Xylocaine LIDOCAINE HYDROCHLORIDE,EPINEPHRINE BITARTRATE 20 mg/mL; .01 mg/mL Injection, Solution — NDC 63323-0483-27 package photo

Xylocaine LIDOCAINE HYDROCHLORIDE,EPINEPHRINE BITARTRATE 20 mg/mL; .01 mg/mL Injection, Solution

by Fresenius Kabi USA, LLC · 25 VIAL, MULTI-DOSE in 1 TRAY (63323-483-27) / 20 mL in 1 VIAL, MULTI-DOSE (63323-483-03)
NDC 63323-0483-27
🏷️ FDA NDC (as labeled) 63323-483-27 billing pads the product segment with a zero
This package
Contains20 mL in 1 vial, multi-dose Cost per mL$0.2655 NADAC Per package$132.75 / 500 ml Pack sizes2 compare ↓
Also priced by: Medicaid pays $4.19/unit — full pricing hub ↓
Also comes in: 25 vials 63323-0483-57
Rx only Brand On market Non-controlled ⚠ On shortage
🗂️ Data synced Sep 17, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →
⚠️
Active FDA shortage. Epinephrine Bitartrate, Lidocaine Hydrochloride Injection is currently reported in shortage by the FDA. Available Shortage details →
🚨
Active recall for this product.
Class II · Jul 16, 2026 — Presence of Particulate Matter: Hair was found in products (Fresenius Kabi USA, LLC) · FDA recall D-0728-2026
Class II · Jul 16, 2026 — Presence of Particulate Matter: Hair was found in products (Fresenius Kabi USA, LLC) · FDA recall D-0729-2026
Check your lot/expiration against the official notice — look up the recall number in the FDA recall database ↗
Past resolved recalls for this product (2)
Class II · Apr 13, 2022 · Terminated — cGMP deviations: Temperature abuse (Mckesson Medical-Surgical Inc. Corporate Office) · FDA recall D-1052-2022
Class II · Apr 13, 2022 · Terminated — cGMP deviations: Temperature abuse (Mckesson Medical-Surgical Inc. Corporate Office) · FDA recall D-1053-2022

🆔 Identity & classification

FDA NDC (as labeled) 63323-483-27
Product NDC 63323-483
11-digit billing NDC 63323048327
NCPDP billing unit ML — per mL (volume)
UNII EC2CNF7XFP, 30Q7KI53AK
UPC 0363323484576, 0363323485016, 0363323483036, 0363323487072 +10 more
Application # NDA006488
SPL Set ID ba082c2f-64f4-419d-9c88-74f203316e17
Established class (EPC) Amide Local Anesthetic; Antiarrhythmic; Catecholamine; alpha-Adrenergic Agonist; beta-Adrenergic Agonist [EPC
Mechanism of action Adrenergic alpha-Agonists; Adrenergic beta-Agonists
Physiologic effect Local Anesthesia
Chemical class Amides; Catecholamines
DEA schedule Non-controlled
Marketing category NDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2010-08-12
Route INFILTRATION, PERINEURAL
Dosage form INJECTION, SOLUTION
Substance LIDOCAINE HYDROCHLORIDE ANHYDROUS; EPINEPHRINE BITARTRATE
GPI-14 69991002402022
GPI class Xylocaine/EPINEPHrine
GCN Seq No 003390
GCN 68237
HICL code 001475
Ingredient (HICL) Lidocaine Hcl/Epinephrine
HIC1 code H
Therapeutic class — broad (HIC1) Nervous System (Except Autonomic)
HIC2 code H0
Therapeutic class — intermediate (HIC2) Act On Non-Autonomic Nervous System
HIC3 code H0A
Therapeutic class — specific (HIC3) Local Anesthetics
AHFS code 12:12.12.00
AHFS class Alpha- And Beta-Adrenergic Agonists
FDB label name XYLOCAINE 2%-EPI 1:100,000
FDB brand name Xylocaine With Epinephrine
Legend status F — Federal legend — prescription drug or device
TE code (Orange Book) AP · RLD · RS
Why two NDCs? The FDA registers this code as 63323-483-27 — a 5-3-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the product segment → 63323-0483-27. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏷️ RxNorm drug class

This medicine belongs to the Antiarrhythmic class.

