Numbing the skin before you have certain medical procedures (eg, injections, minor skin surgery) in the treated area.
Lidokain-adrenalin iontophoretic patch is a local anesthetic. It works by stopping nerves from transmitting painful impulses to the brain.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Lidokain-adrenalin (Lidocaine (Lidokain-adrenalin) and Lidokain-adrenalin Injection, USP) is indicated for the production of local anesthesia for dental procedures by nerve block or infiltration techniques.
Only accepted procedures for these techniques as described in standard textbooks are recommended.
How should I use Lidokain-adrenalin?
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use Lidokain-adrenalin iontophoretic patch as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Lidokain-adrenalin iontophoretic patch is usually applied at your doctor's office, hospital, or clinic. If you will be using Lidokain-adrenalin iontophoretic patch at home, a health care provider will teach you how to use it. Be sure you understand how to use Lidokain-adrenalin iontophoretic patch. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
Lidokain-adrenalin iontophoretic patch is only to be used on intact, clean, dry skin, Do not apply Lidokain-adrenalin iontophoretic patch to broken, damaged, inflamed, or hairy skin.
If you miss a dose of Lidokain-adrenalin iontophoretic patch, contact your doctor right away.
Ask your health care provider any questions you may have about how to use Lidokain-adrenalin iontophoretic patch.
Lidokain-adrenalin/ Adrenaline is sterile, isotonic, and in addition, contains adrenaline acid tartrate and sodium metabisulfite 0.5 mg/mL as antioxidant. It contains no antimicrobial agent and should be used only once and any residue be discarded.
Lidokain-adrenalin/ Adrenaline has a pH of approximately 3-4.5.
The chemical abstracts service (CAS) number for lignocaine HCl [Australian approved name (AAN)], is 6108-05-0 and anhydrous lignocaine HCl is 73-78-9. The chemical name for lignocaine HCl is 2-Diethylaminoaceto-2'6'-xylidide HCl. The CAS number for adrenaline is 51-43-4. The chemical name for adrenaline is (R)-1-(3,4-Dihydroxyphenyl)-2-methylaminoethanol. The AAN is adrenaline.
Lignocaine base has a pKa of 7.85 (25°C), an oil/water coefficient of 2.9 and a molecular weight of 234.3.
Lignocaine is classed as a membrane-stabilising agent and is a local anaesthetic of the amide-type. It is extremely stable.
The dosage of 2% Lidokain-adrenalin solutions (Lidocaine (Lidokain-adrenalin) HCl and Lidokain-adrenalin) depends on the physical status of the patient, the area of the oral cavity to be anesthetized, the vascularity of the oral tissues, and the technique of anesthesia used. The least volume of solution that results in effective local anesthesia should be administered; time should be allowed between injections to observe the patient for manifestations of an adverse reaction. For specific techniques and procedures of a local anesthesia in the oral cavity, refer to standard textbooks.
For most routine dental procedures, 2% Lidokain-adrenalin with Lidokain-adrenalin 1:100,000 (Lidocaine (Lidokain-adrenalin) HCl 2% with a 1:100,000 Lidokain-adrenalin concentration) is preferred. However, when greater depth and a more pronounced hemostasis are required, 2% Lidokain-adrenalin with Lidokain-adrenalin 1:50,000 (Lidocaine (Lidokain-adrenalin) HCl 2 % with 1:50,000 Lidokain-adrenalin concentration) should be used.
Dosage requirements should be determined on an individual basis. In oral infiltration and / or mandibular block, initial dosages of 1.0 - 5.0 mL (1/2 to 21⁄2 cartridges) of 2% Lidokain-adrenalin (Lidocaine (Lidokain-adrenalin) HCl 2% solutions with a 1:50,000 or a 1:100,000 Lidokain-adrenalin concentration) are usually effective.
In children under 10 years of age, it is rarely necessary to administer more than one-half cartridge (0.9-1.0 mL or 18-20 mg of Lidocaine (Lidokain-adrenalin)) per procedure to achieve local anesthesia for a procedure involving a single tooth. In maxillary infiltration, this amount will often suffice to the treatment of two or even three teeth. In the mandibular block, however, satisfactory anesthesia achieved with this amount of drug, will allow treatment of the teeth of an entire quadrant. Aspiration is recommended since it reduces the possibility of intravascular injection, thereby keeping the incidence of side effects and anesthetic failures to a minimum. Moreover, injection should always be made slowly.
Maximum recommended dosages for 2% Lidokain-adrenalin (Lidocaine (Lidokain-adrenalin) HCl 2% solutions with a 1:50,000 or a 1:100,000 Lidokain-adrenalin concentration).
For normal healthy adults, the amount of Lidocaine (Lidokain-adrenalin) HCl administered should be kept below 500 mg, and in any case, should not exceed 7 mg/kg (3.2 mg/lb) of body weight.
