In addition, the systemic clearance of lidocaine decreases from 7. As compared with values before amiodarone administration, the lidocaine elimination half-life and the distribution volume at steady state remain relatively unchanged.
Due to the long half-life of amiodarone, clinicians should use caution when administering lidocaine to patients who are receiving or who have recently discontinued amiodarone. Amitriptyline: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension. In general, concurrent use of a local anesthetic solution containing epinephrine and a TCA should be avoided.
If coadministration is necessary, careful patient monitoring is essential. Amlodipine: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Atorvastatin: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Benazepril: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amlodipine; Celecoxib: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Olmesartan: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amlodipine; Valsartan: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: Moderate Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Amoxicillin; Clarithromycin; Omeprazole: Moderate Concomitant use of systemic lidocaine and clarithromycin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Amprenavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine. The concurrent use of systemic lidocaine and anti-retroviral protease inhibitors should be carefully monitored due to the potential for serious toxicity. Amyl Nitrite: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
In theory, coadministration of anagrelide with substrates of CYP1A2, including lidocaine, could lead to increases in the serum concentrations of lidocaine and, thus, adverse effects. Patients receiving anagrelide and lidocaine concomitantly should be monitored for increased toxicity of lidocaine.
Apalutamide: Moderate Monitor for decreased efficacy of lidocaine if coadministration of systemic lidocaine with apalutamide is necessary; higher doses of lidocaine may be required. Aprepitant, Fosaprepitant: Major Use caution if lidocaine and aprepitant, fosaprepitant are used concurrently and monitor for an increase in lidocaine-related adverse effects, including QT prolongation and torsade de pointes TdP , for several days after administration of a multi-day aprepitant regimen.
This interaction is not expected with topical preparations of lidocaine. Lidocaine is a CYP3A4 substrate. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions.
However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction. Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Articaine; Epinephrine: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias.
Epinephrine may produce ventricular arrhythmias in patients who are on drugs that may sensitize the heart to arrhythmias. Moderate Use articaine and lidocaine together with caution. Additionally, coadministration may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue local anesthetic use. Asciminib: Moderate Monitor for lidocaine toxicity if coadministration with asciminib is necessary as concurrent use may increase lidocaine exposure.
Atazanavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
Atazanavir; Cobicistat: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine. Moderate Monitor for lidocaine-related adverse reactions if coadministration with cobicistat is necessary.
Atenolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Atenolol; Chlorthalidone: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Atracurium: Moderate Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
Atropine; Edrophonium: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Avacopan: Moderate Monitor for lidocaine toxicity if coadministration with avacopan is necessary as concurrent use may increase lidocaine exposure. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate Concomitant use of systemic lidocaine and phenobarbital may decrease lidocaine plasma concentrations. Higher lidocaine doses may be required; titrate to effect.
Additionally, coadministration of lidocaine with oxidizing agents, such as phenobarbital, may increase the risk of developing methemoglobinemia. Belladonna; Opium: Moderate The use of these drugs together must be approached with caution. Belumosudil: Moderate Monitor for lidocaine toxicity if coadministration with belumosudil is necessary as concurrent use may increase lidocaine exposure.
Bendroflumethiazide; Nadolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Benzalkonium Chloride; Benzocaine: Moderate Use lidocaine and benzocaine together with caution. Benzhydrocodone; Acetaminophen: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Benzocaine: Moderate Use lidocaine and benzocaine together with caution. Benzocaine; Butamben; Tetracaine: Moderate Use lidocaine and benzocaine together with caution. Benzonatate: Major Caution is advised if amide local anesthetics are used concurrently with benzonatate. The toxic effects of local anesthetics are additive. Benzoyl Peroxide: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic.
Benzoyl Peroxide; Clindamycin: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic.
Benzoyl Peroxide; Erythromycin: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic. Benzoyl Peroxide; Sulfur: Moderate Concurrent use of benzoyl peroxide and topical anesthetics may decrease the efficacy of the anesthetic.
