NEODOSE

INDICATIONS

Short-term control of ventricular arrhythmias, including ventricular tachycardia, premature ventricular contractions, and arrhythmias resulting from digitalis intoxication.

CONTRAINDICATIONS

• Complete heart block and wide complex tachycardia attributable to accessory conduction pathways.
• Stokes-Adams syndrome.
• Wolff-Parkinson-White Syndrome.
• Severe degrees of sinoatrial, atrioventricular, or intraventricular block.
• Known hypersensitivity to local anesthetics of the amide type.

PRECAUTIONS

• Cardiovascular:
  • Acceleration of ventricular rate may occur, particularly in patients with atrial fibrillation or flutter.
  • More frequent or serious ventricular arrhythmias or complete heart block may occur in patients with sinus bradycardia, or incomplete heart block without prior acceleration in heart rate.
• Endocrine & Metabolic:
  • Malignant hyperthermia may occur; discontinue use immediately and institute countermeasures. Hematologic: Methemoglobinemia has been reported with local anesthetic use; increased risk in patients with glucose-6-phosphate 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; close monitoring recommended in these patients.
• Hepatic:
  • Possible increased risk of toxicity in patients with impaired hepatic function.
• Immunologic:
  • Hypersensitivity reactions have been reported; immediate discontinuation required.
• Musculoskeletal:
  • Chondrolysis may occur with intraarticular infusions following arthroscopic or other surgical procedures (unapproved use).
• Renal:
  • Possible increased risk of toxicity in patients with impaired renal function.
• Special Populations:
  • Viscous lidocaine is not recommended or approved for teething pain. Seizures, cardiopulmonary arrest, and death have been associated with the use of viscous lidocaine for teething pain or oral irritation in infants and children.

ADVERSE EFFECTS

Early signs of CNS toxicity are drowsiness, agitation, vomiting, and muscle twitching. Later signs include seizures, loss of consciousness, respiratory depression, and apnea. Cardiac toxicity is associated with excessive doses and includes bradycardia, hypotension, heart block, and cardiovascular collapse.

ADMINISTRATION

The concentration for an IV push dose is 1 to 20 mg/mL. For continuous infusion, dilute in compatible solution to concentration of 0.8 to 8 mg/mL or use available premixed solutions (4 to 8 mg/mL).

Solution Preparation Calculations

MONITORING

Continuous monitoring of ECG, heart rate, and blood pressure should be performed. Assess level of consciousness. Observe for seizure activity. Therapeutic drug concentration is 1.5 to 6 mg/L, with toxicity associated with concentrations greater than 9 mg/L.