Lidocaine, 10% spray 50 ml

Lidocaine is a local anesthetic and antiarrhythmic drug.

The antiarrhythmic activity is due to inhibition of phase 4 (diastolic depolarization) in Purkinje fibers, reduction of automaticity, suppression of ectopic foci of excitation. The rate of rapid depolarization (phase 0) is not affected or slightly reduced. Increases membrane permeability to potassium ions, accelerates the process of repolarization and shortens the action potential. It does not change sinus-atrial node excitability and has little effect on conduction and myocardial contractility. When administered intravenously it works quickly and shortly (10-20 min).

The mechanism of local anesthetic effect consists in stabilization of neuronal membrane, reduction of its permeability to sodium ions, which prevents the emergence of action potential and impulse conduction. Antagonism with calcium ions is possible. It is rapidly hydrolyzed in a weakly alkaline environment of tissues and after a short latent period is active for 60-90 minutes. During inflammation (tissue acidosis) anesthetic activity decreases. It is effective for all types of local anesthesia. It dilates blood vessels. It has no irritating effect on the tissues.

When using the drug in pharyngeal or nasopharyngeal surgery the pharyngeal reflex is suppressed. By reaching the larynx and trachea, the drug is good at slowing down the cough reflex, which can lead to bronchopneumonia.

The action of lidocaine in aerosol form develops within 1 min and lasts 5-6 min. The desensitization achieved slowly disappears within 15 min.

It is evenly distributed in the body. It penetrates through the placental barrier.

Indications

• prevention and treatment of ventricular rhythm disturbances (ventricular extrasystoles, ventricular paroxysmal tachycardia) associated with the acute phase of myocardial infarction, other forms of CHD, as well as caused by drugs (cardiac glycosides).

Local anesthesia: superficial, infiltration, conduction, epidural, spinal, intraligamentary in surgical procedures, painful manipulations, endoscopic and instrumental studies.

In dental practice, oral surgery:

• open superficial abscesses;
• removal of movable loose teeth;
• removal of bone fragments and suturing of mucosal wounds;
• anesthesia of gingiva for fixation of crown or bridge;
• Manual or instrumental removal (or excision) of enlarged papilla of tongue;
• to decrease or suppress elevated pharyngeal reflex in preparation for radiological examination;
• anesthesia in excision of superficial benign tumors of the oral mucosa;
• in children – for frenullectomy and opening of salivary gland cysts.

In ENT practice:

• before electrocoagulation (in the treatment of nasal bleeding), septectomy and resection of nasal polyps;
• before tonsillectomy to reduce pharyngeal reflex and anesthetize the injection site;
• as additional anesthesia before opening a peritonsillar abscess or before puncture of the maxillary sinus;
• anesthesia before sinus lavage.

In endoscopy and instrumental examinations:

• anesthesia before insertion through the nose or mouth of various probes (duodenal probe, before fractional food test);
• anesthesia before rectoscopy and in case of catheter replacement.

In obstetrics and gynecology:

• anesthesia of the perineum to treat and/or perform an episiotomy;
• anesthesia of the operating field in vaginal or cervical surgery;
• anesthesia for excision and treatment of ruptured hymen;
• anesthesia for suturing abscesses.

In dermatology:

• anesthesia of mucous membranes in minor surgical interventions.
  

Active ingredient

Lidocaine, Chlorhexidine

Composition

Active ingredient:

lidocaine;

Associates:

Ethanol (96%),

Pearmint oil,

Propylene glycol;

How to take, the dosage

Each time you spray 1 dose of aerosol releases 4.8 mg of lidocaine to the surface.

The dose depends on the indication and the surface area to be anesthetized. In order to avoid high plasma concentrations of lidocaine, the lowest dose that provides a satisfactory effect should be used. Usually 1-3 sprays are sufficient, although 15-20 sprays are used in obstetrics (maximum dose is 40 sprays/70 kg body weight).

The drug can be applied to large surfaces using an impregnated swab.

In children under 2 years of age, the product is preferably applied by swabbing to avoid the fear associated with spraying and the burning sensation.

In patients with hepatic and/or cardiac insufficiency, it is recommended that the dose be reduced by 40%.

The can should be held upright when using the aerosol.