Berotralstat: Moderate Monitor for lidocaine toxicity if coadministration with berotralstat is necessary as concurrent use may increase lidocaine exposure.
Beta-adrenergic blockers: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Betaxolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Bexarotene: Moderate Concomitant use of systemic lidocaine and bexarotene may decrease lidocaine plasma concentrations. Bicalutamide: Moderate Monitor for lidocaine toxicity if coadministration with bicalutamide is necessary as concurrent use may increase lidocaine exposure.
Bisoprolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Bisoprolol; Hydrochlorothiazide, HCTZ: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
If lidocaine dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Although this interaction has not been studied, predictions about the interaction can be made based on the metabolic pathway of lidocaine. Lidocaine is partially metabolized by the hepatic isoenzyme CYP3A4; boceprevir inhibits this isoenzyme.
Coadministration may result in elevated lidocaine plasma concentrations. Bosentan: Moderate Bosentan is an inducer of CYP3A4 enzymes, and may decrease plasma concentrations of drugs metabolized by these enzymes. Caution is recommended when administering bosentan to patients receiving lidocaine as lidocaine is a CYP3A4 substrate.
Brimonidine; Timolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Brompheniramine; Guaifenesin; Hydrocodone: Moderate The use of these drugs together must be approached with caution.
Brompheniramine; Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Bupivacaine Liposomal: Major Avoid use of other local anesthetics for 96 hours after liposomal bupivacaine administration. Liposomal bupivacaine administration may follow lidocaine administration after a delay of 20 minutes or more.
Use lidocaine and other formulations of bupivacaine together with caution. Bupivacaine: Major Avoid use of other local anesthetics for 96 hours after liposomal bupivacaine administration.
Bupivacaine; Lidocaine: Major Avoid use of other local anesthetics for 96 hours after liposomal bupivacaine administration. Bupivacaine; Meloxicam: Major Avoid use of other local anesthetics for 96 hours after liposomal bupivacaine administration. Butalbital; Acetaminophen: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Butalbital; Acetaminophen; Caffeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia. Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Coadministration of lidocaine with oxidizing agents, such as acetaminophen, may increase the risk of developing methemoglobinemia.
Calamine; Pramoxine: Moderate Caution is advised if combining local anesthetics. A major cause of adverse reactions appears to be excessive plasma concentrations, which may be due to accidental intravascular administration, slow metabolic degradation, or overdosage.
In addition to additive toxic effects, rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine-containing products. Clinicians should closely monitor patients for the development of methemoglobinemia when a combination local anesthetic is used during a procedure.
If a patient becomes cyanotic or if elevated methemoglobin concentrations are suspected, immediately institute treatment to counteract methemoglobinemia such as administration of methylene blue as oxygen delivery is ineffective throughout the body until the condition is reversed. Patients who are receiving other drugs that can cause methemoglobin formation, such as prilocaine, are at greater risk for developing methemoglobinemia. Calcium Carbonate; Famotidine; Magnesium Hydroxide: Moderate Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Cannabidiol: Moderate Monitor for lidocaine toxicity if coadministration with cannabidiol is necessary as concurrent use may increase lidocaine exposure. Consider a dose reduction of lidocaine as clinically appropriate, if adverse reactions occur when administered with cannabidiol. Capmatinib: Moderate Monitor for an increase in lidocaine-related adverse reactions if coadministration with capmatinib is necessary.
Monitor lidocaine concentrations if clinically indicated and lidocaine is being given intravenously. Concomitant use may increase lidocaine exposure. Capreomycin: Moderate Partial neuromuscular blockade has been reported with capreomycin after the administration of large intravenous doses or rapid intravenous infusion. Lidocaine could potentiate the neuromuscular blocking effect of capreomycin by impairing transmission of impulses at the motor nerve terminals.
