Lidocaine, spray, 6 mg/dose 38 g

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 the excitability of the sinus-atrial node 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, reducing its permeability to sodium ions, which prevents the emergence of action potential and impulse conduction.

Possible antagonism with calcium ions. 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.

At reaching the larynx and trachea, the drug is good at slowing 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

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

In dental practice, oral surgery:

In ENT practice:

In endoscopy and instrumental examinations:

In obstetrics and gynecology:

In dermatology:

Active ingredient

Composition

Active ingredient:

lidocaine;

Excipients:

Ethanol (96%),

Peppermint oil,

propylene glycol

How to take, the dosage

The aerosol is sprayed onto mucous membranes.

In each spraying of 1 portion of the aerosol, 4.8 mg of lidocaine is released 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 effects, with curare-like drugs because muscle relaxation is increased.

Lidocaine should not be used with aymalin, amiodarone, verapamil or quinidine due to increased cardiodepressant effects.

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 the inhibitory effect on neuromuscular transmission, so the respiratory function of the patient should be monitored in this case.

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 due to increased plasma levels of lidocaine, which is explained by the release of lidocaine from bonding with blood proteins, as well as by slowing its inactivation in the liver.

If combination 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 case of 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 when administering lidocaine solutions into highly vascularized tissue to avoid entrapment in the lumen (e.g., neck during thyroid surgery) (Lower doses of lidocaine are indicated in these cases).

Particular caution should be exercised when mucosal trauma is present, when there is mental retardation, and in very old and/or debilitated patients who are already receiving lidocaine-type medications for cardiac problems.

In dentistry and orthopedics, the drug should only be used with elastic impression materials.

Ingestion of the aerosol or contact with the eyes should be avoided and it is important to prevent aerosol from entering 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
Keep in mind that children have a much more frequent swallowing reflex than 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 to driving and operating machinery.

Contraindications

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

Side effects

Overdose

Symptoms: CNS symptoms (including seizures) and cardiovascular symptoms are possible.

Treatment: in case of CNS and cardiovascular symptoms it is necessary to make sure that the airway is clear, provide fresh air, oxygen and/or artificial respiration.

In case of convulsions, 50-100 mg of ditilin and/or 5-15 mg of diazepam should be administered as soon as possible; barbituric acid derivatives (sodium thiopental) may be used. Dialysis is ineffective in the acute phase of lidocaine overdose.

In case of bradycardia, cardiac conduction abnormalities, atropine 0.5-1 mg IV may be administered.

Pregnancy use

Lidocaine aerosol can be used during pregnancy because it is not dangerous in the recommended doses.

During lactation, the use of the drug is possible after a preliminary careful assessment of the expected benefits of therapy for the mother and the potential risk to the infant.

Similarities