Pharmacologic class Antiarrhythmic, Amide Local Anesthetic
Drug family (ATC) Antiarrhythmics, class Ib, Local anesthetics, Anesthetics for topical use
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

🏭 Manufacturer & labeler

LabelerFresenius Kabi USA, LLC
Application holderFRESENIUS KABI USA LLC
FDA applicationNDA006488 (NDA)
Labeler code63323
First marketedAug 2010
Product typeHuman Prescription Drug
Portfolio554 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

Label name XYLOCAINE 2%-EPI 1:100,000 Ingredient Lidocaine Hcl/Epinephrine
📗 Our plain-language guide HelloPharmacist
  • This combination is used in two main ways. When given as an injection by a healthcare provider, it numbs a specific part of your body — for example, during surgery, a dental proced...
  • Some lightheadedness, drowsiness, or tingling around the mouth can happen if a little more drug than expected gets into your bloodstream — those are early warning signs your care t...
  • Will I feel any side effects from the injection?
  • Make sure your provider knows about all your medications — especially antidepressants called MAO inhibitors or tricyclics, any beta-blocker blood pressure medications, and anything...
📖 Read our full Epinephrine / Lidocaine guide →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • 0.2 mg / 1 mL UNII 2968PHW8QP
    A weak organic acid derived from citrus fruits or made through fermentation. It works as a buffer to control pH, a preservative to extend shelf life, and a flavoring agent in medications.
  • UNII QTT17582CB
    A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
  • 1 mg / 1 mL UNII A2I8C7HI9T
    Methylparaben is a preservative derived from benzoic acid that prevents growth of bacteria, fungi, and mold in medicines. It extends the product's shelf life and maintains safety during storage.
  • 6 mg / 1 mL UNII 451W47IQ8X
    Sodium chloride is common table salt. It's used in medicines as a buffer to maintain proper pH, as a filler to add bulk, or to adjust the osmotic balance in liquid formulations.
  • UNII 55X04QC32I
    A strong alkaline chemical used to adjust and maintain the pH balance of liquid medicines. It helps keep the medicine stable and ensures it stays effective during storage.
  • 0.5 mg / 1 mL UNII 4VON5FNS3C
    Sodium metabisulfite is a preservative derived from sulfur compounds. It prevents microbial growth and oxidation in medicines, helping extend shelf life and maintain product stability.

6 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMedingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer mLPer package
Retail pharmacies payNADAC · weekly $0.266 $132.75 / 500 ml
Medicaid paysCMS SDUD · 12 mo $4.19 $2,097.30 / 500 ml
Medicare drug plans payPart D · quarterly No Part D plan price is available for this NDC in our data.
NADAC price history (per mL) — tap or hover for the price & month
Feb 2025 $0.266 $0.266
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🔁 Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Lidocaine Hydrochloride and Epinephrine 20 mg/mL; 10 ug/mL 00409-3182-01 Hospira, 25 vials $0.134 FDA listed save 50%
Xylocaine 20 mg/mL; .01 mg/mLthis 63323-0483-27 Fresenius 25 vials $0.265 AP FDA listed
Lidocaine Hydrochloride and Epinephrine 20 mg/mL; 10 ug/mL 00404-9788-20 Henry 1 vial FDA listed
Lidocaine Hydrochloride and Epinephrine 20 mg/mL; 10 ug/mL 00404-9896-20 Henry 1 vial FDA listed
Xylocaine 20 mg/mL; .01 mg/mL 00404-9976-20 Henry 1 vial AP FDA listed
Lidocaine Hydrochloride and Epinephrine 20 mg/mL; 10 ug/mL 00409-0147-10 Hospira, 10 vials FDA listed
Xylocaine 20 mg/mL; .01 mg/mL 50090-6851-00 A-S 25 vials AP FDA listed
LIDOCAINE HCl AND EPINEPHRINE 20 mg/mL; 10 ug/mL 51662-1503-01 HF 30 ml FDA listed
LIDOCAINE HCl AND EPINEPHRINE 10 ug/mL; 20 mg/mL 51662-1504-01 HF 50 ml FDA listed
Lidocaine Hci And Epinephrine 20 mg/mL; .01 mg/mL 51662-1505-01 HF 50 ml AP FDA listed
Lidocaine Hci And Epinephrine 20 mg/mL; .01 mg/mL 51662-1506-01 HF 20 ml AP FDA listed
Lidocaine Hydrochloride and Epinephrine 20 mg/mL; 10 ug/mL 84549-0182-03 ProPharma 50 ml FDA listed
About this product: this is the brand-name version. Some generic versions are approved by the FDA, but we could not confirm current pharmacy availability from our pricing/market data.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2010
On the market since
Aug 2010
📍
2026
Currently FDA-listed
16 years listed
🔒
·
Generic approved (availability unconfirmed)
see note
🔒Generic approved by FDA, but pharmacy availability is not confirmed

The FDA lists approved generic versions of this medicine, but that does not always mean a pharmacy can get one today. Patent rules, launch agreements, supply and pricing can affect when generics actually arrive.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

🗺️ Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for 63323-0483-27, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q4 2025 · 4 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
2.8K
Units reimbursed last 4 qtrs
32.8K
Gross reimbursed last 4 qtrs
$137.6K
Avg / prescription
$49.28
Avg / unit
$4.1946
Latest quarter Q4 2025
552Rx
Medicaid pays / mL
$4.1946
gross reimbursed
vs
NADAC / mL
$0.2655
acquisition cost
=
Spread
+$3.9291
+1480% vs cost
What Medicaid paid per mL (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care
23% FFS 77% MCO
Fee-for-service · 652 Rx Managed care · 2,141 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: no data reported WA Idaho: 1,117 units · 56.9 per 100k residents ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: 497 units · 8.7 per 100k residents MN Wisconsin: no data reported WI Michigan: no data reported MI New York: 503 units · 2.6 per 100k residents NY Vermont: no data reported VT New Hampshire: 765 units · 54.6 per 100k residents NH Oregon: no data reported OR Nevada: 64 units · 2.0 per 100k residents NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: 212 units · 6.6 per 100k residents IA Illinois: no data reported IL Indiana: 14 units · 0.2 per 100k residents IN Ohio: 6,768 units · 57.4 per 100k residents OH Pennsylvania: no data reported PA New Jersey: 650 units · 7.0 per 100k residents NJ Massachusetts: 6,894 units · 98.5 per 100k residents MA California: 5,278 units · 13.5 per 100k residents CA Utah: no data reported UT Colorado: no data reported CO Nebraska: 1,197 units · 60.5 per 100k residents NE Missouri: 1,267 units · 20.4 per 100k residents MO Kentucky: 290 units · 6.4 per 100k residents KY West Virginia: no data reported WV Virginia: 214 units · 2.5 per 100k residents VA Maryland: no data reported MD Connecticut: no data reported CT Rhode Island: no data reported RI Arizona: no data reported AZ New Mexico: no data reported NM Kansas: no data reported KS Arkansas: no data reported AR Tennessee: 326 units · 4.6 per 100k residents TN North Carolina: 1,500 units · 13.8 per 100k residents NC South Carolina: no data reported SC Delaware: no data reported DE Oklahoma: 3,560 units · 87.8 per 100k residents OK Louisiana: no data reported LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: no data reported GA D.C.: no data reported DC Hawaii: 254 units · 17.7 per 100k residents HI Texas: no data reported TX Florida: 1,445 units · 6.4 per 100k residents FL
Units reimbursed · per 100k residents
0.298.5
gray = no data reported
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 Massachusetts 98.5 /100k
2 Oklahoma 87.8 /100k
3 Nebraska 60.5 /100k
4 Ohio 57.4 /100k
5 Idaho 56.9 /100k
6 New Hampshire 54.6 /100k
7 Missouri 20.4 /100k
8 Hawaii 17.7 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

💊 Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
25 vials this page63323-0483-27 2,793 Rx · $137,649
25 vials63323-0483-57 No Medicaid data
Drug total (last 4 qtrs): 2,793 Rx · 32,816 units · $137,649 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.

📊 Medicare Part D spend CMS · PART D · 2026 (Q1)

Medicare Part D (outpatient prescription) spending for Xylocaine — the program that covers self-administered drugs. 1 manufacturer.
⚠️ Drug-level data: CMS publishes Part D spending by drug, not by NDC — these figures combine every manufacturer, strength and package size sold under the name Xylocaine. That’s a different level of aggregation than the Medicaid card above, which is specific to this exact 11-digit NDC (pack size included), so the two aren’t directly comparable.
Period
Total Part D spend
$327.44
Claims incl. refills
35
Beneficiaries
33
Spend / beneficiary
$9.92
Spend / claim
$9.36
Trend by period
💵 About the dollar figures: spending is what Part D plans paid before confidential manufacturer rebates, so the program’s real net cost is lower. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part D Spending by Drug (data.cms.gov), updated quarterly.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Xylocaine (this brand).