If these drugs are used in combination, monitor patients for increased adverse effects. Carbamazepine: Moderate Concomitant use of systemic lidocaine and carbamazepine may decrease lidocaine plasma concentrations. Carbinoxamine; Hydrocodone; Phenylephrine: Moderate The use of these drugs together must be approached with caution. Carbinoxamine; Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution.
Carteolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Carvedilol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Ceritinib: Moderate Monitor for lidocaine toxicity if coadministration with ceritinib is necessary. Concomitant treatment CYP3A4 inhibitors has the potential to increase lidocaine plasma levels by decreasing lidocaine clearance and prolonging the elimination half-life.
Chloramphenicol: Moderate Concomitant use of systemic lidocaine and chloramphenicol may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Chlordiazepoxide; Amitriptyline: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension.
Chloroprocaine: Moderate Use lidocaine and chloroprocaine together with caution. Chloroquine: Moderate Coadministration of lidocaine with oxidizing agents, such as chloroquine, may increase the risk of developing methemoglobinemia. Chloroxylenol; Hydrocortisone; Pramoxine: Moderate Caution is advised if combining local anesthetics.
Chlorpheniramine; Codeine: Moderate The use of these drugs together must be approached with caution. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate The use of these drugs together must be approached with caution.
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution.
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Chlorpheniramine; Hydrocodone: Moderate The use of these drugs together must be approached with caution.
Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate The use of these drugs together must be approached with caution. Chlorpheniramine; Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Cholinesterase inhibitors: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Cimetidine: Moderate Concomitant use of systemic lidocaine and cimetidine may increase lidocaine plasma concentrations. Ciprofloxacin: Moderate Concomitant use of systemic lidocaine and ciprofloxacin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Cisatracurium: Moderate Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade. Citalopram: Moderate Concomitant use of systemic lidocaine and citalopram may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Clarithromycin: Moderate Concomitant use of systemic lidocaine and clarithromycin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Clomipramine: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension.
Cobicistat: Moderate Monitor for lidocaine-related adverse reactions if coadministration with cobicistat is necessary. Codeine: Moderate The use of these drugs together must be approached with caution. Codeine; Guaifenesin: Moderate The use of these drugs together must be approached with caution.
Codeine; Guaifenesin; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Codeine; Phenylephrine; Promethazine: Moderate The use of these drugs together must be approached with caution. Codeine; Promethazine: Moderate The use of these drugs together must be approached with caution.
Colesevelam: Moderate Colesevelam may decrease the absorption of lidocaine. To minimize potential for interactions, consider administering lidocaine at least 1 hour before or at least 4 hours after colesevelam.
Colistin: Moderate Lidocaine can potentiate the neuromuscular blocking effect of colistimethate sodium by impairing transmission of impulses at the motor nerve terminals. Neuromuscular blockade may be associated with colistimethate sodium, and is more likely to occur in patients with renal dysfunction.
Conivaptan: Moderate Monitor for lidocaine toxicity if coadministration with conivaptan is necessary as concurrent use may increase lidocaine exposure. Crizotinib: Moderate Monitor for lidocaine-related adverse reactions and toxicities if coadministration with crizotinib is necessary. Cyclophosphamide: Moderate Coadministration of lidocaine with oxidizing agents, such as cyclophosphamide, may increase the risk of developing methemoglobinemia.
Cyclosporine: Moderate Concomitant use of systemic lidocaine and cyclosporine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Dabrafenib: Moderate Concomitant use of systemic lidocaine and dabrafenib may decrease lidocaine plasma concentrations. Dalfopristin; Quinupristin: Moderate Coadministration of lidocaine with dalfopristin; quinupristin may result in elevated lidocaine plasma concentrations.
If these drugs are used together, closely monitor for signs of lidocaine-related adverse events. Patients receiving lidocaine should be closely monitored for toxicity if danazol is added to therapy. Dapsone: Moderate Coadministration of dapsone with lidocaine may increase the risk of developing methemoglobinemia.
