October 2014 ). `` ( Local anaesthesia with vasoconstrictor is safe to use in areas with end - arteries in fingers, toes, noses and ears. ) ''. Ugeskrift for laeger. 176 ( 44 ). PMID 25354008. Jump up ^ `` Lidocaine ''. Epocrates. Archived from the original on 2014 - 04 - 22. ^ Jump up to : `` Lidocaine Hydrochloride and 5 % Dextrose Injection ''. Safety Labeling Changes. FDA Center for Drug Evaluation and Research ( CDER ). January 2014. Archived from the original on 2013 - 04 - 03. Jump up ^ `` Lidocaine Viscous : Drug Safety Communication - Boxed Warning Required - Should Not Be Used to Treat Teething Pain ''. FDA Center for Drug Evaluation and Research ( CDER ). June 2014. Archived from the original on 2014 - 07 - 14. Jump up ^ `` Table 96 -- 4. Drugs and Porphyria '' ( PDF ). Merck Manual. Merck & Company, Inc. 2011. Archived ( PDF ) from the original on 2014 - 04 - 20. Jump up ^ `` Lidocaine - N01BB02 ''. Drug porphyrinogenicity monograph. The Norwegian Porphyria Centre and the Swedish Porphyria Centre. Archived from the original on 2014 - 04 - 20. strong clinical evidence points to lidocaine as probably not porphyrinogenic Jump up ^ Khan, M. Gabriel ( 2007 ). Cardiac Drug Therapy ( 7th ed. ). Totowa, NJ : Humana Press. ISBN 9781597452380. Jump up ^ Baselt R ( 2008 ). Disposition of Toxic Drugs and Chemicals in Man ( 8th ed. ). Foster City, CA : Biomedical Publications. pp. 840 -- 4. ISBN 0 - 9626523 - 7 - 7. Jump up ^ Picard J, Ward SC, Zumpe R, Meek T, Barlow J, Harrop - Griffiths W ( February 2009 ). `` Guidelines and the adoption of ' lipid rescue ' therapy for local anaesthetic toxicity ''. Anaesthesia. 64 ( 2 ) : 122 -- 5. PMID 19143686. doi : 10.1111 / j. 1365 - 2044.2008. 05816. x. Jump up ^ Carterall, William A. ( 2001 ). `` Molecular mechanisms of gating and drug block of sodium channels ''. Sodium Channels and Neuronal Hyperexcitability. Novartis Foundation Symposia. 241. pp. 206 -- 225. ISBN 9780470846681. doi : 10.1002 / 0470846682. ch14. Jump up ^ Sheu SS, Lederer WJ ( Oct 1985 ). `` Lidocaine 's negative inotropic and antiarrhythmic actions. Dependence on shortening of action potential duration and reduction of intracellular sodium activity ''. Circulation Research. 57 ( 4 ) : 578 -- 90. PMID 2412723. doi : 10.1161 / 01. res. 57.4. 578. Jump up ^ Lewin NA, Nelson LH ( 2006 ). `` Chapter 61 : Antidysrhythmics ''. In Flomenbaum N, Goldfrank LR, Hoffman RL, Howland MD, Lewin NA, Nelson LH. Goldfrank 's Toxicologic Emergencies ( 8th ed. ). New York : McGraw - Hill. pp. 963 -- 4. ISBN 0 - 07 - 143763 - 0. Jump up ^ Thomson PD, Melmon KL, Richardson JA, Cohn K, Steinbrunn W, Cudihee R, Rowland M ( April 1973 ). `` Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans ''. Ann. Intern. Med. 78 ( 4 ) : 499 -- 508. PMID 4694036. doi : 10.7326 / 0003 - 4819 - 78 - 4 - 499. Jump up ^ Collinsworth KA, Kalman SM, Harrison DC ( 1974 ). `` The clinical pharmacology of lidocaine as an antiarrhythymic drug ''. Circulation. 50 ( 6 ) : 1217 -- 30. PMID 4609637. doi : 10.1161 / 01. CIR. 50.6. 1217. ^ Jump up to : Löfgren N ( 1948 ). Studies on local anesthetics : Xylocaine : a new synthetic drug ( Inaugural dissertation ). Stockholm, Sweden : Ivar Heggstroms. OCLC 646046738. Jump up ^ Löfgren N, Lundqvist B ( 1946 ). `` Studies on local anaesthetics II ''. Svensk Kemisk Tidskrift. 58 : 206 -- 17. Jump up ^ Wildsmith JAW ( 2011 ). `` Lidocaine : A more complex story than ' simple ' chemistry suggests '' ( PDF ). The Proceedings of the History of Anaesthesia Society. 