▶ Levobupivacaine (Non-proprietary)
Levobupivacaine (as Levobupivacaine hydrochloride).625 mg per
1 ml Levobupivacaine 62.5mg/100ml infusion bags | 5 bag P s
Levobupivacaine 125mg/200ml infusion bags | 5 bag P s
Levobupivacaine (as Levobupivacaine hydrochloride) 1.25 mg per
1 ml Levobupivacaine 125mg/100ml infusion bags | 5 bag P s
Levobupivacaine (as Levobupivacaine hydrochloride) 1.25 mg per
1 ml Chirocaine 125mg/100ml infusion bags | 24 bag P £174.22
Chirocaine 250mg/200ml infusion bags | 12 bag P s
▶ Adult: Dose to be given according to patient’s weight
and nature of procedure; max. 200 mg, maximum dose
500 mg if given in solutions containing adrenaline
DOSES AT EXTREMES OF BODY-WEIGHT
▶ When used by local infiltration To avoid excessive dosage in
obese patients, weight-based doses for non-emergency
indications may need to be calculated on the basis of ideal
Intravenous regional anaesthesia and nerve block
Pain relief (in anal fissures, haemorrhoids, pruritus ani,
pruritus vulvae, herpes zoster, or herpes labialis)|
Lubricant in cystoscopy | Lubricant in proctoscopy
▶ Adult: Apply 1–2 mL as required, avoid long-term use
Sore nipples from breast-feeding
▶ Adult: Apply using gauze and wash off immediately
Anaesthesia before venous cannulation or venepuncture
▶ Child 1–2 months: Apply up to 1 g, apply thick layer to
small area (2.5 cm 6 2.5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
60 minutes, remove cream with gauze and perform
procedure after approximately 5 minutes
▶ Child 3–11 months: Apply up to 1 g, apply thick layer to
small area (2.5 cm 6 2.5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
4 hours, remove cream with gauze and perform
procedure after approximately 5 minutes
▶ Child 1–17 years: Apply 1–2.5 g, apply thick layer to
small area (2.5 cm 6 2.5 cm) of non-irritated skin at
least 30 minutes before procedure; may be applied
under an occlusive dressing; max. application time
5 hours, remove cream with gauze and perform
procedure after approximately 5 minutes
▶ Adult: Apply 1–2.5 g, apply thick layer to small area
(2.5 cm 6 2.5 cm) of non-irritated skin at least
30 minutes before procedure; may be applied under an
occlusive dressing; max. application time 5 hours,
remove cream with gauze and perform procedure after
▶ Adult: Apply once daily for up to 12 hours, followed by
a 12-hour plaster-free period; discontinue if no
response after 4 weeks, to be applied to intact, dry,
non-hairy, non-irritated skin, up to 3 plasters may be
used to cover large areas; plasters may be cut
▶ When used by local infiltration
The licensed doses stated may not be appropriate in
some settings and expert advice should be sought.
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and should not be administered
parenterally unless adequate resuscitation equipment is
▶ When used by regional administration All grades of
atrioventricular block . application to the middle ear (can
containing preservatives should not be used for caudal,
epidural, or spinal block, or for intravenous regional
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ When used by regional administration Local anaesthetics
should not be injected into inflamed or infected tissues nor
should they be applied to damaged skin. Increased
absorption into the blood increases the possibility of
systemic side-effects, and the local anaesthetic effect may
also be reduced by altered local pH.
▶ When used by regional administration Acute porphyrias
reduction). congestive cardiac failure (consider lower
function . myasthenia gravis . post cardiac surgery
l INTERACTIONS → Appendix 1: antiarrhythmics
▶ With parenteral use Anxiety . arrhythmias . atrioventricular
altered .tinnitus .tremor. vision blurred . vomiting
SIDE-EFFECTS, FURTHER INFORMATION Toxic effects The
systemic toxicity of local anaesthetics mainly involves the
central nervous and cardiovascular systems.
Methaemoglobinaemia Methylthioninium chloride is
licensed for the acute symptomatic treatment of druginduced methaemoglobinaemia.
l ALLERGY AND CROSS-SENSITIVITY
▶ Hypersensitivity and cross-sensitivity Hypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
l PREGNANCY Crosses the placenta but not known to be
harmful in animal studies—use if benefit outweighs risk.
When used as a local anaesthetic, large doses can cause
fetal bradycardia; if given during delivery can also cause
neonatal respiratory depression, hypotonia, or bradycardia
after paracervical or epidural block.
l BREAST FEEDING Present in milk but amount too small to
l HEPATIC IMPAIRMENT Caution—increased risk of sideeffects.
l RENAL IMPAIRMENT Possible accumulation of lidocaine
and active metabolite; caution in severe impairment.