Advise patients to discontinue treatment and seek immediate medical attention with any signs or symptoms of methemoglobinemia. Daratumumab; Hyaluronidase: Moderate Hyaluronidase, when used in combination with local anesthetics, hastens the onset of analgesia and reduces the swelling caused by local infiltration; this interaction is beneficial and is the reason hyaluronidase is used adjunctively in local infiltrative anesthesia techniques.
However, the wider spread of the local anesthetic solution may increase the systemic absorption of the local anesthetic, which shortens the duration of anesthetic action and tends to increase the potential risk for systemic side effects. The concurrent use of systemic lidocaine and darunavir should be carefully monitored due to the potential for serious toxicity. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
Deferasirox: Major Concomitant use of systemic lidocaine and deferasirox may alter lidocaine plasma concentrations; avoid concurrent use. If use together is necessary, monitor patients closely for lidocaine toxicity and therapeutic efficacy. Delavirdine: Moderate Delavirdine is a potent inhibitor of the CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, such as lidocaine, should be expected with concurrent use of delavirdine.
Desipramine: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension. Dexamethasone: Moderate Concomitant use of systemic lidocaine and dexamethasone may decrease lidocaine plasma concentrations. Dextromethorphan; Quinidine: Major Avoid concurrent use of quinidine with other antiarrhythmics with Class I activities, such as lidocaine.
Concurrent use may result in additive or antagonistic cardiac effects and additive toxicity. Dibucaine: Moderate Caution is advised if combining local anesthetics. Dihydrocodeine; Guaifenesin; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Diltiazem: Moderate Concomitant use of systemic lidocaine and diltiazem may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Diphenhydramine; Hydrocodone; Phenylephrine: Moderate The use of these drugs together must be approached with caution. Disopyramide: Major The effects of concomitant administration of disopyramide with other antiarrhythmics could potentially be synergistic or antagonistic, and adverse cardiac effects could potentially be additive.
Class IA antiarrhythmic agents are associated with proarrhythmias e. Coadministration of disopyramide with other Class IA antiarrhythmics should be reserved for patients with life-threatening arrhythmias who are unresponsive to single-agent antiarrhythmic therapy. Lidocaine has occasionally been used concurrently with disopyramide; however, additive electrophysiologic effects may occur.
Since disopyramide and lidocaine are both sodium-channel-acting agents, it is somewhat irrational to use these drugs together; isolated cases of intraventricular conduction abnormalities have been reported with this drug combination. Patients receiving more than one antiarrhythmic drug must be carefully monitored. Disulfiram: Moderate Concomitant use of systemic lidocaine and disulfiram may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Dofetilide: Contraindicated Concurrent exposure of systemic lidocaine with dofetilide could increase the risk of dofetilide-induced proarrhythmias. Before switching from lidocaine to dofetilide therapy, lidocaine generally should be withheld for at least three half-lives prior to initiating dofetilide. Donepezil: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Donepezil; Memantine: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Dorzolamide; Timolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance. Doxacurium: Moderate Concomitant use of neuromuscular blockers and local anesthetics may prolong neuromuscular blockade. Doxepin: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension.
Dronedarone: Moderate Concomitant use of systemic lidocaine and dronedarone may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Edrophonium: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary.
Caution is recommended when administering efavirenz with CYP3A4 substrates that have a narrow therapeutic range e. Elagolix: Moderate Concomitant use of systemic lidocaine and elagolix may decrease lidocaine plasma concentrations. Elagolix; Estradiol; Norethindrone acetate: Moderate Concomitant use of systemic lidocaine and elagolix may decrease lidocaine plasma concentrations. Elbasvir; Grazoprevir: Moderate Administering lidocaine with elbasvir; grazoprevir may result in elevated lidocaine plasma concentrations.
If these drugs are used together, closely monitor for signs of adverse events. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Monitor for lidocaine-related adverse reactions if coadministration with cobicistat is necessary. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Monitor for lidocaine-related adverse reactions if coadministration with cobicistat is necessary.