Top reported reactions

Infusion Site Pain730
Nausea715
Dyspnoea626
Diarrhoea558
Headache555
Pain545
Fatigue509

Age at onset

Neonate42
Infant26
Child34
Adolescent31
Adult1,139
Elderly585

Reporter sex

11,075 reports
Male · 39%
Female · 61%
Unknown · 1%

Serious outcomes

Hospitalization4,329
Death1,084
Reports over time (by year) — tap or hover for the count & year
2020 2022 2024 2026 1,726 0
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startStatus
63323-0483-27 You're viewing this 25 VIAL, MULTI-DOSE in 1 TRAY (63323-483-27) / 20 mL in 1 VIAL, MULTI-DOSE (63323-483-03) $0.2655 / mL $132.73 2010-08-12 Active
63323-0483-57 25 VIAL, MULTI-DOSE in 1 TRAY (63323-483-57) / 50 mL in 1 VIAL, MULTI-DOSE (63323-483-01) 2010-08-12 Active

In Medicaid, this is the most-dispensed pack of this product — about 100% of fills over the last four reported quarters. See all packs ↓

Pack size FAQ

What quantity is in NDC 63323-0483-27?
NDC 63323-0483-27 is listed by the FDA — 25 vial, multi-dose in 1 tray / 20 ml in 1 vial, multi-dose.
What NDC number is used to bill for this package of Xylocaine LIDOCAINE HYDROCHLORIDE,EPINEPHRINE BITARTRATE 20 mg/mL; .01 mg/mL Injection, Solution?
Bill NDC 63323-0483-27 — the 11-digit billing format is 63323048327. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

📄 Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage 64 words

INDICATIONS AND USAGE Xylocaine (lidocaine HCl) Injections are indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed.

⏱️ Dosage and Administration ~3 min read

DOSAGE AND ADMINISTRATION Table 1 (Recommended Dosages) summarizes the recommended volumes and concentrations of Xylocaine Injection for various types of anesthetic procedures. The dosages suggested in this table are for normal healthy adults and refer to the use of epinephrine-free solutions. When larger volumes are required, only solutions containing epinephrine should be used except in those cases where vasopressor drugs may be contraindicated.

There have been adverse event reports of chondrolysis in patients receiving intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures. Xylocaine is not approved for this use (see WARNINGS and DOSAGE AND ADMINISTRATION ). These recommended doses serve only as a guide to the amount of anesthetic required for most routine procedures.

The actual volumes and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. In all cases the lowest concentration and smallest dose that will produce the desired result should be given. Dosages should be reduced for children and for the elderly and debilitated patients and patients with cardiac and/or liver disease.

The onset of anesthesia, the duration of anesthesia and the degree of muscular relaxation are proportional to the volume and concentration (i.e., total dose) of local anesthetic used. Thus, an increase in volume and concentration of Xylocaine Injection will decrease the onset of anesthesia, prolong the duration of anesthesia, provide a greater degree of muscular relaxation and increase the segmental spread of anesthesia. However, increasing the volume and concentration of Xylocaine Injection may result in a more profound fall in blood pressure when used in epidural anesthesia.

Although the incidence of side effects with lidocaine HCl is quite low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose of local anesthetic agent injected. For intravenous regional anesthesia, only the 50 mL single dose vial containing Xylocaine (lidocaine HCl) 0.5% Injection should be used. Epidural Anesthesia For epidural anesthesia, only the following dosage forms of Xylocaine Injection are recommended: 1% without epinephrine 10 mL Plastic Ampule 1% without epinephrine 30 mL single dose solutions 1% with epinephrine 1:200,000 30 mL single dose solutions 1.5% without epinephrine 10 mL Plastic Ampule 1.5% without epinephrine 20 mL Plastic Ampule 1.5% with epinephrine 1:200,000 30 mL ampules, 30 mL single dose solutions 2% without epinephrine 10 mL Plastic Ampule 2% with epinephrine 1:200,000 20 mL ampules, 20 mL single dose solutions Although these solutions are intended specifically for epidural anesthesia, they may also be used for infiltration and peripheral nerve block, provided they are employed as single dose units.

These solutions contain no bacteriostatic agent. In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3 mL of the indicated concentration per dermatome). Caudal and Lumbar Epidural Block As a precaution against the adverse experience sometimes observed following unintentional penetration of the subarachnoid space, a test dose such as 2 to 3 mL of 1.5% lidocaine HCl should be administered at least 5 minutes prior to injecting the total volume required for a lumbar or caudal epidural block.

The test dose should be repeated if the patient is moved in a manner that may have displaced the catheter. Epinephrine, if contained in the test dose (10 to 15 mcg have been suggested), may serve as a warning of unintentional intravascular injection. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient “epinephrine response” within 45 seconds,…

Contraindications 20 words

CONTRAINDICATIONS Lidocaine HCl is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type.

