Indications and Dose:

Infiltration Anesthesia:

• • Adults: Dose dependent on patient’s weight and procedure specifics; typically maxes at 200 mg, up to 500 mg with adrenaline.

Regional Anesthesia and Nerve Block:

• • Adults: Should be administered under expert guidance.

Pain Relief for Skin Conditions:

• • Adults: Apply 1-2 mL of ointment as needed. Long-term use is discouraged.

Sore Nipples from Breastfeeding:

• • Adults: Apply with gauze and wash off immediately before feeding.

Venous Cannulation or Venepuncture:

• • Apply 1-2.5 g of LMX 4® 30 minutes before the procedure. Maximum application time varies with age.

Postherpetic Neuralgia:

• • Adults: Use VERSATIS® plaster once daily for up to 12 hours followed by a 12-hour plaster-free period.

Patch Application Guidelines:

Pain (localized):

• 3.5% Products:

• • Apply the patch to the painful area.
  • The patch can remain in place for up to 12 hours within any 24-hour period.
  • Use no more than one patch in a 24-hour period.

• 4% Products:

• • Apply the patch to the painful area.
  • Usage frequency and duration vary according to manufacturer’s recommendations, ranging from 1 to 4 applications daily, and 8 to 24 hours of application. Refer to specific product labeling for detailed instructions.

Postherpetic Neuralgia:

• 1.8% [ZTlido] and 5% Products:

• • Application of one ZTlido 1.8% patch provides the same exposure to lidocaine as one 5% patch.
  • Apply the patch(es) to the most painful area.
  • Up to three patches may be used at once.
  • Patches can be worn for up to 12 hours within any 24-hour period.

Contraindications:

• Avoid in cases of recent myocardial infarction or in patients with complete heart block.
• Do not use with inflamed or infected tissues.
• Contraindicated in patients with a known hypersensitivity to any components.

Cautions:

• Special care required for elderly, debilitated patients, and those with conditions like epilepsy, congestive heart failure, or respiratory impairments.
• Recommended to be administered by experienced personnel in settings equipped for resuscitation.

Side Effects:

• Systemic use can cause: Arrhythmias, AV block, circulatory collapse, CNS effects (confusion, seizures), methemoglobinemia.
• Topical use: Potential for systemic absorption increases risk; ensure application to intact skin.

Pregnancy and Breastfeeding:

• Crosses the placenta but not linked to harm in animal studies. Use only if the benefits outweigh the risks.
• Found in breast milk in insignificant amounts.

Monitoring:

• Continuous ECG monitoring recommended during systemic use.

Notes:

• VERSATIS® is funded under specific conditions for treating post-herpetic neuralgia in Scotland as per Scottish Medicines Consortium recommendations.

Medicinal Forms Overview

Solution for Injection:

• Lidocaine Hydrochloride Variants:

• • Available in various concentrations ranging from 0.5% to 2%.
  • Packaged in ampoules, pre-filled disposable injection syringes, Mini-Plasco ampoules, and vials.
  • Specific dosages include 5 mg/ml, 10 mg/ml, and 20 mg/ml concentrations.

Medicated Plaster:

• Ralvo and Versatis:

• • Each contains 50 mg of Lidocaine per 1 gram.
  • Typically used in 700 mg medicated plasters.

Cream:

• LMX 4 and Vagisil Medicated:

• • LMX 4 contains 40 mg of Lidocaine per 1 gram.
  • Vagisil Medicated Cream contains 20 mg of Lidocaine per 1 gram.

Ointment:

• Lidocaine Hydrochloride Ointment:

• • Contains 50 mg of Lidocaine per 1 gram.
  • Available in various package sizes.

Spray:

• Xylocaine Spray:

• • Contains 10 mg of Lidocaine per actuation.
  • Sugar-free formulation.

Key Points:

• Lidocaine Hydrochloride is available in multiple forms and strengths for a variety of medical uses including local anesthesia and pain relief.
• Medicated plasters, creams, ointments, and sprays are formulated for topical application.
• Solutions for injection are used for more direct, controlled anesthetic purposes in medical procedures.