43 : 9 -- 16. Archived ( PDF ) from the original on 2014 - 04 - 22. Jump up ^ `` The 2010 Prohibited List International Standard '' ( PDF ). The World Anti-Doping Code. World Anti-Doping Agency ( WADA ). 19 September 2009. Archived from the original ( PDF ) on 11 September 2013. Jump up ^ `` New York Drug Threat Assessment ''. National Drug Intelligence Center. November 2002. Archived from the original on 2012 - 08 - 12. Jump up ^ Pupka, A ; Sikora, J ; Mauricz, J ; Cios, D ; Płonek, T ( 2009 ). `` ( The usage of synthol in the body building ). ''. Polimery w medycynie. 39 ( 1 ) : 63 -- 5. PMID 19580174. Jump up ^ Bernardo NP ; Siqueira MEPB ; De Paiva MJN ; Maia PP ( 2003 ). `` Caffeine and other adulterants in seizures of street cocaine in Brazil ''. International Journal of Drug Policy. 14 ( 4 ) : 331 -- 4. doi : 10.1016 / S0955 - 3959 ( 03 ) 00083 - 5. Jump up ^ `` UNITED STATES of America, Plaintiff - Appellee, v. Luis A. CUELLO, Alvaro Bastides - Benitez, John Doe, a / k / a Hugo Hurtado, and Alvaro Carvajal, Defendants - Appellants ''. Docket No. 78 - 5314. United States Court of Appeals, Fifth Circuit. 1979 - 07 - 25. Archived from the original on 2012 - 05 - 24. Jump up ^ Winterman, Denise. `` How cutting drugs became big business ''. BBC News Magazine. Archived from the original on 2 February 2017. Retrieved 20 January 2017. Jump up ^ `` Revision Bulletin : Lidocaine and Prilocaine Cream -- Revision to Related Compounds Test ''. The United States Pharmacopeial Convention. November 30, 2007. Archived from the original on May 1, 2013. Jump up ^ Peterson, Michael E. ; Talcott, Patricia A. ( 2013 - 08 - 07 ). Small Animal Toxicology. Elsevier Health Sciences. ISBN 0323241980. Archived from the original on 2017 - 09 - 08. Jump up ^ `` FDA Freedom of Information Summary - TRIBUTAME '' ( PDF ). Archived ( PDF ) from the original on 2015 - 05 - 18. External links U.S. National Library of Medicine : Drug Information Portal - Lidocaine Endo Pharmaceuticals ' Lidoderm website Antiarrhythmic agents ( C01B ) Channel blockers class I ( Na channel blockers ) class Ia ( Phase 0 → and Phase 3 → ) Ajmaline Disopyramide Hydroquinidine Lorajmine Prajmaline Procainamide Quinidine Sparteine class Ib ( Phase 3 ← ) IV Lidocaine enteral Aprindine Mexiletine Tocainide class Ic ( Phase 0 → ) Encainide Ethacizine Flecainide Indecainide Lorcainide Moracizine Propafenone class III ( Phase 3 →, K channel blockers ) Amiodarone Bretylium Bunaftine Celivarone Dofetilide Dronedarone E-4031 Ibutilide Nifekalant Sotalol Tedisamil Vernakalant class IV ( Phase 4 →, Ca channel blockers ) Diltiazem Verapamil Receptor agonists and antagonists class II ( Phase 4 →, β blockers ) Nadolol Pindolol Propranolol cardioselective Acebutolol Atenolol Esmolol Metoprolol A agonist Adenosine Benzodiazepines Barbiturates muscarinic antagonist : Atropine Disopyramide Quinidine muscarinic agonist : Digoxin α receptors Amiodarone Bretylium Quinidine Verapamil Ion transporters Na / K - ATPase Digoxin WHO - EM Withdrawn from market Clinical trials : Phase III Never to phase III Vasoprotectives ( C05 ) Antihemorrhoidals for topical use corticosteroids Hydrocortisone Prednisolone Betamethasone Fluorometholone Fluocortolone Dexamethasone Fluocinolone acetonide Fluocinonide local anesthetics Lidocaine Tetracaine Benzocaine Dibucaine Procaine Oxetacaine Pramocaine other Tribenoside Antivaricose therapy heparins or heparinoids for topical use Organo - heparinoid Sodium apolate Heparin Pentosan polysulfate sclerosing agents for local injection Monoethanolamine oleate Polidocanol Inverted sugar syrup Sodium tetradecyl sulfate Phenol other Calcium