⚠️ Warnings ~3 min read

WARNINGS XYLOCAINE INJECTIONS FOR INFILTRATION AND NERVE BLOCK SHOULD BE EMPLOYED ONLY BY CLINICIANS WHO ARE WELL VERSED IN DIAGNOSIS AND MANAGEMENT OF DOSE-RELATED TOXICITY AND OTHER ACUTE EMERGENCIES THAT MIGHT ARISE FROM THE BLOCK TO BE EMPLOYED AND THEN ONLY AFTER ENSURING THE IMMEDIATE AVAILABILITY OF OXYGEN, OTHER RESUSCITATIVE DRUGS, CARDIOPULMONARY EQUIPMENT AND THE PERSONNEL NEEDED FOR PROPER MANAGEMENT OF TOXIC REACTIONS AND RELATED EMERGENCIES (see also ADVERSE REACTIONS and PRECAUTIONS ). DELAY IN PROPER MANAGEMENT OF DOSE-RELATED TOXICITY, UNDERVENTILATION FROM ANY CAUSE AND/OR ALTERED SENSITIVITY MAY LEAD TO THE DEVELOPMENT OF ACIDOSIS, CARDIAC ARREST AND, POSSIBLY, DEATH.

Methemoglobinemia Cases of methemoglobinemia have been reported in association with local anesthetic use. Although all patients are at risk for methemoglobinemia, patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.

Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood. Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Discontinue Xylocaine and any other oxidizing agents.

Depending on the severity of the signs and symptoms, patients may respond to supportive care, i.e., oxygen therapy, hydration. A more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have been post-marketing reports of chondrolysis in patients receiving such infusions.

The majority of reported cases of chondrolysis have involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intra-articular infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours. There is insufficient information to determine whether shorter infusion periods are not associated with these findings. The time of onset of symptoms, such as joint pain, stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery.

Currently, there is no effective treatment for chondrolysis; patients who experienced chondrolysis have required additional diagnostic and therapeutic procedures and some required arthroplasty or shoulder replacement. To avoid intravascular injection, aspiration should be performed before the local anesthetic solution is injected. The needle must be repositioned until no return of blood can be elicited by aspiration.

Note, however, that the absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Local anesthetic solutions containing antimicrobial preservatives (e.g., methylparaben) should not be used for epidural or spinal anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental. Xylocaine with epinephrine solutions contain sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.

The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than…

🤒 Adverse Reactions ~3 min read

ADVERSE REACTIONS To report SUSPECTED ADVERSE REACTIONS, contact Fresenius Kabi USA, LLC at 1-800-551-7176 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Systemic Adverse experiences following the administration of lidocaine HCl are similar in nature to those observed with other amide local anesthetic agents. These adverse experiences are, in general, dose-related and may result from high plasma levels caused by excessive dosage, rapid absorption or inadvertent intravascular injection, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient.

Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported: Central Nervous System CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. The excitatory manifestations may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest.

Drowsiness following the administration of lidocaine HCl is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Cardiovascular System Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. Allergic Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions.

Allergic reactions may occur as a result of sensitivity either to local anesthetic agents or to the methylparaben used as a preservative in the multiple dose vials. Allergic reactions, including anaphylactic reactions, may occur as a result of sensitivity to lidocaine, but are infrequent. If allergic reactions do occur, they should be managed by conventional means.

The detection of sensitivity by skin testing is of doubtful value. There have been no reports of cross sensitivity between lidocaine hydrochloride and procainamide or between lidocaine hydrochloride and quinidine. Neurologic The incidences of adverse reactions associated with the use of local anesthetics may be related to the total dose of local anesthetic administered and are also dependent upon the particular drug used, the route of administration and the physical status of the patient.

In a prospective review of 10,440 patients who received lidocaine HCl for spinal anesthesia, the incidences of adverse reactions were reported to be about 3 percent each for positional headaches, hypotension and backache; 2 percent for shivering; and less than 1 percent each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision. Many of these observations may be related to local anesthetic techniques, with or without a contribution from the local anesthetic. In the practice of caudal or lumbar epidural block, occasional unintentional penetration of the subarachnoid space by the catheter may occur.

Subsequent adverse effects may depend partially on the amount of drug administered subdurally. These may include spinal block of varying magnitude (including total spinal block), hypotension secondary to spinal block, loss of bladder and bowel control, and loss of perineal sensation and sexual function. Persistent motor, sensory and/or autonomic (sphincter control) deficit of some lower spinal segments with slow recovery (several months) or incomplete recovery have been reported in rare instances when caudal or lumbar epidural block has been attempted.

