Lignospan Forte Uses

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What is Lignospan Forte?

Numbing the skin before you have certain medical procedures (eg, injections, minor skin surgery) in the treated area.

Lignospan Forte iontophoretic patch is a local anesthetic. It works by stopping nerves from transmitting painful impulses to the brain.

Lignospan Forte indications

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.
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Production of local or regional anaesth by infiltration techniques; IV regional anaesth, by peripheral nerve block techniques eg intercostal blocks; major plexus blocks eg brachial plexus blocks & by epidural & subarachnoid blocks. As Spray: Surface anaesth: In dentistry Otorhinolaryngology for maxillary sinus Paracentesis During delivery Introduction of instruments & catheters into the resp & digestive tract Laryngeal & tracheal procedures As Gel: As a surface anaesth & lubricant for the male & female urethra during cystoscopy, catheterisation, exploration by sound & other endourethral procedures, nasal & pharyngeal cavities in endoscopic procedures eg gastroscopy & bronchoscopy, during proctoscopy & rectoscopy & tracheal intubation. Symptomatic treatment of pain in connection w/ cystitis & urethritis. As Rectal Cream or suppositories for hemorrhoids

How should I use Lignospan Forte?

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 Lignospan Forte iontophoretic patch as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Lignospan Forte iontophoretic patch.

Lignospan Forte description

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Lignospan Forte/ 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.

Lignospan Forte/ 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.

Lignospan Forte dosage

The lowest dosage and volume that results in effective anaesthesia should be used and should be based on the status of the patient and the type of regional anaesthesia intended. Lignospan Forte/ Adrenaline contains no antimicrobial agent and should be used only once and any residue discarded.

Lignocaine should be administered with great caution to patients with impaired cardiovascular function as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs.

Adults: See table.

Recommended Doses: The previously suggested concentrations and volumes serve only as a guide. Toxic doses vary widely between patients and toxic effects may occur after any local anaesthetic procedure.

Careful observation of the patient must therefore be maintained. It is recommended that the dose of lignocaine at any one time should not exceed 7 mg/kg. However, the dose administered must be tailored to the individual patient and procedure, and the maximum doses here quoted should be used as a guide only.

Hypotension: During thoracic, lumbar and caudal epidural anaesthesia, a marked fall in blood pressure and/or intercostal paralysis may be seen, possibly due to the use of excessive doses, improper positioning of the patient or accidental disposition of the anaesthetic within the subarachnoid space. Hypotension and bradycardia may occur as a result of sympathetic blockade.

Test Dose: For epidural anaesthesia, a 3-5 mL test dose of a local anaesthetic solution preferably containing up to 15 mcg of adrenaline (eg, 3 mL of Xylocaine 2% with adrenaline 1:200,000) should be administered.

Verbal contact and repeated monitoring of heart rate and blood pressure should be maintained for 5 min after the test dose, after which, in the absence of signs of subarachnoid or intravascular injection, the main dose may be administered.

Use of a test dose containing adrenaline may have further advantages in that an intravascular injection of adrenaline will be quickly recognised by an increase in heart rate, usually within about 40 sec. To detect this, the heart rate and rhythm should be monitored with an electrocardiogram.

Prior to administration of the total dose, aspiration should be repeated. The main dose should be injected slowly, with continual assessment of the patient. If toxic symptoms or signs occur, the injection should be stopped immediately.

Children: A reduced dosage based on bodyweight or surface area should be used. The dosage should be calculated for each patient individually and modified in accordance with the physician's experience and knowledge of the patient.

In order to minimise the possibility of toxic effects, the use of Xylocaine 0.5% or 1% solutions is recommended for most anaesthetic procedures involving paediatric patients.

In children, early signs of local anaesthetic toxicity may be difficult to detect in cases where the block is given during general anaesthesia.

Elderly: A reduction in dosage may be necessary for elderly patients especially those with compromised cardiovascular and/or hepatic function.

In epidural anaesthesia, a smaller dose may provide adequate anaesthesia.

Impaired Hepatic Function: Although lignocaine is metabolised by the liver, dosage reduction for local anaesthesia is probably not warranted. However, caution should be exercised with repeated doses.

Impaired Renal Function: Impairment of renal function is unlikely to affect lignocaine clearance in the short-term (24 hrs). However, toxicity due to accumulation may develop with prolonged or repeated administration.

Lignospan Forte interactions

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Lignospan Forte 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.

Lignospan Forte 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 Lignospan Forte 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. Lignospan Forte 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 Lignospan Forte.

Lignospan Forte may antagonize the neuron blockade produced by guanethidine resulting in decreased antihypertensive effect and requiring increased dosage of the latter.

Lignospan Forte side effects

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What are the possible side effects of Lignospan Forte?

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Adverse experiences following the administration of lignocaine are similar in nature to those observed with other amide local anaesthetic agents. These adverse experiences are in general, dose-related and may result from high plasma levels caused by excessive dosage or rapid absorption, 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 characterised by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, hyperacusis, blurred vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and/or arrest, agitation, difficulty in swallowing, paraesthesia circumoral, numbness of the tongue and slurred speech.

