Version July 2025
Anesthesia:
Dental: Oral infiltration/mandibular block: Lidocaine 2% with epinephrine solution: Initial: 1 to 5 mL (lidocaine 20 mg to 100 mg). Note: For most routine dental procedures, lidocaine 2% with epinephrine 1:100,000 is preferred. When a more pronounced hemostasis is required, use a 1:50,000 epinephrine concentration. Do not exceed 7 mg/kg body weight, up to a maximum range of 300 mg (usual dental practice) to 500 mg (approved product labeling) of lidocaine and 3 mcg (0.003 mg) of epinephrine/kg of body weight or 0.2 mg epinephrine per dental appointment.
Local infiltration anesthesia or nerve block: Dosage of lidocaine/epinephrine varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient. Maximum dose of lidocaine (with epinephrine): 7 mg/kg (up to 500 mg).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling. However, accumulation of metabolites may be increased in renal impairment.
Dialysis: Not dialyzable (0% to 5%) by hemo- or peritoneal dialysis; supplemental dose is not necessary (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution (hepatically metabolized); patients with severe hepatic impairment are at greater risk of lidocaine toxicity.
Refer to adult dosing; use with caution and at reduced dosages.
(For additional information see "Lidocaine and epinephrine: Pediatric drug information")
Note: Dose varies with procedure, depth of anesthesia, vascularity of tissues, duration of anesthesia, and condition of patient should only be administered under the supervision of a qualified physician experienced in the use of anesthetics. Dosing units variable (mL/kg, mg/kg); use extra precaution to ensure accuracy.
Note: Dosing should be based on lean body mass (Ref). Due to shorter duration of action and potential toxicity with repeat dosing, lidocaine is not typically used for central (spinal) or regional (epidural/caudal) anesthesia (Ref).
Local anesthesia; dermal/cutaneous infiltration: Infants, Children, and Adolescents: Usual concentration ≤2% (eg, 1% or 2%) solution: Infiltrate area locally; maximum dose is 7 mg/kg, not to exceed adult maximum dose of 500 mg (Ref). Note: Aspiration should be performed prior to each injection; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided (Ref).
Peripheral nerve block; excluding digital or penile: Infants ≥6 months, Children, and Adolescents: Usual concentrations ≤1%: Dosage (concentration [0.25, 0.5 or 1%]) and volume varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient. Maximum dose of lidocaine: 7 mg/kg, not to exceed adult maximum of 500 mg (Ref). For infants <6 months, maximum doses should be reduced by 30% (Ref).
Dental anesthesia; oral infiltration/mandibular block: Note: For most routine dental procedures, lidocaine 2% with epinephrine 1:100,000 is preferred. When a more pronounced hemostasis is required, a 1:50,000 epinephrine concentration should be used.
Children <10 years: Lidocaine 2% with epinephrine solution: ≤0.9 to 1 mL (lidocaine 18 mg to 20 mg) per procedure; maximum dose: 4.4 mg/kg not to exceed 300 mg (Ref); dosing is for procedures involving a single tooth, maxillary infiltration for 2 to 3 teeth, or mandibular block of an entire quadrant; it is rare that a patient would require a higher dose (ie, >1 mL)
Children ≥10 years and Adolescents: Lidocaine 2% with epinephrine solution: Initial: 1 to 5 mL (lidocaine 20 mg to 100 mg). Do not exceed usual dental guideline recommended maximum dose of 4.4 mg/kg up to a maximum total dose of 300 mg (Ref); some suggest a higher maximum of 7 mg/kg up to total maximum of 500 mg (approved product labeling) of lidocaine and 3 mcg (0.003 mg) of epinephrine/kg of body weight or 0.2 mg epinephrine per dental appointment.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; however, accumulation of metabolites may be increased in renal impairment. Not dialyzable (0% to 5%) by hemo- or peritoneal dialysis; supplemental dose is not necessary (Ref).
Use with caution; reduce dose; use with caution (hepatically metabolized); patients with severe hepatic impairment are at greater risk of lidocaine toxicity.
The following adverse drug reaction is derived from product labeling unless otherwise specified. Also see individual agents.