Backache and headache have also been noted following use of these anesthetic procedures. There have been reported cases of permanent injury to extraocular muscles requiring surgical repair following retrobulbar…

🆘 Overdosage ~3 min read

OVERDOSAGE Acute emergencies from local anesthetics are generally related to high plasma levels encountered during therapeutic use of local anesthetics or to unintended subarachnoid injection of local anesthetic solution (see ADVERSE REACTIONS, WARNINGS, and PRECAUTIONS ). Management of Local Anesthetic Emergencies The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient’s state of consciousness after each local anesthetic injection.

At the first sign of change, oxygen should be administered. The first step in the management of convulsions, as well as underventilation or apnea due to unintended subarachnoid injection of drug solution, consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask. Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously.

Should convulsions persist despite adequate respiratory support, and if the status of the circulation permits, small increments of an ultra-short acting barbiturate (such as thiopental or thiamylal) or a benzodiazepine (such as diazepam) may be administered intravenously. The clinician should be familiar, prior to the use of local anesthetics, with these anticonvulsant drugs. Supportive treatment of circulatory depression may require administration of intravenous fluids and, when appropriate, a vasopressor as directed by the clinical situation (e.g., ephedrine).

If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias and cardiac arrest. Underventilation or apnea due to unintentional subarachnoid injection of local anesthetic solution may produce these same signs and also lead to cardiac arrest if ventilatory support is not instituted. If cardiac arrest should occur, standard cardiopulmonary resuscitative measures should be instituted.

Endotracheal intubation, employing drugs and techniques familiar to the clinician, may be indicated, after initial administration of oxygen by mask, if difficulty is encountered in the maintenance of a patent airway or if prolonged ventilatory support (assisted or controlled) is indicated. Dialysis is of negligible value in the treatment of acute overdosage with lidocaine HCl. The oral LD 50 of lidocaine HCl in non-fasted female rats is 459 (346 to 773) mg/kg (as the salt) and 214 (159 to 324) mg/kg (as the salt) in fasted female rats.

Management of Local Anesthetic Emergencies The first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient’s state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered. The first step in the management of convulsions, as well as underventilation or apnea due to unintended subarachnoid injection of drug solution, consists of immediate attention to the maintenance of a patent airway and assisted or controlled ventilation with oxygen and a delivery system capable of permitting immediate positive airway pressure by mask.

Immediately after the institution of these ventilatory measures, the adequacy of the circulation should be evaluated, keeping in mind that drugs used to treat convulsions sometimes depress the circulation when administered intravenously. Should convulsions persist despite adequate respiratory support, and if the status of the circulation permits, small increments of an ultra-short acting barbiturate (such as thiopental or thiamylal) or a benzodiazepine (such as diazepam) may be administered intravenously. The clinician should be familiar, prior to the use of loca…

🧬 Clinical Pharmacology ~3 min read

CLINICAL PHARMACOLOGY Mechanism of Action Lidocaine HCl stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses thereby effecting local anesthetic action. Hemodynamics Excessive blood levels may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. With central neural blockade these changes may be attributable to block of autonomic fibers, a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system, and/or the beta-adrenergic receptor stimulating action of epinephrine when present.

The net effect is normally a modest hypotension when the recommended dosages are not exceeded. Pharmacokinetics and Metabolism Information derived from diverse formulations, concentrations and usages reveals that lidocaine HCl is completely absorbed following parenteral administration, its rate of absorption depending, for example, upon various factors such as the site of administration and the presence or absence of a vasoconstrictor agent. Except for intravascular administration, the highest blood levels are obtained following intercostal nerve block and the lowest after subcutaneous administration.

The plasma binding of lidocaine HCl is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 mcg of free base per mL 60 to 80 percent of lidocaine HCl is protein bound. Binding is also dependent on the plasma concentration of the alpha-1-acid glycoprotein.

Lidocaine HCl crosses the blood-brain and placental barriers, presumably by passive diffusion. Lidocaine HCl is metabolized rapidly by the liver, and metabolites and unchanged drug are excreted by the kidneys. Biotransformation includes oxidative N-dealkylation, ring hydroxylation, cleavage of the amide linkage, and conjugation.

N-dealkylation, a major pathway of biotransformation, yields the metabolites monoethylglycinexylidide and glycinexylidide. The pharmacological/toxicological actions of these metabolites are similar to, but less potent than, those of lidocaine HCl. Approximately 90% of lidocaine HCl administered is excreted in the form of various metabolites, and less than 10% is excreted unchanged.