Pediatric patients : It is difficult to recommend a maximum dose of any drug for pediatric patients since this varies as a function of age and weight. For pediatric patients of less than ten years who have a normal lean body mass and normal body development, the maximum dose may be determined by the application of one of the standard pediatric drug formulas (e.g., Clark's rule). For example, in pediatric patients of five years weighing 50 Ibs, the dose of Lidocaine (Lidokain-adrenalin) hydrochloride should not exceed 75-100mg when calculated according to Clark's rule. In any case, the maximum dose of Lidocaine (Lidokain-adrenalin) hydrochloride should not exceed 7 mg/kg (3.2 mg/lb) of body weight.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever the solution and container permit. Solutions that are discolored and or contain particulate matter should not be used and any unused portion of a cartridge of 2% Lidokain-adrenalin should be discarded.
Lidokain-adrenalin should be used cautiously in patients with hyperthyroidism, hypertension and cardiac arrhythmias. All vasopressors should be used cautiously in patients taking monoamine oxidase (MAO) inhibitors.
Lidokain-adrenalin should not be administered concomitantly with other sympathomimetic drugs (such as isoproterenol) because of possible additive effects and increased toxicity.
Combined effects may induce serious cardiac arrhythmias. They may be administered alternately when the preceding effect of other such drug has subsided.
Administration of Lidokain-adrenalin to patients receiving cyclopropane or halogenated hydrocarbon general anesthetics such as halothane which sensitize the myocardium, may induce cardiac arrhythmia.. When encountered, such arrhythmias may respond to administration of a beta-adrenergic blocking drug. Lidokain-adrenalin also should be used cautiously with other drugs (e.g., digitalis, glycosides) that sensitize the myocardium to the actions of sympathomimetic drugs.
Diuretic agents may decrease vascular response to pressor drugs such as Lidokain-adrenalin.
Lidokain-adrenalin may antagonize the neuron blockade produced by guanethidine resulting in decreased antihypertensive effect and requiring increased dosage of the latter.
Adverse experiences following the administration of Lidocaine (Lidokain-adrenalin) are similar in nature to those observed with other amide-type local anesthetic agents. These adverse experiences are, in general, dose-related and may result from high plasma levels (which may be caused by excessive dosage, rapid absorption, unintended intravascular injection or slow metabolic degradation), injection technique, volume of injection, 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 (Lidokain-adrenalin) is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption.
Cardiovascular manifestations in response to Lidocaine (Lidokain-adrenalin) are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. In addition, the beta-adrenergic receptor-stimulating action of Lidokain-adrenalin may lead to excitatory cardiovascular responses, such as tachycardia, palpitations, and hypertension.
Signs and symptoms of depressed cardiovascular function may commonly result from a vasovagal reaction, particularly if the patient is in an upright position. Less commonly, they may result from a direct effect of the drug. Failure to recognize the premonitory signs such as sweating, a feeling of faintness, changes in pulse or sensorium may result in progressive cerebral hypoxia and seizure or serious cardiovascular catastrophe. Management consists of placing the patient in the recumbent position and ventilation with oxygen. Supportive treatment of circulatory depression may require the administration of intravenous fluids and, when appropriate, a vasopressor (e.g, ephedrine) as directed by the clinical situation.
Allergic reactions are characterized by cutaneous lesions, urticaria, edema, anaphylactoid reactions, or dyspnea due to bronchoconstriction. Allergic reactions as a result of sensitivity to Lidocaine (Lidokain-adrenalin) are extremely rare and, if they occur, should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value.
The incidences of adverse reactions (e.g., persistent neurologic deficit) associated with the use of local anesthetics may be related to the technique employed, the total dose of local anesthetic administered, the particular drug used, the route of administration, and the physical condition of the patient.
Persistent paresthesias of the lips, tongue, and oral tissues have been reported with the use of Lidocaine (Lidokain-adrenalin), with slow, incomplete, or no recovery. These post-marketing events have been reported chiefly following nerve blocks in the mandible and have involved the trigeminal nerve and its branches.
Allergy or hypersensitivity to amide-type local anaesthetics, sodium metabisulfite or to any excipients of Lidokain-adrenalin/ Adrenaline. Detection of suspected hypersensitivity by skin testing is of limited value.
Local anaesthetics are contraindicated for epidural and spinal anaesthesia in patients with uncorrected hypotension or coagulation disorders or in patients receiving anticoagulation treatment.
Local anaesthetic techniques must not be used when there is inflammation and/or sepsis in the region of the proposed injection and/or in the presence of septicaemia.
General contraindications related to epidural anaesthesia, regardless of the local anaesthetic used, should be taken into account.
Adrenaline is contraindicated in conditions where the production or exacerbation of tachycardia may prove fatal eg, thyrotoxicosis or severe heart disease, or in obstetrics when maternal blood pressure exceeds 130/80 mmHg.
Solutions with adrenaline must not be used for local analgesia in parts of the body with compromised blood supply or supplied by end arteries eg, fingers, toes, nose, ears or penis. There is a possibility of producing arterial vasoconstriction and subsequent ischaemic gangrene distal to the site of injection.
Solutions with adrenaline must not be used for IV regional techniques.
Solutions with adrenaline should not be used in patients with known sensitivity to sympathomimetic amines.
Solutions with adrenaline should not be used in most patients with cerebral arteriosclerosis.
DailyMed. "LIDOCAINE; TETRACAINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
DailyMed. "EPINEPHRINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology