Home Drug Guide Lidocaine Hydrochloride with Epinephrine

Drug Guide

Generic Name

Lidocaine Hydrochloride with Epinephrine

Brand Names Xylocaine W/ Epinephrine, Iontocaine, Xylocaine Dental With Epinephrine, Lidocaine Hydrochloride And Epinephrine, Lidosite Topical System Kit, Lidocaine Hydrochloride W/ Epinephrine, Octocaine, Alphacaine Hydrochloride W/ Epinephrine, Lidocaton

Classification

Therapeutic: Local anesthetic and vasoconstrictor

Pharmacological: Amide local anesthetic with adrenergic agent

FDA Approved Indications

  • Local anesthesia for minor surgical procedures including dental, surgical, and diagnostic procedures

Mechanism of Action

Lidocaine stabilizes neuronal membranes by inhibiting the influx of sodium ions during depolarization, thereby blocking nerve impulse conduction. Epinephrine causes vasoconstriction at the site of injection, prolonging anesthesia and reducing systemic absorption.

Dosage and Administration

Adult: Dose depends on procedure; typically 1-5 mL per site, not to exceed maximum doses (e.g., 4.5 mg/kg without epinephrine, 7 mg/kg with epinephrine).

Pediatric: Dosing based on weight; consult specific guidelines.

Geriatric: Use with caution; start at lower end of dosing range.

Renal Impairment: Adjust dose as needed; monitor for toxicity.

Hepatic Impairment: Use caution; lidocaine is metabolized in the liver.

Pharmacokinetics

Absorption: Absorbed rapidly at the injection site.

Distribution: Widely distributed into body tissues; crosses placenta.

Metabolism: Hepatic metabolism via CYP1A2 and CYP3A4 enzymes.

Excretion: Renal excretion of metabolites.

Half Life: Approximately 1.5 to 2 hours in healthy adults.

Contraindications

  • Hypersensitivity to lidocaine, amide-type local anesthetics, or epinephrine.
  • History of severe adverse reactions to local anesthetics.

Precautions

  • Use with caution in patients with cardiovascular disease, significant hypertension, or hyperthyroidism. Avoid in patients with narrow-angle glaucoma and those on monoamine oxidase inhibitors (MAOIs).

Adverse Reactions - Common

  • Transient local tissue irritation or burning. (Common)
  • Headache, dizziness. (Uncommon)

Adverse Reactions - Serious

  • Anaphylaxis. (Rare)
  • Cardiovascular effects such as arrhythmias, hypertension, or hypotension. (Uncommon)

Drug-Drug Interactions

  • Other vasoconstrictors, other local anesthetics.
  • Certain beta-blockers and monoamine oxidase inhibitors (MAOIs).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for allergic reactions, cardiovascular status, and CNS effects.

Diagnoses:

  • Risk for allergic reaction.
  • Ineffective tissue perfusion.

Implementation: Administer slowly, aspirate before injection, and use the lowest effective dose.

Evaluation: Monitor for adequate anesthesia and absence of adverse reactions.

Patient/Family Teaching

  • Report signs of allergic reactions such as rash, itching, or swelling.
  • Avoid driving or operating machinery until anesthesia wears off.
  • Inform about possible side effects and when to seek medical attention.

Special Considerations

Black Box Warnings:

  • Epinephrine should not be used in fingers, toes, noses, ears, or appendages due to risk of ischemia.

Genetic Factors: Variability in metabolism may occur due to genetic differences in CYP enzymes.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: CNS excitation (tremors, seizures), cardiovascular depression, arrhythmias.

Treatment: Supportive care; administer benzodiazepines for seizures, monitored cardiac support, lipid emulsion therapy for systemic toxicity.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for expiration date on package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.