Enzalutamide: Moderate Monitor for decreased efficacy of lidocaine if coadministration of systemic lidocaine with enzalutamide is necessary; higher doses of lidocaine may be required. Epinephrine: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias. Erythromycin; Sulfisoxazole: Moderate Coadministration of lidocaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia.
Eslicarbazepine: Moderate Concomitant use of systemic lidocaine and eslicarbazepine may decrease lidocaine plasma concentrations. Esmolol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Ethotoin may enhance lidocaine clearance by inducing cytochrome P enzymes. Ethyl Chloride: Moderate Caution is advised if combining local anesthetics. Etravirine: Major Etravirine is an inducer of CYP3A4; systemic lidocaine concentrations may be decreased with coadministration. Coadminister these drugs with caution. It is recommended to monitor lidocaine concentrations when possible. Everolimus: Moderate Monitor for lidocaine toxicity if coadministration with everolimus is necessary as concurrent use may increase lidocaine exposure.
Famotidine: Moderate Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Famotidine; Ibuprofen: Moderate Concomitant use of systemic lidocaine and famotidine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Felbamate: Moderate Concomitant use of systemic lidocaine and felbamate may decrease lidocaine plasma concentrations. Fentanyl: Moderate The use of these drugs together must be approached with caution. Although commonly used together for epidural analgesia or additive analgesic effects, the patient must be monitored for respiratory depression, hypotension, and excessive sedation due to additive effects on the CNS and blood pressure.
Flecainide: Major Although causality for torsades de pointes has not been established for flecainide, patients receiving concurrent drugs which have the potential for QT prolongation, such as local anesthetics, may have an increased risk of developing proarrhythmias. Use with caution. Fluconazole: Moderate Concomitant use of systemic lidocaine and fluconazole may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Fluoxetine: Moderate Concomitant use of systemic lidocaine and fluoxetine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Flutamide: Moderate Coadministration of lidocaine with oxidizing agents, such as flutamide, may increase the risk of developing methemoglobinemia. Fluvoxamine: Moderate Concomitant use of systemic lidocaine and fluvoxamine increases lidocaine exposure by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Fosamprenavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
Fosphenytoin: Moderate Concomitant use of systemic lidocaine and fosphenytoin may decrease lidocaine plasma concentrations. Additionally, coadministration of lidocaine with oxidizing agents, such as fosphenytoin, may increase the risk of developing methemoglobinemia.
Furazolidone: Moderate Combined hypotensive effects are possible with the combined use of monoamine oxidase inhibitors MAOIs e.
If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking MAOIs may lead to severe, prolonged hypertension. In general, concurrent use of a local anesthetic solution containing epinephrine and a MAOI or drugs with monoamine oxidase inhibitor activity such as furazolidone should be avoided.
Galantamine: Moderate Local anesthetics can antagonize the effects of cholinesterase inhibitors by inhibiting neuronal transmission in skeletal muscle, especially if large doses of local anesthetics are used; dosage adjustments of the cholinesterase inhibitor may be necessary. Ginger, Zingiber officinale: Minor In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no clinical data are available.
Guaifenesin; Hydrocodone: Moderate The use of these drugs together must be approached with caution. Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution.
Homatropine; Hydrocodone: Moderate The use of these drugs together must be approached with caution. Hyaluronidase, Recombinant; Immune Globulin: Moderate Hyaluronidase, when used in combination with local anesthetics, hastens the onset of analgesia and reduces the swelling caused by local infiltration; this interaction is beneficial and is the reason hyaluronidase is used adjunctively in local infiltrative anesthesia techniques.
Hyaluronidase: Moderate Hyaluronidase, when used in combination with local anesthetics, hastens the onset of analgesia and reduces the swelling caused by local infiltration; this interaction is beneficial and is the reason hyaluronidase is used adjunctively in local infiltrative anesthesia techniques.