The primary metabolite in urine is a conjugate of 4-hydroxy-2,6-dimethylaniline. The elimination half-life of lidocaine HCl following an intravenous bolus injection is typically 1.5 to 2 hours. Because of the rapid rate at which lidocaine HCl is metabolized, any condition that affects liver function may alter lidocaine HCl kinetics.

The half-life may be prolonged two-fold or more in patients with liver dysfunction. Renal dysfunction does not affect lidocaine HCl kinetics but may increase the accumulation of metabolites. Factors such as acidosis and the use of CNS stimulants and depressants affect the CNS levels of lidocaine HCl required to produce overt systemic effects.

Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6 mcg free base per mL. In the rhesus monkey arterial blood levels of 18 to 21 mcg/mL have been shown to be threshold for convulsive activity.

Mechanism of Action Lidocaine HCl stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses thereby effecting local anesthetic action.

Hemodynamics Excessive blood levels may cause changes in cardiac output, total peripheral resistance, and mean arterial pressure. With central neural blockade these changes may be attributable to block of autonomic fibers, a direct depressant effect of the local anesthetic agent on various components of the cardiovascular system, and/or the beta-adrenergic receptor stimulating action of epinephrine when present. The net effect is normally a modest hypotension when the recommended dosages are not exceeded.

Pharmacokinetics and Metabolism Information derived from diverse formulatio…

📦 How Supplied / Storage and Handling ~4 min read

HOW SUPPLIED: Xylocaine ® (lidocaine HCl Injection, USP) Product Code Unit of Sale Strength Each 480457 NDC 63323-484-57 Unit of 25 0.5% 250 mg per 50 mL (5 mg per mL) NDC 63323-484-57 50 mL Multiple Dose Vial 480527 NDC 63323-485-27 Unit of 25 1% 200 mg per 20 mL (10 mg per mL) NDC 63323-485-01 20 mL Multiple Dose Vial 480557 NDC 63323-485-57 Unit of 25 1% 500 mg per 50 mL (10 mg per mL) NDC 63323-485-03 50 mL Multiple Dose Vial 480617 NDC 63323-486-17 Unit of 25 2% 200 mg per 10 mL (20 mg per mL) NDC 63323-486-01 10 mL Multiple Dose Vial 480627 NDC 63323-486-27 Unit of 25 2% 400 mg per 20 mL (20 mg per mL) NDC 63323-486-02 20 mL Multiple Dose Vial 480657 NDC 63323-486-57 Unit of 25 2% 1,000 mg per 50 mL (20 mg per mL) NDC 63323-486-05 50 mL Multiple Dose Vial Xylocaine ® -MPF (lidocaine HCl Injection, USP) Product Code Unit of Sale Strength Each 491157 NDC 63323-491-57 Unit of 25 0.5% 250 mg per 50 mL (5 mg per mL) NDC 63323-491-01 50 mL Single Dose Vial RF491227 NDC 65219-810-02 Unit of 25 1% 20 mg per 2 mL (10 mg per mL) This product contains an RFID.

NDC 65219-810-01 2 mL Single Dose Vial 491227 NDC 63323-492-27 Unit of 25 1% 20 mg per 2 mL (10 mg per mL) NDC 63323-492-04 2 mL Single Dose Vial 491257 NDC 63323-492-57 Unit of 25 1% 50 mg per 5 mL (10 mg per mL) NDC 63323-492-09 5 mL Single Dose Vial 491297 NDC 63323-492-97 Unit of 5 1% 100 mg per 10 mL (10 mg per mL) NDC 63323-492-08 10 mL Plastic Ampule 491237 NDC 63323-492-37 Unit of 25 1% 300 mg per 30 mL (10 mg per mL) NDC 63323-492-07 30 mL Single Dose Vial 491231 NDC 63323-492-31 Unit of 5 1% 300 mg per 30 mL (10 mg per mL) NDC 63323-492-03 30 mL Single Dose Vial 491397 NDC 63323-493-97 Unit of 5 1.5% 150 mg per 10 mL (15 mg per mL) NDC 63323-493-03 10 mL Plastic Ampule 491391 NDC 63323-493-91 Unit of 5 1.5% 300 mg per 20 mL (15 mg per mL) NDC 63323-493-01 20 mL Plastic Ampule RF491527 NDC 65219-812-02 Unit of 25 2% 40 mg per 2 mL (20 mg per mL) This product contains an RFID.