Postmarketing: Hematologic & oncologic: Methemoglobinemia
Hypersensitivity to lidocaine, other local anesthetics of the amide type, epinephrine, or any component of the formulation.
Concerns related to adverse effects:
• Cardiovascular effects: Lidocaine can cause cardiac depression (eg, bradycardia, hypotension); patients with hypovolemia may be at increased risk.
• CNS toxicity: Careful and constant monitoring of the patient's state of consciousness should be done following each local anesthetic injection; at such times, restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression, or drowsiness may be early warning signs of CNS toxicity. Treatment is primarily symptomatic and supportive.
• Hypersensitivity: Anaphylactic reactions may occur following administration.
• Intra-articular infusion related chondrolysis: Continuous intra-articular infusion of local anesthetics after arthroscopic or other surgical procedures is not an approved use; chondrolysis (primarily in the shoulder joint) has occurred following infusion, with some cases requiring arthroplasty or shoulder replacement.
• Methemoglobinemia: Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment along with discontinuation of the anesthetic and other oxidizing agents. Onset may be immediate or delayed (hours) after anesthetic exposure. Patients with G6PD deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, exposure to oxidizing agents or their metabolites, or infants <6 months of age are more susceptible and should be closely monitored for signs and symptoms of methemoglobinemia (eg, cyanosis, headache, rapid pulse, shortness of breath, lightheadedness, fatigue).
• Respiratory arrest: Local anesthetics have been associated with occurrences of respiratory arrest.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with bradycardia, severe shock, heart block, or impaired cardiovascular function; use with caution in areas of the body supplied by end arteries or having otherwise compromised blood supply. Patients with peripheral vascular disease or hypertensive vascular disease may exhibit exaggerated vasoconstrictor response. Ischemic injury (eg, exfoliating, ulcerating lesions) or necrosis may result.
• Diabetes: Use with caution in patients with diabetes.
• Hepatic impairment: Use with caution in patients with hepatic impairment; lidocaine is hepatically metabolized and patients with severe hepatic impairment are at greater risk of lidocaine toxicity.
• Renal impairment: Use with caution in patients with severe renal impairment (lidocaine metabolites may accumulate).
• Thyroid disease: Use with caution in patients with poorly controlled hyperthyroidism.
Special populations:
• Acutely ill patients: Use with caution in acutely ill; reduce dose consistent with age and physical status.
• Debilitated patients: Use with caution in debilitated patients; reduce dose consistent with age and physical status.
• Older adult: Use with caution in the elderly; reduce dose consistent with age and physical status.
• Pediatric: Use with caution in children; reduce dose consistent with age and physical status.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP 1997; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates See manufacturer’s labeling.
• Sodium metabisulfite: May contain sodium metabisulfite; use caution in patients with a sulfite allergy.
Other warnings/precautions:
• Appropriate use: Avoid intravascular injections. Aspirate the syringe prior to administration; the needle must be repositioned until no return of blood can be elicited by aspiration; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided. Use with caution when there is inflammation and/or sepsis in the region of the proposed injection. Do not use injections containing preservatives (eg, methylparaben) for epidural or spinal anesthesia, or for any route of administration that would introduce solution into the cerebrospinal fluid.
• Epidural anesthesia: Use lumbar and caudal epidural anesthesia with extreme caution in patients with existing neurological disease, spinal deformities, septicemia, and impaired cardiovascular function (eg, severe hypertension).
• Repeat doses: Repeat doses of lidocaine may cause significant increases in blood levels with each repeated dose due to slow accumulation of the drug or its metabolites. Tolerance to elevated blood levels varies with the status of the patient.
