Dextrose / Lidocaine Hydrochloride Anhydrous

Lidocaine Hydrochloride and Dextrose Injection is used intravenously in acute, hospital-based situations to control dangerous heart rhythm problems.

• Lidocaine Hydrochloride and Dextrose treats ventricular arrhythmias (abnormal heart rhythms from the heart's lower chambers) that occur during cardiac surgery or other cardiac procedures
• Lidocaine Hydrochloride and Dextrose treats life-threatening ventricular arrhythmias that develop during an acute myocardial infarction (heart attack)

Lidocaine raises the electrical stimulation threshold in the ventricles during the resting phase of the heart's cycle (diastole). This means the heart's lower chambers need a stronger-than-normal signal before they fire, which helps suppress the chaotic electrical activity that causes dangerous arrhythmias. At standard treatment doses, it does not reduce the heart's pumping strength or change blood pressure.

About 90% of lidocaine is broken down by the liver, and the remaining 10% is cleared unchanged by the kidneys. This means patients with liver problems or reduced liver blood flow — including those with heart failure — process the drug more slowly, making careful dose management critical.

Lidocaine Hydrochloride and Dextrose is given only by intravenous (IV) infusion in a hospital under continuous heart monitoring. Treatment typically begins with a single IV bolus dose, followed by a continuous drip that is adjusted to keep the heart rhythm stable.

• The infusion rate is titrated (fine-tuned) based on each patient's response — no two patients get the exact same rate
• Infusions rarely need to continue for more than 24 hours; the drug can build up to harmful levels with prolonged use
• Once the heart rhythm is stable, patients are switched to an oral antiarrhythmic medication as soon as possible
• Older patients (especially those over 70) and patients with liver disease or heart failure require lower doses

Like all medicines, Lidocaine Hydrochloride and Dextrose can cause side effects — your care team monitors closely for these during the infusion.

• Light-headedness, dizziness, or drowsiness
• Nausea and vomiting
• Blurred or double vision
• Ringing in the ears (tinnitus)
• Numbness or unusual sensations of heat or cold
• Tremors or muscle twitching
• Apprehension or a sense of euphoria
• Low blood pressure (hypotension) or slow heart rate (bradycardia)

More serious reactions — including convulsions (seizures), loss of consciousness, respiratory arrest, or cardiac arrest — can occur with toxic drug levels and require immediate emergency response.

• Continuous ECG monitoring is required — the infusion must be stopped immediately if there are signs of excessive heart conduction slowing or worsening arrhythmias
• Emergency resuscitation equipment and drugs must always be available during treatment
• Lidocaine can accumulate to toxic levels during prolonged infusions (especially beyond 24 hours) — the infusion rate must be reduced over time to account for slower clearance
• Patients with atrial fibrillation may experience an increase in ventricular rate; extra caution is needed
• Severe allergic (anaphylactic) reactions can occur — the infusion must be stopped immediately if this happens
• No additives should be mixed into the Lidocaine Hydrochloride and 5% Dextrose Injection bag
• Solutions should be visually checked for particles or discoloration before use

Several medications can affect how lidocaine behaves in the body — always tell your care team about everything you take.

• Propranolol — reduces how fast lidocaine is cleared, raising blood levels by as much as 30% and increasing toxicity risk
• Cimetidine — similarly slows lidocaine clearance and can lead to drug buildup
• Other antiarrhythmics (phenytoin, procainamide, amiodarone, quinidine) — can have additive or opposing effects on heart rhythm; side effects may also add together
• Digitalis with atrioventricular block — use with lidocaine requires caution
• Phenytoin — may speed up liver breakdown of lidocaine, though the clinical significance is uncertain

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Do not use if you have a known allergy to amide-type local anesthetics (such as bupivacaine, mepivacaine, or ropivacaine)
• Not for use in patients with Stokes-Adams syndrome or Wolff-Parkinson-White syndrome
• Not for use in patients with severe sinoatrial, atrioventricular, or intraventricular heart block
• Patients with liver disease or reduced liver blood flow (including heart failure) need lower doses and careful monitoring
• Patients over 65 years old tend to clear lidocaine more slowly and may need dose adjustments
• Patients over 70 years old or those who have had cardiac surgery should receive a reduced loading dose and lower maintenance levels
• Avoid if you have a known allergy to corn or corn products (due to the dextrose component)
• Use in pediatric (child) patients has limited supporting evidence; therapy is initiated with a single IV bolus followed by a carefully monitored infusion

Taking too much lidocaine leads to systemic toxicity, which can affect the brain, nervous system, and heart. Signs can include tremors, convulsions (seizures), loss of consciousness, slowed heart rate, very low blood pressure, and in severe cases, respiratory or cardiac arrest. If overdose is suspected, the infusion is stopped immediately and emergency supportive care is provided.

Lidocaine raises the electrical stimulation threshold in the heart's ventricles during diastole (the resting phase between beats), making it harder for abnormal electrical signals to trigger dangerous rhythms. At standard therapeutic doses, it does not reduce the force of the heart's contractions, does not lower blood pressure, and does not change the heart's absolute refractory period (the brief window right after each beat when the heart cannot be restimulated). This relatively targeted effect makes it useful for calming ventricular arrhythmias without broadly suppressing heart function.

About 90% of lidocaine is metabolized (broken down) in the liver, and the remaining 10% is excreted unchanged by the kidneys. With prolonged infusions lasting around 24 hours, the body's ability to clear the drug slows significantly — the half-life (the time it takes for half the drug to leave the body) can triple compared to a single dose. This means drug levels can build up over time, so the infusion rate must be reduced with prolonged use. Patients over 65, those with liver disease, or those with heart failure clear lidocaine more slowly, and propranolol use can raise lidocaine blood levels by as much as 30%.

Avoid excessive heat. Protect from freezing. stored at room temperature (25°C); however, brief exposure up to 40°C does not adversely affect the product.