NDC 65219-812-01 2 mL Single Dose Vial 491527 NDC 63323-495-27 Unit of 25 2% 40 mg per 2 mL (20 mg per mL) NDC 63323-495-09 2 mL Single Dose Vial RF491507 NDC 65219-814-05 Unit of 25 2% 100 mg per 5 mL (20 mg per mL) This product contains an RFID. NDC 65219-814-01 5 mL Single Dose Vial 491507 NDC 63323-495-07 Unit of 25 2% 100 mg per 5 mL (20 mg per mL) NDC 63323-495-04 5 mL Single Dose Vial 491697 NDC 63323-496-97 Unit of 5 2% 200 mg per 10 mL (20 mg per mL) NDC 63323-496-03 10 mL Plastic Ampule Xylocaine ® (lidocaine HCl and epinephrine Injection, USP) with Epinephrine 1:100,000 Product Code Unit of Sale Strength Each 480217 NDC 63323-482-17 Unit of 25 1% 100 mg per 10 mL (10 mg per mL) NDC 63323-482-01 10 mL Multiple Dose Vial 480227 NDC 63323-482-27 Unit of 25 1% 200 mg per 20 mL (10 mg per mL) NDC 63323-482-03 20 mL Multiple Dose Vial 480257 NDC 63323-482-57 Unit of 25 1% 500 mg per 50 mL (10 mg per mL) NDC 63323-482-05 50 mL Multiple Dose Vial 480327 NDC 63323-483-27 Unit of 25 2% 400 mg per 20 mL (20 mg per mL) NDC 63323-483-03 20 mL Multiple Dose Vial 480357 NDC 63323-483-57 Unit of 25 2% 1,000 mg per 50 mL (20 mg per mL) NDC 63323-483-01 50 mL Multiple Dose Vial Xylocaine® (lidocaine HCl and epinephrine Injection, USP) with Epinephrine 1:200,000 Product Code Unit of Sale Strength Each 480157 NDC 63323-481-57 Unit of 25 0.5% 250 mg per 50 mL (5 mg per mL) NDC 63323-481-01 50 mL Multiple Dose Vial Xylocaine ® -MPF (lidocaine HCl and epinephrine Injection, USP) with Epinephrine 1:200,000 Product Code Unit of Sale Strength Each 480717 NDC 63323-487-17 Unit of 25 1% 100 mg per 10 mL (10 mg per mL) NDC 63323-487-01 10 mL Single Dose Vial 480737 NDC 63323-487-37 Unit of 25 1% 300 mg per 30 mL (10 mg per mL) NDC 63323-487-07 30 mL Single Dose Vial 480731 NDC 63323-487-31 Unit of 5 1% 300 mg per 30 mL (10 mg per mL) NDC 63323-487-03 30 mL Single Dose Vial 480817 NDC 63323-488-17 Unit of 25 1.5% 150 mg per 10 mL (15 mg per mL) NDC 63323-488-01 10 mL Single Dose Vial 480837 NDC 63323-488-37 Unit o…

📋 Description ~1 min read

DESCRIPTION Xylocaine (lidocaine HCl) Injections are sterile, nonpyrogenic, aqueous solutions that contain a local anesthetic agent with or without epinephrine and are administered parenterally by injection. See INDICATIONS AND USAGE section for specific uses. Xylocaine solutions contain lidocaine HCl, which is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl)-, monohydrochloride and has the molecular wt.

270.8. Lidocaine HCl (C 14 H 22 N 2 O • HCl) has the following structural formula: Epinephrine is (-) -3, 4-Dihydroxy-α-[(methylamino) methyl] benzyl alcohol and has the molecular wt. 183.21.

Epinephrine (C 9 H 13 NO 3 ) has the following structural formula: Dosage forms listed as Xylocaine-MPF indicate single dose solutions that are M ethyl P araben F ree (MPF). Xylocaine MPF is a sterile, nonpyrogenic, isotonic solution containing sodium chloride. Xylocaine in multiple dose vials: Each mL also contains 1 mg methyl­paraben as antiseptic preservative.

The pH of these solutions is adjusted to approximately 6.5 (5.0 to 7.0) with sodium hydroxide and/or hydrochloric acid. Xylocaine MPF with Epinephrine is a sterile, nonpyrogenic, isotonic solution containing sodium chloride. Each mL contains lidocaine hydrochloride and epinephrine, with 0.5 mg sodium metabisulfite as an antioxidant and 0.2 mg citric acid as a stabilizer.

Xylocaine with Epinephrine in multiple dose vials: Each mL also contains 1 mg methylparaben as antiseptic preservative. The pH of these solutions is adjusted to approximately 4.5 (3.3 to 5.5) with sodium hydroxide and/or hydrochloric acid. Filled under nitrogen. structure 1 structure 2

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗
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