• Trained personnel: Dental practitioners and/or clinicians using local anesthetic agents should be well trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Xylocaine/EPINEPHrine: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:100,000 (10 mL, 20 mL, 50 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:100,000 (20 mL, 50 mL); Lidocaine hydrochloride 0.5% [5 mg/mL] and epinephrine 1:200,000 (50 mL) [contains methylparaben, sodium metabisulfite]
Generic: Lidocaine hydrochloride 0.5% [5 mg/mL] and epinephrine 1:200,000 (50 mL); Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:100,000 (20 mL, 30 mL, 50 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:100,000 (1.7 mL, 1.8 mL [DSC], 20 mL, 30 mL, 50 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:50,000 (1.8 mL [DSC])
Solution, Injection [preservative free]:
Xylocaine-MPF/EPINEPHrine: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:200,000 (10 mL, 30 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:200,000 (10 mL, 20 mL); Lidocaine hydrochloride 1.5% [15 mg/mL] and epinephrine 1:200,000 (5 mL, 10 mL, 30 mL) [methylparaben free; contains sodium metabisulfite]
Generic: Lidocaine hydrochloride 1.5% [15 mg/mL] and epinephrine 1:200,000 (5 mL, 30 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:200,000 (20 mL)
Yes
Solution (Lidocaine-EPINEPHrine (PF) Injection)
1.5%-1:200000 (per mL): $1.12 - $1.30
2%-1:200000 (per mL): $0.30
Solution (Lidocaine-EPINEPHrine Injection)
0.5%-1:200000 (per mL): $0.09
1%-1:100000 (per mL): $0.23
2%-1:100000 (per mL): $0.20
Solution (Xylocaine-MPF/EPINEPHrine Injection)
1%-1:200000 (per mL): $0.41
1.5%-1:200000 (per mL): $0.46
2%-1:200000 (per mL): $0.77
Solution (Xylocaine/EPINEPHrine Injection)
0.5%-1:200000 (per mL): $0.22
1%-1:100000 (per mL): $0.34
2%-1:100000 (per mL): $0.34
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Lignospan Forte: 2 %-1:50000 (1.8 mL)
Lignospan Standard: 2 %-1:100000 (1.8 mL)
Octocaine/Epinephrine: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:50,000 (1.8 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:100,000 (1.8 mL)
Xylocaine Dental Lidocaine/Epi: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:50,000 (1.8 mL)
Xylocaine/EPINEPHrine: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:100,000 (20 mL) [contains methylparaben, sodium metabisulfite]
Xylocaine/Epinephrine: Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:200,000 (20 mL) [contains methylparaben, sodium metabisulfite]
Xylocaine/Epinephrine: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:200,000 (20 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:100,000 (1.8 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:200,000 (20 mL) [contains sodium metabisulfite]
Generic: Lidocaine hydrochloride 1% [10 mg/mL] and epinephrine 1:100,000 ([DSC]); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:100,000 (1.8 mL, 20 mL, 30 mL, 50 mL); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:200,000 ([DSC]); Lidocaine hydrochloride 2% [20 mg/mL] and epinephrine 1:50,000 (1.7 mL)
Avoid intravascular injections. Aspirate the syringe after tissue penetration and before injection to minimize chance of direct vascular injection. Use with caution or avoid use when there is inflammation and/or sepsis in the region of the proposed injection. Do not use injections containing preservatives (eg, methylparaben) for epidural or spinal anesthesia, or for any route of administration that would introduce solution into the cerebrospinal fluid. For continuous epidural or caudal anesthesia, the maximum dose should not be administered at intervals of <90 minutes.
Avoid intravascular injections. Aspirate the syringe after tissue penetration and before injection to minimize chance of direct vascular injection. Use with caution or avoid use when there is inflammation and/or sepsis in the region of the proposed injection. Do not use injections containing preservatives (eg, methylparaben) for epidural or spinal anesthesia, or for any route of administration that would introduce solution into the cerebrospinal fluid. For continuous epidural or caudal anesthesia, the maximum dose should not be administered at intervals of <90 minutes.
Anesthesia, local: Local or regional anesthesia or analgesia for surgery, dental and oral procedures, diagnostic and therapeutic procedures, and obstetrical procedures in adult and pediatric patients.
