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Author: Admin | 2025-04-28
Use: Off LabelInterstitial cystitis (bladder pain syndrome) (alkalinized lidocaine)byesIntravesical lidocaine (alkalinized) in the management of interstitial cystitis/bladder pain syndrome has been studied in several controlled and noncontrolled trials demonstrating efficacy rates up to 94%. American Urological Association guidelines recommend intravesical lidocaine as a second-line treatment option; while evidence from controlled trials appears to support use, intravesical lidocaine offers only short-term relief (less than 2 weeks) in a subset of patients, and the procedure itself is associated with pain.Additional Off-Label UsesACLS guidelines: Drug-induced monomorphic VT; Hemodynamically stable monomorphic ventricular tachycardia (VT) (preserved ventricular function); Polymorphic VT (preserved ventricular function); An alternative to amiodarone for pulseless VT or ventricular fibrillation (VF) (unresponsive to CPR, defibrillation, and vasopressor therapy) ContraindicationsHypersensitivity to lidocaine or any component of the formulation; hypersensitivity to another local anesthetic of the amide type; Adam-Stokes syndrome; Wolff-Parkinson-White syndrome; severe degrees of SA, AV, or intraventricular heart block (except in patients with a functioning artificial pacemaker); premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn or corn-related productsCanadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to ester local anesthetics (paraben-containing solutions only); antimicrobial preservative-containing solutions should not be used intra-or retro-ocularly or for epidural or spinal anesthesia or any route that would introduce solution into the cerebrospinal fluid or in doses ≥15 mL for other types of blockades. Dosage and AdministrationDosing: AdultAntiarrhythmic (ACLS 2010; ACLS 2015; ACLS 2018) (off-label use):Ventricular fibrillation or pulseless ventricular tachycardia (after defibrillation attempts, CPR, and epinephrine):IV, intraosseous (IO): Initial: 1 to 1.5 mg/kg bolus. If refractory ventricular fibrillation or pulseless ventricular tachycardia (VT), repeat 0.5 to 0.75 mg/kg bolus every 5 to 10 minutes (maximum cumulative dose: 3 mg/kg). Follow with continuous infusion (1 to 4 mg/minute) after return of perfusion (AHA/ACC/HRS [Al-Khatib 2017]). Reappearance of arrhythmia during constant infusion: 0.5 mg/kg bolus and reassessment of infusion (Zipes 2000).Endotracheal (loading dose only): 2 to 3.75 mg/kg (2 to 2.5 times the recommended IV dose); dilute in 5 to 10 mL NS or sterile water. Note: Absorption is greater with sterile water and results in less impairment of PaO2.Hemodynamically stable monomorphic VT:IV: 1 to 1.5 mg/kg; repeat with 0.5 to 0.75 mg/kg every 5 to 10 minutes as necessary (maximum cumulative dose: 3 mg/kg). Follow with continuous infusion of 1 to 4 mg/minute (or 14 to 57 mcg/kg/minute).Note: Reduce maintenance infusion in patients with congestive heart failure, shock,
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