Hydralazine; Isosorbide Dinitrate, ISDN: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Hydrocodone: Moderate The use of these drugs together must be approached with caution. Hydrocodone; Ibuprofen: Moderate The use of these drugs together must be approached with caution. Hydrocodone; Phenylephrine: Moderate The use of these drugs together must be approached with caution.
Hydrocodone; Potassium Guaiacolsulfonate: Moderate The use of these drugs together must be approached with caution. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution. Hydrocodone; Pseudoephedrine: Moderate The use of these drugs together must be approached with caution.
Hydrocortisone; Pramoxine: Moderate Caution is advised if combining local anesthetics. Hydromorphone: Moderate The use of these drugs together must be approached with caution. Hydroxyurea: Moderate Coadministration of lidocaine with oxidizing agents, such as hydroxyurea, may increase the risk of developing methemoglobinemia.
Ibuprofen; Oxycodone: Moderate The use of these drugs together must be approached with caution. Ifosfamide: Moderate Coadministration of lidocaine with oxidizing agents, such as ifosfamide, may increase the risk of developing methemoglobinemia. Imatinib: Moderate Monitor for lidocaine-related toxicity when administering with imatinib; lidocaine exposure may increase. Imipramine: Major If epinephrine is added to lidocaine for the purpose of infiltration and nerve block or spinal anesthesia, receipt of the product to a patient taking tricyclic antidepressants TCA may lead to severe, prolonged hypertension.
Indinavir: Moderate Anti-retroviral protease inhibitors can inhibit hepatic cytochrome P 3A4, an isoenzyme that is partially responsible for the metabolism of lidocaine.
Isavuconazonium: Moderate Concomitant use of isavuconazonium with lidocaine may result in increased serum concentrations of lidocaine. Lidocaine is a substrate of the hepatic isoenzyme CYP3A4; isavuconazole, the active moiety of isavuconazonium, is a moderate inhibitor of this enzyme. Caution and close monitoring are advised if these drugs are used together.
Isocarboxazid: Major Patients receiving local anesthetics may have an increased risk of hypotension. Combined hypotensive effects are possible with use of MAOIs and spinal anesthetics.
When local anesthetics containing sympathomimetic vasoconstrictors e. MAOIs can increase the sensitivity to epinephrine by inhibiting epinephrine reuptake or metabolism. If concurrent therapy is necessary, carefully monitor the patient. Phenelzine and tranylcypromine are contraindicated for use for at least 10 days prior to elective surgery. Isoniazid, INH: Moderate Concomitant use of systemic lidocaine and isoniazid may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Isoniazid, INH; Pyrazinamide, PZA; Rifampin: Moderate Concomitant use of systemic lidocaine and isoniazid may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Moderate Rifampin is a potent inducer of the cytochrome P hepatic enzyme system and can reduce the plasma concentrations and possibly the efficacy of lidocaine, Isoniazid, INH; Rifampin: Moderate Concomitant use of systemic lidocaine and isoniazid may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Moderate Rifampin is a potent inducer of the cytochrome P hepatic enzyme system and can reduce the plasma concentrations and possibly the efficacy of lidocaine, Isosorbide Dinitrate, ISDN: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
Isosorbide Mononitrate: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Itraconazole: Moderate Concomitant use of systemic lidocaine and itraconazole may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Ketoconazole: Moderate Concomitant use of systemic lidocaine and ketoconazole may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Labetalol: Major Drugs such as beta-blockers that decrease cardiac output reduce hepatic blood flow and thereby decrease lidocaine hepatic clearance.
Lacosamide: Moderate Use lacosamide with caution in patients taking concomitant medications that affect cardiac conduction, such as Class IB antiarrhythmics, because of the risk of AV block, bradycardia, or ventricular tachyarrhythmia. If use together is necessary, obtain an ECG prior to lacosamide initiation and after treatment has been titrated to steady-state.