dobesilate Capillary stabilising agents bioflavonoids Rutoside Monoxerutin Diosmin Troxerutin Hidrosmin other Tribenoside Etamsylate Antipruritics ( D04 ) Antihistamines for topical use Thonzylamine Mepyramine Thenalidine Tripelennamine Chloropyramine Promethazine Tolpropamine Dimetindene Clemastine Bamipine Isothipendyl Diphenhydramine Chlorphenoxamine Anesthetics for topical use Lidocaine Dibucaine Oxybuprocaine Benzocaine Quinisocaine Tetracaine Pramocaine Others Corticosteroids ( e.g., hydrocortisone ) Counterirritants ( e.g., mint oil, menthol, camphor ) Nalfurafine Local anesthetics ( primarily sodium channel blockers ) ( N01B ) Esters by acid Aminobenzoic Benzocaine Butacaine Butamben Chloroprocaine Dimethocaine Lucaine Meprylcaine Metabutethamine Metabutoxycaine Nitracaine Orthocaine Propoxycaine Procaine ( Novocaine ) Proxymetacaine Risocaine Tetracaine Benzoic Amylocaine Cocaine Cyclomethycaine α - Eucaine β - Eucaine Hexylcaine Isobucaine Piperocaine ArCO2 - ( not para-amino or Ph ) Amoproxan ( 3, 4, 5 - Trimethoxybenzoyl ) 3 - ( p - Fluorobenzoyloxy ) tropane Amides Articaine Bupivacaine / Levobupivacaine / Ropivacaine Butanilicaine Carticaine Dibucaine Etidocaine Lidocaine Mepivacaine Prilocaine Trimecaine Combinations Lidocaine / prilocaine Anesthetic / vasoconstrictor TAC Iontocaine WHO - EM Withdrawn from market Clinical trials : Phase III Never to phase III Neuropathic pain and fibromyalgia pharmacotherapies Monoaminergics SNRIs ( e.g., duloxetine, milnacipran ) TCAs ( e.g., amitriptyline, nortriptyline, dosulepin ) Opioid MRIs ( e.g., tapentadol, tramadol ) Ion channel blockers Anticonvulsants ( e.g., gabapentin, pregabalin, carbamazepine, oxcarbazepine, lacosamide, lamotrigine ) Local anesthetics ( e.g., lidocaine ) Mexiletine TCAs ( e.g., amitriptyline, nortriptyline, desipramine ) Ziconotide Others Alpha lipoic acid Benfotiamine Botulinum toxin A Bupropion Cannabinoids ( e.g., cannabis, dronabinol, nabilone ) NMDA receptor antagonists ( e.g., ketamine, dextromethorphan, methadone ) Opioids ( e.g., hydrocodone, morphine, oxycodone, methadone, buprenorphine, tramadol, tapentadol ) Sodium oxybate ( GHB ) Throat preparations ( R02 ) Antiseptics Acriflavinium chloride Ambazone Amylmetacresol Benzalkonium Benzethonium Cetrimonium ( bromide / chloride ) Cetylpyridinium Chlorhexidine Chlorquinaldol Dequalinium Dichlorobenzyl alcohol Hexamidine Hexylresorcinol Myristyl - benzalkonium Oxyquinoline Phenol Povidone - iodine Antibiotics Bacitracin Fusafungine Gramicidin Neomycin Tyrothricin Local anesthetics Benzocaine Cocaine Dyclonine Lidocaine Other Flurbiprofen Drugs used for diseases of the ear ( S02 ) Infection Acetic acid Aluminium acetotartrate Aluminium triacetate ( Burow 's solution ) Boric acid Chloramphenicol Chlorhexidine Ciprofloxacin Clioquinol Gentamicin Hydrogen peroxide Miconazole Neomycin Nitrofurazone Ofloxacin Polymyxin B Rifamycin Tetracycline Corticosteroids Betamethasone Dexamethasone Fluocinolone acetonide Hydrocortisone Prednisolone Analgesics and anesthetics Lidocaine Cocaine Phenazone Ion channel modulators Calcium VDCCs Blockers L - type - selective : Dihydropyridines : Amlodipine Aranidipine Azelnidipine Barnidipine Clevidipine Cronidipine Darodipine Dexniguldipine Elgodipine Elnadipine Felodipine Flordipine Furnidipine Iganidipine Isradipine Lacidipine Lemildipine Lercanidipine Levamlodipine Levniguldipine Manidipine Mepirodipine Mesudipine Nicardipine Nifedipine Niguldipine Niludipine Nilvadipine Nimodipine Nisoldipine Nitrendipine Olradipine Oxodipine Palonidipine Pranidipine Ryodipine ( riodipine ) Sagandipine Sornidipine Teludipine Tiamdipine Trombodipine Vatanidipine ; Diltiazem derivatives : Clentiazem Diltiazem Iprotiazem Nictiazem Siratiazem ; Phenylalkylamines : Anipamil Dagapamil Devapamil Dexverapamil Emopamil Etripamil Falipamil Gallopamil Levemopamil Nexopamil Norverapamil Ronipamil Tiapamil Verapamil ; Others : AH - 1058 Brinazarone Budiodarone Celivarone Cyproheptadine Dronedarone Fantofarone SR - 33805 Tetrahydropalmatine N - type - selective : ω - Conotoxins ω - Conotoxin GVIA Caroverine Huwentoxin XVI Leconotide ( ω - conotoxin CVID ) PD - 173212 Ralfinamide Safinamide Z160 Ziconotide ( ω - conotoxin MVIIA ) P - type - selective : ω - Agatoxin IVA ω - Agatoxin IVB R - type - selective : SNX - 482 T - type - selective : ABT - 639 ML - 218 Niflumic acid NNC 55 - 0396 ProTx I Z944 Zonisamide Non-selective : ω - Agatoxin TK ω - Conotoxin MVIIC Benidipine Bepridil Cilnidipine Cinnarizine Dotarizine Efonidipine Flunarizine Lamotrigine Levetiracetam Lomerizine Loperamide Mibefradil NP078585 Ruthenium red TROX - 1 α δ subunit - selective ( gabapentinoids ) : 4 - Methylpregabalin Arbaclofen Arbaclofen placarbil Atagabalin Baclofen Gabapentin Gabapentin enacarbil Imagabalin Mirogabalin PD - 200,347 PD - 217,014 PD - 299,685 Phenibut Pregabalin Others / unsorted : Bencyclane Berbamine Bevantolol Canadine Carboxyamidotriazole Cycleanine Dauricine Dimeditiapramine Diproteverine Enpiperate Eperisone Elpetrigine Ethadione Ethanol ( alcohol ) Ethosuximide Fasudil Fendiline Fostedil Imepitoin JTV - 519 Lidoflazine Magnesium Manoalide Mesuximide Monatepil Naftopidil Ochratoxin A Osthol Otilonium bromide Paramethadione Phensuximide Pinaverium Prenylamine Rhynchophylline Sesamodil Silperisone Sipatrigine Terodiline Tetrandrine Tolperisone Trimethadione Valperinol Activators L - type - selective : Bay K8644 Potassium VGKCs Blockers 3, 4 - Diaminopyridine ( amifampridine ) 4 - Aminopyridine ( fampridine / dalfampridine ) Adekalant Almokalant Amiodarone Azimilide Bretylium Bunaftine Charybdotoxin Clamikalant Conotoxins Dalazatide Dendrotoxin Dofetilide Dronedarone E-4031 Hanatoxin HgeTx1 HsTx1 Ibutilide Inakalant Kaliotoxin Linopirdine Lolitrem B Maurotoxin Nifekalant Notoxin Paxilline Pinokalant Quinidine ShK - 186 Sotalol Tedisamil Terikalant Tetraethylammonium Vernakalant hERG ( KCNH2, K 11.1 ) - specific : Ajmaline Amiodarone AmmTX3 Astemizole Azaspiracid AZD1305 Azimilide Bedaquiline BeKm - 1 BmTx3 BRL - 32872 Chlorpromazine Cisapride Clarithromycin Darifenacin Dextropropoxyphene Diallyl trisulfide Domperidone E-4031 Ergtoxins Erythromycin Gigactonine Haloperidol Ketoconazole Norpropoxyphene Orphenadrine Pimozide PNU - 282,987 Promethazine Quinidine Ranolazine Roxithromycin Sertindole Solifenacin Tamulotoxin Terodiline Terfenadine Thioridazine Tolterodine Vanoxerine Vernakalant KCNQ ( K 7 ) - specific : Linopirdine XE - 991 Activators KCNQ ( K 7 ) - specific : Flupirtine Retigabine IRKs Blockers K - specific : Acetohexamide Carbutamide Chlorpropamide Glibenclamide ( glyburide ) Glibornuride Glicaramide Gliclazide Glimepiride Glipizide Gliquidone Glisoxepide Glyclopyramide Glycyclamide Metahexamide Mitiglinide Nateglinide Repaglinide Tolazamide Tolbutamide GIRK - specific : Barium Caramiphen Cloperastine Clozapine Dextromethorphan Ethosuximide Ifenprodil Tertiapin Tipepidine Activators K - specific : Aprikalim Bimakalim Cromakalim Diazoxide Emakalim Levcromakalim Mazokalim Minoxidil Naminidil Nicorandil Pinacidil Rilmakalim Sarakalim GIRK - specific : ML - 297 ( VU0456810 ) Blockers BK - specific : Ethanol ( alcohol ) GAL - 021 Activators BK - specific : Flufenamic acid Meclofenamic acid Niflumic acid Nimesulide Rottlerin ( mallotoxin ) Tolfenamic acid K2Ps Blockers 12 - O - Tetradecanoylphorbol - 13 - acetate Arachidonic acid Fluoxetine Norfluoxetine Activators Riluzole Sodium VGSCs Blockers Antianginals : Ranolazine Antiarrhythmics ( class I ) : Ajmaline Aprindine Disopyramide Dronedarone Encainide Flecainide Lidocaine Lorajmine Lorcainide Mexiletine Moricizine Pilsicainide Prajmaline Procainamide Propafenone Quinidine Sparteine Tocainide Anticonvulsants : Acetylpheneturide Carbamazepine Cenobamate Chlorphenacemide Elpetrigine Eslicarbazepine acetate Ethotoin Fosphenytoin Lacosamide Licarbazepine Mephenytoin Oxcarbazepine Oxitriptyline Phenacemide Pheneturide Phenytoin Rufinamide Sipatrigine Topiramate Sodium valproate Valnoctamide Valproate pivoxil Valproate semisodium Valproic acid Valpromide Zonisamide Local anesthetics : pFBT Amylocaine Articaine Benzocaine Bupivacaine ( Levobupivacaine, Ropivacaine ) Butacaine Butamben Chloroprocaine Cinchocaine Cocaine Cyclomethycaine Dimethocaine Diphenhydramine Etidocaine Hexylcaine Iontocaine Lidocaine Mepivacaine Meprylcaine Metabutoxycaine Orthocaine Piperocaine Prilocaine Procaine Propoxycaine Proxymetacaine Risocaine Tetracaine Trimecaine Analgesics : AZD - 3161 DSP - 2230 Funapide GDC - 0276 NKTR - 171 PF - 04531083 PF - 05089771 Ralfinamide Raxatrigine RG7893 ( GDC - 0287 ) Toxins : Conotoxins Neosaxitoxin Saxitoxin Tetrodotoxin Others : Buprenorphine Evenamide Menthol ( mint ) Safinamide Tricyclic antidepressants Activators Atracotoxins ( Robustoxin, Versutoxin ) Ciguatoxins Poneratoxin ENaC Blockers Amiloride Benzamil Triamterene Activators Solnatide ASICs Blockers A-317567 Amiloride Aspirin Ibuprofen PcTX1 Chloride CaCCs Blockers Crofelemer DIDS Ethacrynic acid Flufenamic acid Fluoxetine Furosemide Glibenclamide Mefloquine Mibefradil Niflumic acid Activators Carbachol CFTR Blockers Glibenclamide Lonidamine Piretanide Activators 1, 7 - Phenanthroline 1, 10 - Phenanthroline 4, 7 - Phenanthroline 7, 8 - Benzoquinoline Ivacaftor Phenanthridine Unsorted Blockers Bumetanide Flufenamic acid Meclofenamic acid Mefenamic acid Mepacrine Niflumic acid Talniflumate Tolfenamic acid Trifluoperazine Others TRPs See here instead. See also : Receptor / signaling modulators Transient receptor potential channel modulators Retrieved from `` https://en.wikipedia.org/w/index.php?title=Lidocaine&oldid=807719512 '' Categories : Acetamides Antiarrhythmic agents Chemical substances for emergency medicine Local anesthetics Sodium channel blockers World Health Organization essential medicines Hidden categories : CS1 maint : Uses authors parameter CS1 maint : Uses editors parameter Wikipedia articles needing page number citations from May 2013 Infobox drug with local INN variant Template : drugs.com link with non-standard subpage ECHA InfoCard ID from Wikidata Drug has EMA link Drugboxes which contain changes to watched fields RTT Talk Contents About Wikipedia Azərbaycanca Български Čeština Dansk Deutsch Español فارسی Français 한국어 Hrvatski Bahasa Indonesia Italiano עברית Magyar Македонски Nederlands 日本 語 Norsk nynorsk ଓଡ଼ିଆ Polski Português Română Русский Slovenščina Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska తెలుగు Türkçe Українська اردو 中文 Edit links This page was last edited on 29 October 2017, at 19 : 16. 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Question: when is lidocaine used to treat ventricular tachycardia
Answer: after defibrillation, CPR, and vasopressors have been initiated