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (epidural and intrathecal medications) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha1-Blockers: May decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Amiodarone: May increase serum concentration of Lidocaine (Systemic). Risk C: Monitor
Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor
Articaine: May increase adverse/toxic effects of Local Anesthetics. Risk C: Monitor
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Azosemide: May decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor
Benperidol: May decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor
Benzylpenicilloyl Polylysine: Coadministration of Alpha-/Beta-Agonists and Benzylpenicilloyl Polylysine may alter diagnostic results. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider Therapy Modification
Beta-Blockers (Beta1 Selective): May decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor
Beta-Blockers (Nonselective): May increase hypertensive effects of EPINEPHrine (Systemic). Risk C: Monitor
Beta-Blockers (with Alpha-Blocking Properties): May decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor
Blonanserin: May decrease therapeutic effects of EPINEPHrine (Systemic). Risk X: Avoid
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bretylium: May increase therapeutic effects of Alpha-/Beta-Agonists (Direct-Acting). Risk C: Monitor
Broccoli: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha-/Beta-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Bromperidol: May decrease therapeutic effects of EPINEPHrine (Systemic). Risk X: Avoid
BUPivacaine (Liposomal): Lidocaine (Systemic) may increase adverse/toxic effects of BUPivacaine (Liposomal). Management: Liposomal bupivacaine should not be administered with lidocaine. Liposomal bupivacaine may be administered 20 minutes or more after the administration of lidocaine. Lidocaine may be administered 96 hours or more after liposomal bupivacaine administration. Risk D: Consider Therapy Modification
BUPivacaine: Local Anesthetics may increase adverse/toxic effects of BUPivacaine. Management: Avoid using any additional local anesthetics within 96 hours after insertion of the bupivacaine implant (Xaracoll) or bupivacaine and meloxicam periarticular solution (Zynrelef) or within 168 hours after subacromial infiltration (Posimir brand). Risk C: Monitor
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Cannabis: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
Cardiac Glycosides: EPINEPHrine (Systemic) may increase arrhythmogenic effects of Cardiac Glycosides. Risk C: Monitor
Chloroprocaine (Systemic): May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
Chlorprothixene: May increase adverse/toxic effects of EPINEPHrine (Systemic). Specifically, paradoxical hypotension and tachycardia may be increased. EPINEPHrine (Systemic) may increase therapeutic effects of Chlorprothixene. Risk C: Monitor
Cimetidine: May increase serum concentration of Lidocaine (Systemic). Risk C: Monitor
Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor
CloZAPine: May decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
COMT Inhibitors: May increase serum concentration of COMT Substrates. Risk C: Monitor
CYP1A2 Inducers (Moderate): May decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
CYP1A2 Inhibitors (Strong): May increase serum concentration of Lidocaine (Systemic). Risk C: Monitor
CYP3A4 Inducers (Strong): May decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
CYP3A4 Inhibitors (Moderate): May increase serum concentration of Lidocaine (Systemic). CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Lidocaine (Systemic). Specifically, concentrations of monoethylglycinexylidide (MEGX) may be increased. Risk C: Monitor
CYP3A4 Inhibitors (Strong): May increase serum concentration of Lidocaine (Systemic). Risk C: Monitor
Dapsone (Topical): May increase adverse/toxic effects of Methemoglobinemia Associated Agents. Risk C: Monitor
Diazoxide Choline: May increase serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Risk X: Avoid
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Disopyramide: May increase arrhythmogenic effects of Lidocaine (Systemic). Disopyramide may increase serum concentration of Lidocaine (Systemic). Specifically, the unbound/free fraction of lidocaine may be increased. Risk C: Monitor
Diuretics: May increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha-/Beta-Agonists. Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
Etravirine: May decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification
Grapefruit Juice: May increase serum concentration of Lidocaine (Systemic). Grapefruit Juice may increase active metabolite exposure of Lidocaine (Systemic). Specifically, concentrations of monoethylglycinexylidide (MEGX) may be increased. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Haloperidol: May decrease vasoconstricting effects of EPINEPHrine (Systemic). Management: Consider alternatives to this combination and monitor for reduced epinephrine efficacy, and possible paradoxical effects (ie, hypotension), when combined. Use of alternative vasopressor agents (eg, phenylephrine, metaraminol, norepinephrine) is preferred. Risk D: Consider Therapy Modification
Hexoprenaline: May increase adverse/toxic effects of Alpha-/Beta-Agonists. Risk X: Avoid