Interaction

It is undesirable to combine lidocaine with the following drugs:

With beta-adrenoblockers because of increased toxic properties of lidocaine, with digitoxin because of weakened cardiotonic effect, with curare-like drugs because muscle relaxation is increased.

Lidocaine should not be administered together with aymalin, amiodarone, verapamil or quinidine due to increased cardiodepressant effect.

The combined use of lidocaine and novocainamide may cause CNS agitation and hallucinations.

In intravenous administration of hexenal or thiopental sodium with lidocaine may cause respiratory depression.

MoA inhibitors may increase the local anesthetic effect of lidocaine. Patients taking MAO inhibitors should not administer lidocaine parenterally.

The simultaneous administration of lidocaine and polymyxin-B may increase inhibitory effects on neuromuscular transmission, so in this case the patient’s respiratory function should be monitored.

The simultaneous use of lidocaine with hypnotics or sedatives may increase their CNS depressant effect. When lidocaine is administered intravenously to patients taking cimetidine such unwanted effects as stunned state, somnolence, bradycardia, parasthesias and others are possible. This is associated with increased plasma levels of lidocaine, which is explained by the release of lidocaine from bonding with blood proteins, as well as a slowdown of its inactivation in the liver. If combined therapy with these drugs is necessary, the dose of lidocaine should be reduced.

Pharmaceutical interactions

The following drugs increase serum concentrations of lidocaine when used concomitantly: aminasine, cimetidine, propranolol, pethidine, bupivacaine, quinidine, disopyramide, amitriptyline, imipramine, nortriptyline.

Special Instructions

With caution is used in patients with liver dysfunction, circulatory insufficiency, arterial hypotension, renal failure, epilepsy. In these cases, reduction of the dose of the drug is required.

In rapid intravenous administration there may be a sharp decrease in blood pressure and development of collapse.

In these cases, mesaton, ephedrine and other vasoconstrictors are used. Care should be used to inject lidocaine solutions into highly vascularized tissues to avoid entering the drug into the lumen (e.g., neck during thyroid surgery) (Lower doses of lidocaine are indicated in these cases).

Particular caution should be exercised when mucous membrane injuries are present, when mentally retarded, and in very old and/or weakened patients who are already receiving lidocaine type medications for cardiac problems.
In dentistry and orthopedics, the drug should only be used with elastic blinders.

Ingestion of the aerosol or contact with the eyes should be avoided and it is important to prevent aerosol entry into the respiratory tract (risk of aspiration). Special care should be taken when applying to the back of the throat. Remember that Lidocaine suppresses the pharyngeal reflex and inhibits the cough reflex, which can lead to aspiration and bronchopneumonia.

Pediatric use

Please note that the swallowing reflex is much more common in children than in adults.

Lidocaine in aerosol form is not recommended for local anesthesia before tonsillectomy and adenotomy in children under 8 years of age.

Influence on driving and operating machinery

If the side effects after using the drug do not cause discomfort, there are no restrictions on driving and operating machinery.

Contraindications

• Sinus node weakness syndrome.
• Developed bradycardia.
• Antrioventricular block of degree 2 and 3 (except when a ventricular simulation probe is inserted).
• Cardiogenic shock.
• Myasthenia gravis.
• High individual sensitivity to lidocaine.
• A history of lidocaine-induced epileptiform seizures.
• Developed impairment of liver function.

If plaster is used in dentistry as an impression material, aerosol is contraindicated because of the risk of aspiration.

Side effects

CNS disorders: headaches, dizziness, somnolence, anxiety, euphoria, tinnitus, numbness of tongue and mucous membrane of the mouth, speech and vision disorders are possible.

Cardiovascular system disorders: arterial hypotension, collapse, bradycardia, conduction disorders are possible in high doses.

Allergic reactions: rash, itching, exfoliative dermatitis, anaphylactic shock, hyperthermia are rare.

Local reactions: sensation of slight burning, which disappears as the anesthetic effect develops (within 1 minute).

Pregnancy use

The use of Lidocaine in pregnancy should be excluded, because after I.V. administration the drug passes through the placenta after a few minutes.

Lidocaine aerosol can be used during pregnancy because it is safe in the recommended doses.

It is not known whether lidocaine is excreted with breast milk.

Caution should be exercised when prescribing the drug to a nursing mother.

In lactation, the drug may be used after careful assessment of the expected benefit to the mother and the potential risk to the infant.