In addition, monitor patients receiving lacosamide via the intravenous route closely. Concomitant use of class IB antiarrhythmics with lamotrigine may increase the risk of proarrhythmia. In vitro testing showed that lamotrigine exhibits Class IB antiarrhythmic activity at therapeutically relevant concentrations.
Lansoprazole; Amoxicillin; Clarithromycin: Moderate Concomitant use of systemic lidocaine and clarithromycin may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. Lapatinib: Major Monitor for lidocaine toxicity if coadministration with lapatinib is necessary. You can apply the lidocaine 1. Do not bandage the affected area tightly.
If you are using the prescription lidocaine 1. If the lidocaine 1. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. This medication is usually used as needed. If your doctor has told you to use lidocaine patches or topical systems regularly, apply the missed patch or topical system as soon as you remember it. However, if it is almost time for the next dose, skip the missed patch and continue your regular dosing schedule.
Do not apply a double dose to make up for a missed one. Lidocaine transdermal may cause other side effects. Call your doctor if you have any unusual problems while using this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children.
Store it at room temperature and away from excess heat and moisture not in the bathroom. Do not store patches and topical systems outside the sealed envelope. Fold used patches or topical systems so that the adhesive side sticks to itself and then safely discard into trash and where children and pets cannot get to them.
It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. If you wear too many lidocaine transdermal patches or topical systems or wear them for too long, too much lidocaine may be absorbed into your blood. In that case, you may experience symptoms of an overdose.
In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. Distribution When lidocaine is administered intravenously to healthy volunteers, the volume of distribution is 0. Lidocaine crosses the placental and blood brain barriers, presumably by passive diffusion.
Metabolism It is not known if lidocaine is metabolized in the skin. Lidocaine is metabolized rapidly by the liver to a number of metabolites, including monoethylglycinexylidide MEGX and glycinexylidide GX , both of which have pharmacologic activity similar to, but less potent than that of lidocaine. A minor metabolite, 2,6-xylidine, has unknown pharmacologic activity but is carcinogenic in rats.
Excretion Lidocaine and its metabolites are excreted by the kidneys. The systemic clearance is 0. Single-dose treatment with LIDODERM was compared to treatment with vehicle patch without lidocaine , and to no treatment observation only in a double-blind, crossover clinical trial with 35 post-herpetic neuralgia patients.
Pain intensity and pain relief scores were evaluated periodically for 12 hours. The constant type of pain was evaluated but not the pain induced by sensory stimuli dysesthesia. About half of the patients also took oral medication commonly used in the treatment of post-herpetic neuralgia. The extent of use of concomitant medication was similar in the two treatment groups.
It should be applied only to intact skin. LIDODERM is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type, or to any other component of the product.
Cases of methemoglobinemia have been reported in association with local anesthetic use. Although all patients are at risk for methemoglobinemia, patients with glucosephosphate 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. 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.
Depending on the severity of the signs and symptoms, patients may respond to supportive care, i. A more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. The potential exists for a small child or a pet to suffer serious adverse effects from chewing or ingesting a new or used LIDODERM patch, although the risk with this formulation has not been evaluated.
The blood concentration of lidocaine is determined by the rate of systemic absorption and elimination. Longer duration of application, application of more than the recommended number of patches, smaller patients, or impaired elimination may all contribute to increasing the blood concentration of lidocaine.
Hepatic Disease Patients with severe hepatic disease are at greater risk of developing toxic blood concentrations of lidocaine, because of their inability to metabolize lidocaine normally. Allergic Reactions Patients allergic to para-aminobenzoic acid derivatives procaine, tetracaine, benzocaine, etc.
Non-intact Skin Application to broken or inflamed skin, although not tested, may result in higher blood concentrations of lidocaine from increased absorption. External Heat Sources Placement of external heat sources, such as heating pads or electric blankets, over LIDODERM patches is not recommended as this has not been evaluated and may increase plasma lidocaine levels. If eye contact occurs, immediately wash out the eye with water or saline and protect the eye until sensation returns.
Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to stop use and seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin cyanosis ; headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.
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