▶ With systemic use Monitor ECG and have resuscitation
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (July 2008)
that Versatis ® is accepted for restricted use within NHS
Scotland for the treatment of postherpetic neuralgia in
patients who are intolerant of first-line systemic therapies
or when they have been ineffective.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
▶ Lidocaine hydrochloride (Non-proprietary)
Lidocaine hydrochloride 5 mg per 1 ml Lidocaine 50mg/10ml
(0.5%) solution for injection ampoules | 10 ampoule P £7.00
Lidocaine hydrochloride 10 mg per 1 ml Lidocaine 100mg/10ml
(1%) solution for injection Mini-Plasco ampoules | 20 ampoule P £1.15–£11.21
Lidocaine 100mg/10ml (1%) solution for injection ampoules | 10 ampoule P £4.00–£5.00 DT = £4.40
Lidocaine 200mg/20ml (1%) solution for injection vials | 10 vial P £19.00–£22.00 DT = £22.00
Lidocaine 200mg/20ml (1%) solution for injection ampoules | 10 ampoule P £7.00–£11.00 DT = £11.00
Lidocaine 50mg/5ml (1%) solution for injection ampoules | 10 ampoule P £2.59–£12.00 DT = £2.59
Lidocaine 200mg/20ml (1%) solution for injection Mini-Plasco
Lidocaine 20mg/2ml (1%) solution for injection ampoules | 10 ampoule P £12.00 DT = £2.20
Lidocaine 50mg/5ml (1%) solution for injection Mini-Plasco ampoules
Lidocaine 50mg/5ml (1%) solution for injection Sure-Amp ampoules | 20 ampoule P £6.00
Lidocaine hydrochloride 20 mg per 1 ml Lidocaine 100mg/5ml
(2%) solution for injection ampoules | 10 ampoule P £2.70–
Lidocaine 400mg/20ml (2%) solution for injection vials | 10 vial P £19.50–£23.00 DT = £23.00
Lidocaine 200mg/10ml (2%) solution for injection Mini-Plasco
ampoules | 20 ampoule P £14.95
Lidocaine 400mg/20ml (2%) solution for injection Mini-Plasco
Lidocaine 40mg/2ml (2%) solution for injection ampoules | 10 ampoule P £12.00 DT = £2.37
Lidocaine 100mg/5ml (2%) solution for injection Mini-Plasco ampoules
Lidocaine 400mg/20ml (2%) solution for injection ampoules | 10 ampoule P £8.00–£11.40 DT = £11.40
EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene
Lidocaine 50 mg per 1 gram Ralvo 700mg medicated plasters | 30 plaster P £61.54 DT = £72.40
Lidocaine 50 mg per 1 gram Versatis 700mg medicated plasters |
30 plaster P £72.40 DT = £72.40
EXCIPIENTS: May contain Benzyl alcohol, propylene glycol
▶ LMX 4 (Ferndale Pharmaceuticals Ltd)
Lidocaine 40 mg per 1 gram LMX 4 cream | 5 gram p £2.98 DT =
£2.98 | 30 gram p £14.90 DT = £14.90
▶ Vagisil medicated (Combe International Ltd)
Lidocaine 20 mg per 1 gram Vagisil 2% medicated cream | 30 gram G £2.99 DT = £2.99
▶ Lidocaine hydrochloride (Non-proprietary)
Lidocaine hydrochloride 50 mg per 1 gram Lidocaine 5% ointment
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, lidocaine hydrochloride p. 103,
adrenaline/epinephrine p. 222.
▶ Adult: Dosed according to the type of nerve block
required (consult product literature)
Adrenaline/epinephrine must be used in a low
concentration when administered with a local
anaesthetic. The total dose of adrenaline should not
exceed 500 micrograms and it is essential not to exceed a
concentration of 1 in 200 000 (5 micrograms/mL) if more
than 50 mL of the mixture is to be injected.
l INTERACTIONS → Appendix 1: antiarrhythmics . sympathomimetics, vasoconstrictor
l PROFESSION SPECIFIC INFORMATION
A variety of lidocaine injections with adrenaline is
available in dental cartridges.
Consult expert dental sources for specific advice in
relation to dose of lidocaine for dental anaesthesia.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
EXCIPIENTS: May contain Sulfites
▶ Lignospan Special (Septodont Ltd)
Adrenaline (as Adrenaline acid tartrate) 12.5 microgram per 1 ml,
Lidocaine hydrochloride 20 mg per 1 ml Lignospan Special 2%
injection 2.2ml cartridges | 50 cartridge P £21.95
Lignospan Special 2% injection 1.8ml cartridges | 50 cartridge P £21.95
▶ Rexocaine (Henry Schein Ltd)
Adrenaline (as Adrenaline acid tartrate) 12.5 microgram per 1 ml,
Lidocaine hydrochloride 20 mg per 1 ml Rexocaine 2% injection
2.2ml cartridges | 50 cartridge P £23.29
▶ Xylocaine with Adrenaline (Aspen Pharma Trading Ltd)
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Lidocaine hydrochloride 10 mg per 1 ml Xylocaine 1% with
Adrenaline 100micrograms/20ml (1 in 200,000) solution for injection
vials | 5 vial P £9.66 DT = £9.66
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
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