Hyaluronidase: May increase vasoconstricting effects of Alpha-/Beta-Agonists. Management: Do not use hyaluronidase to enhance the dispersion or absorption of alpha-/beta-agonists. Use of hyaluronidase for other purposes in patients receiving alpha-/beta-agonists may be considered as clinically indicated. Risk D: Consider Therapy Modification
Inhalational Anesthetics: May increase arrhythmogenic effects of EPINEPHrine (Systemic). Management: Administer epinephrine with added caution in patients receiving, or who have recently received, inhalational anesthetics. Use lower than normal doses of epinephrine and monitor for the development of cardiac arrhythmias. Risk D: Consider Therapy Modification
Isoproterenol: May increase therapeutic effects of EPINEPHrine (Systemic). Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Lacosamide: Lidocaine (Systemic) may increase adverse/toxic effects of Lacosamide. Specifically the risk for bradycardia, ventricular tachyarrhythmias, or a prolonged PR interval may be increased. Risk C: Monitor
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Lidocaine (Topical): May increase adverse/toxic effects of Antiarrhythmic Agents (Class IB). Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk X: Avoid
Local Anesthetics: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor
Melperone: May increase adverse/toxic effects of EPINEPHrine (Systemic). Risk C: Monitor
Methemoglobinemia Associated Agents: May increase adverse/toxic effects of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor
Monoamine Oxidase Inhibitors: May increase hypertensive effects of EPINEPHrine (Systemic). Risk C: Monitor
Neuromuscular-Blocking Agents: Local Anesthetics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor
Nitric Oxide: May increase adverse/toxic effects of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor
Pergolide: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
Phenobarbital-Primidone: May decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
Prilocaine: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor for signs of methemoglobinemia when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid use of these agents with prilocaine/lidocaine cream in infants less than 12 months of age. Risk C: Monitor
Primaquine: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Primaquine. Specifically, the risk for methemoglobinemia may be increased. Management: Avoid concomitant use of primaquine and other drugs that are associated with methemoglobinemia when possible. If combined, monitor methemoglobin levels closely. Risk D: Consider Therapy Modification
Promethazine: May decrease vasoconstricting effects of EPINEPHrine (Systemic). Management: Avoid epinephrine and consider norepinephrine or phenylephrine when treating hypotension due to promethazine overdose. Consider alternative vasocontrictors in patients treated with promethazine. This combination may be indicated in anaphylaxis treatment. Risk D: Consider Therapy Modification
Propranolol: May increase serum concentration of Lidocaine (Systemic). Risk C: Monitor
ROPivacaine: May increase adverse/toxic effects of Local Anesthetics. Risk C: Monitor
Saquinavir: May increase serum concentration of Lidocaine (Systemic). Risk X: Avoid
Serotonin/Norepinephrine Reuptake Inhibitor: May increase tachycardic effects of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitor may increase vasopressor effects of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider Therapy Modification
Sodium Nitrite: Methemoglobinemia Associated Agents may increase adverse/toxic effects of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Spironolactone: May decrease vasoconstricting effects of Alpha-/Beta-Agonists. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Technetium Tc 99m Tilmanocept: Coadministration of Local Anesthetics and Technetium Tc 99m Tilmanocept may alter diagnostic results. Management: Avoid mixing and simultaneously co-injecting technetium Tc 99m tilmanocept with local anesthetics. This interaction does not appear to apply to other uses of these agents in combination. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Tobacco (Smoked): May decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
Tricyclic Antidepressants: May increase vasopressor effects of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Risk D: Consider Therapy Modification
Vasopressin: Alpha-/Beta-Agonists (Direct-Acting) may increase hypertensive effects of Vasopressin. The effect of other hemodynamic parameters may also be enhanced. Risk C: Monitor
Adverse events have not been observed in animal reproduction studies. See individual agents.
It is not known if lidocaine/epinephrine is excreted in breast milk. The manufacturer recommends that caution be exercised when administering lidocaine/epinephrine to nursing women. See individual agents.
Vital signs; ECG during administration of a test dose; state of consciousness after each injection; CNS toxicity.
Lidocaine: Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction.
Epinephrine: Increases the duration of action of lidocaine by causing vasoconstriction (via alpha effects) which slows the vascular absorption of lidocaine.
Onset of action: Dental: ≤2 to 4 minutes
Duration: Dental: ~2.5 hours (infiltration); 3 to 3.5 hours (nerve block); dose and anesthetic procedure dependent
