Lidocaine - Benefits, dosage and side effects

Lidocaine is a medication to relieve pain or numb certain parts of the body (a local anesthetic). This drug can also be used to treat certain types of arrhythmias, so it is included in the class of antiarrhythmic drugs.

Lidocaine works by blocking the signal that causes pain, thereby temporarily preventing the onset of pain. Lidocaine is available in various dosage forms with different intended uses.

The following is an explanation of the dosage form of lidocaine and its intended use:

1. Topical drug lidocaine (cream, gel, ointment)

   Used to numb the skin area. This type of preparation is usually used before certain medical procedures or can be used to relieve pain from insect bites, exposure to poisonous plant sap, minor cuts or burns.

2. Lidocaine spray

   Used to numb the mouth or throat before undergoing certain medical procedures, such as insertion of a breathing tube or gastroscopy.

3. Lidocaine injection / injection

   In addition to being used as a local anesthetic, lidocaine injection is also used to treat arrhythmias or heart rhythm disorders.

4. Lidocaine suppository

   Used to relieve pain, itching, or swelling of the anus due to hemorrhoids or other disorders of the anal area. The drug is used by inserting it through the anus or rectum.

5. Lidocaine lozenges

   Used to relieve sore throat. For this dosage form, further research is needed to determine its effectiveness and safety.

6. Lidocaine ear drops

   Used to reduce pain and swelling in inflammation of the middle ear (otitis media) or inflammation of the outer ear (otitis externa). As with lidocaine lozenges, the effectiveness and safety of using lidocaine ear drops still requires further research.

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What is Lidocaine

Precautions Before Using Lidocaine

Lidocaine should only be used as prescribed by a doctor. Before using this drug, you need to pay attention to the following points:

• Do not use lidocaine if you are allergic to this drug. Tell your doctor about any allergies you have.
• Tell your doctor if you have or have had heart disease, lung disease, methemoglobinemia, heart rhythm disorders (arrhythmias), sepsis, liver disease, glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• Please be careful, patients with heart rhythm disorders who receive injectable lidocaine must do an electrocardiography (ECG) examination first. This is done to help doctors the type and duration of treatment.
• Tell your doctor if you are taking certain medications, supplements, or herbal products.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.
• See your doctor right away if you have an allergic reaction or overdose after using lidocaine.

Dosage and Instructions for Use of Lidocaine

The dose of lidocaine in each person can be different based on the patient's condition and the form of the drug. The following is the dose of lidocaine for adults:

Condition: Epidural anesthesia

• Injections in the spinal cord area (lumbar epidural, thoracic epidural, or caudal anesthesia): 250–300 mg as a 1% solution for lumbar/waist epidural analgesia.

Condition: spinal anesthesia

• Spinal area injections: 50 mg–100 mg as a 5% solution depending on the type of surgery.

Condition: Regional anesthesia for certain body parts

• Intravenous injection: Dosage 50–300 mg as a 0.5% solution. Maximum dose: 4 mg/kg body weight.

Condition: Anesthesia for external areas (skin, oral cavity, urethra)

• Spray: Spray 40–200 mg of the 4% solution onto the area to be anesthetized.
• 5% ointment: The dose is 5 grams for each administration, a maximum of 20 g per day for the skin or mucous layers, such as the oral cavity.
• Gel 2%: Usually used before urinary catheter insertion. For women, 60–100 mg. For men, 100–200 mg.

Condition: Hemorrhoids and anal itching

• Suppositories: Used 2-3 times a day.

Condition: Sore throat

• Lozenges: Discuss with your doctor the method and dosage needed

Condition: Otitis externa

• Ear drops: Dosage 4-5 drops into the ear canal 2-4 times per day.

Condition: Arrhythmia

• Injection (emergency): A dose of 300 mg given through the shoulder muscle. May be repeated after 60–90 minutes, if needed.
• Injectable (stable): Dose 1–1.5 mg/kgBW, may be repeated if needed. The maximum dose is 3 mg/kg, can be repeated 2 times. The dose needs to be reduced if the use of the drug is longer than 24 hours.

How to Use Lidocaine Correctly

Follow your doctor's advice and read the information on the lidocaine package before starting to use it. Do not reduce or increase the dose without consulting your doctor first.

Lidocaine spray is usually given by the doctor shortly before the medical procedure begins. Avoid eating and drinking until the numbing effect wears off, as this medicine may cause you to have difficulty swallowing or accidentally bite the inside of your mouth.

The administration of injectable lidocaine will be given directly by a doctor or medical officer under the supervision of a doctor. Tell the doctor about the condition or disease you are or have ever had, so that the doctor can adjust the dose and duration of treatment.

Before using topical lidocaine, wash your hands with soap first. Avoid contact between the drug and the eyes. In case of contact with eyes, immediately wash eyes with clean running water.

For lidocaine suppositories, the drug is administered through the anus. Wet the medicine with water for easy insertion. Administration of the drug can be done by standing and lifting one leg, or lying down with one leg bent and the other positioned straight. This is done so that the position of the buttocks is more open so as to facilitate the process of entering the drug.

Gently push the suppository into the anus with the pointed end first, until it is 2–3 cm deep. After the medication is inserted, remain seated or lie down and wait about 15 minutes for the medication to melt. Always prioritize hand and body hygiene during and after using the drug.

Take lidocaine lozenges only when needed. Check the packaging before taking the medicine. If the packaging is damaged or open, the drug should not be consumed.

The use of lidocaine ear drops is done by lying on your side or tilting your head, so that the ear hole where the drug will be dripped is facing up. After the drops, hold the position and wait for 2 minutes for the drug to enter.

Store lidocaine at room temperature and away from direct sunlight. Keep medicine out of reach of children.

Lidocaine Interactions with Other Drugs

Lidocaine can cause drug interactions when used with other medicines. The following are some of the effects of drug interactions that may occur:

• Increased blood levels of lidocaine when used with cimetidine or propranolol
• Increased risk of heart problems if used with -class drugs beta blockers, for example bisoprolol
• Increased side effects on the heart when used with injectable phenytoin
• Decreased effectiveness of lidocaine when used with loop diuretics, acetazolamide, or thiazides

Lidocaine Side Effects and Dangers

Some of the side effects that may arise after using lidocaine are:

• Nausea, vomiting, or constipation
• Dizzy
• tingling
• Tremor
• Headache
• Hypotension
• Skin irritation, redness, or swelling at the injection site or on the skin that was applied to lidocaine

Check with your doctor if the side effects above do not subside or get worse. See your doctor right away if you have an allergic reaction to a drug or a more serious side effect, such as:

• Seizures
• Heart rhythm disturbances or cardiac arrest
• Joint pain or muscle pain
• Methemoglobinemia characterized by cyanosis, fatigue, shortness of breath
• Skin that bruises or bleeds easily
• Hyperthermia