The excitatory manifestations may be very brief or may not occur at all, in which case the 1st manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest. Drowsiness following administration of lignocaine is usually an early sign of a high blood level of the drug and may occur as a result of rapid absorption. In unconscious patients, circulatory collapse should be watched for as CNS effects may not be apparent, as an early manifestation of toxicity may, in some cases, progress to frank convulsions and ultimately lead to respiratory depression and/or arrest. It is crucial to have resuscitative equipment and anticonvulsant drugs available to manage such patients.

Cardiovascular: Cardiovascular manifestations are usually depressant and are characterised by bradycardia, hypotension and cardiovascular collapse, which may lead to cardiac arrest.

Cardiac arrhythmias and hypertension have also been observed.

Methaemoglobinaemia can occur following IV administration.

Cardiovascular toxic effects are generally preceded by signs of toxicity in the CNS, unless the patient is receiving a general anaesthetic or is heavily sedated with drugs eg, a benzodiazepine or a barbiturate. In rare cases, cardiac arrest has occurred without prodromal CNS effects.

In children, early signs of local anaesthetic toxicity may be difficult to detect in cases where the block is given during general anaesthesia.

Haemodynamic: Regional anaesthesia may lead to maternal hypotension.

Allergic: Allergic reactions are characterised by cutaneous lesions, urticaria, oedema or anaphylactoid reactions/shock.

Allergy to amide-type local anaesthetics is rare. Sodium metabisulfite (a sulfite), which is included in solutions with adrenaline, may also 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 in nonasthmatic people. If such reaction occurs, it should be managed by conventional means.

The detection of sensitivity by skin testing is of doubtful value.

Neurologic: The incidences of adverse reactions associated with the use of local anaesthetics may be related to the total dose of local anaesthetic administered and are also dependent on the particular drug used, the route of administration and the physical status of the patient.

Neurological reactions following regional nerve blocks have included persistent numbness, paraesthesia and other sensory disturbances.

In a prospective review of 10,440 patients who received lignocaine for spinal anaesthesia, the incidences were reported to be about 3% each for positional headaches, hypotension and backache; 2% for shivering; and <1% each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision. Many of these observations may be related to local anaesthetic techniques, with or without a contribution from the local anaesthetic.

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 anaesthetic procedures.

Peripheral nerve injury and arachnoiditis have been observed.

Lignospan Forte contraindications

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What is the most important information I should know about Lignospan Forte?

Allergy or hypersensitivity to amide-type local anaesthetics, sodium metabisulfite or to any excipients of Lignospan Forte/ 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.



Active ingredient matches for Lignospan Forte:

Epinephrine/Lidocaine in United States.


Unit description / dosage (Manufacturer)Price, USD
Injectable; Injection; Epinephrine Bitartrate 0.02 mg; Lidocaine Hydrochloride 2%

List of Lignospan Forte substitutes (brand and generic names):

Injectable; Injection; Epinephrine Tartrate 22.5 mcg; Lidocaine Hydrochloride 36 mg
LIGNOX+ADRENLINE 0.005MG/2% INJECTION 1 vial / 30 ML injection each (Indoco Remedies Ltd)$ 0.41
Lignox+adrenline Injection (Indoco Remedies Ltd)$ 0.01
Lignox2% ADR Lidocaine HCI26.64mg, Adrenaline Bitartrate0.0125mg VIAL / 30ml$ 0.30
Lignox2% ADR Lidocaine HCI26.64mg, Adrenaline Bitartrate0.0125mg VIAL / 30ml$ 0.31
Injectable; Injection; Lidocaine Hydrochloride (Astrazeneca)
Injectable; Injection; Epinephrine 0.01 mg; Lidocaine Hydrochloride 20 mg / ml
Injectable; Injection; Epinephrine Hydrochloride 0.001%; Lidocaine Hydrochloride 2%
Injectable; Injection; Epinephrine Hydrochloride 0.002%; Lidocaine Hydrochloride 2%
Injectable; Injection; Epinephrine Hydrochloride 0.001%; Lidocaine Hydrochloride 2%
Injectable; Injection; Epinephrine Hydrochloride 0.002%; Lidocaine Hydrochloride 2%
Ora 0.5 mg x 1, 000's$ 24.24
Ora 1 mg x 1, 000's$ 30.30
ORA 1 mL x 100's
ORA 1.8 mL x 50's
Pehacain 2 mL x 20's (Phapros)$ 6.68
Injectable; Injection; Epinephrine Hydrochloride 10 mcg; Lidocaine Hydrochloride 10 mg / ml
Injectable; Injection; Epinephrine Hydrochloride 12.5 mcg; Lidocaine Hydrochloride 20 mg / ml
Injectable; Injection; Epinephrine Tartrate; Lidocaine Hydrochloride 1%
Injectable; Injection; Epinephrine Tartrate; Lidocaine Hydrochloride 2%
Injectable; Injection; Lidocaine Hydrochloride 0.5%
Injectable; Injection; Lidocaine Hydrochloride 1%
Injectable; Injection; Lidocaine Hydrochloride 2%

References

  1. 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).
  2. 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).
  3. PubChem. "epinephrine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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