Lidocaine Topical Dosage

Drug Detail:Lidoderm (Lidocaine topical [ lye-doe-kane-top-i-kal ])

Usual Adult Dose for Anesthesia

2% viscous solution: Gargle 15 mL, undiluted, and spit out or swallow, no less than every 3 hours
Maximum dose: 300 mg for normal healthy adult - not to exceed 4.5 mg/kg (2 mg/lb), or 8 doses in 24 hours

Comments:

Adjust dose based on patient's age, weight, and physical condition.

Uses:

Topical anesthesia of irritated or inflamed mucous membranes of the mouth and pharynx
Reducing gagging during dental x-rays and impressions

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2% jelly:
Endotracheal intubation: Apply a moderate amount of jelly to the external surface of the endotracheal tube shortly before insertion
Maximum dose: 600 mg in any 12 hour period
Comments:

Avoid introducing jelly into tube lumen due to possibility of inner lumen occlusion.
Do not use the jelly to lubricate endotracheal stylettes.
Avoid use of endotracheal tubes with dried jelly on the external surface due to lack of lubricating effect.

4% solution: Spray 1 to 5 mL (40 to 200 mg) to the desired area. May also be applied with cotton applicators or by instillation
Maximum dose: 300 mg for normal healthy adult - not to exceed 4.5 mg/kg (2 mg/lb)
Comments:

When spraying, transfer solution to an atomizer.
Dosage varies and depends on the area to be anesthetized, vascularity of the tissues, individual tolerance, and technique.
Reduce dose for elderly and debilitated patients.

5% ointment: Apply topically for adequate control of symptoms. Apply to the tube prior to intubation
Maximum dose: 5 g per single application (approximately 6 inches of ointment squeezed from the tube); 20 g total in any day
Comments:

Adjust dose based on patient's age, weight, and physical condition.
In dentistry, apply to previously dried oral mucosa; subsequent saliva removal with cotton rolls or saliva ejector minimizes dilution, permits maximum penetration, and minimizes swallowing of the drug.
For insertion of new dentures, apply to all denture surfaces contacting mucosa; patients should consult a dentist at least every 48 hours throughout the fitting period.

Uses:

Production of anesthesia of accessible mucous membranes of the oropharynx
Anesthetic lubricant for endotracheal intubation (oral and nasal)

Usual Adult Dose for Gastrointestinal Tract Examination

Adjust dose based on patient's age, weight, and physical condition.

Uses:

Topical anesthesia of irritated or inflamed mucous membranes of the mouth and pharynx
Reducing gagging during dental x-rays and impressions

Avoid introducing jelly into tube lumen due to possibility of inner lumen occlusion.
Do not use the jelly to lubricate endotracheal stylettes.
Avoid use of endotracheal tubes with dried jelly on the external surface due to lack of lubricating effect.

When spraying, transfer solution to an atomizer.
Dosage varies and depends on the area to be anesthetized, vascularity of the tissues, individual tolerance, and technique.
Reduce dose for elderly and debilitated patients.

Adjust dose based on patient's age, weight, and physical condition.
In dentistry, apply to previously dried oral mucosa; subsequent saliva removal with cotton rolls or saliva ejector minimizes dilution, permits maximum penetration, and minimizes swallowing of the drug.
For insertion of new dentures, apply to all denture surfaces contacting mucosa; patients should consult a dentist at least every 48 hours throughout the fitting period.

Uses:

Production of anesthesia of accessible mucous membranes of the oropharynx
Anesthetic lubricant for endotracheal intubation (oral and nasal)

Usual Adult Dose for Pain

Lidocaine 0.5% spray: Apply a thin film to affected area up to 3 to 4 times daily as needed

3% lotion or cream: Apply a thin film to affected area 2 to 3 times daily as needed

3% gel: Apply a thin film to affected area 2 to 3 times daily as needed
Maximum dose: A single application should not exceed 4 pumps; do not exceed 12 pumps in 24 hours

4% cream, gel, solution: Apply a thin film to affected area 3 to 4 times daily as needed

5% ointment: Apply topically for adequate control of symptoms
Maximum dose: 5 gm per single application (approximately 6 inches of ointment squeezed from the tube); 20 gm total in any day

Comments:

Adjust dose based on patient's age, weight, and physical condition.
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Uses: Relief of pruritus, pruritic eczemas, abrasions, minor burns, insect bites, pain, soreness, and discomfort due to pruritus ani, pruritus vulvae, anal fissures, and similar conditions of the skin and mucous membranes.

Usual Adult Dose for Pruritus

Adjust dose based on patient's age, weight, and physical condition.
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Usual Adult Dose for Burns - External

Adjust dose based on patient's age, weight, and physical condition.
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Usual Adult Dose for Hemorrhoids

3% lotion or cream: Apply a thin film to affected area 2 to 3 times daily as needed

3% gel: Apply a thin film to affected area 2 to 3 times daily as needed
Maximum dose: A single application should not exceed 4 pumps; do not exceed 12 pumps in 24 hours

4%, 5% lotion or cream: Apply a thin film to affected area up to 6 times daily as needed

Comments:

When practical, cleanse the affected area before applying medication.
Gently dry by patting or blotting with toilet tissue or a soft cloth before application of product.
Onset of action is 3 to 5 minutes.
Use with caution in ill, elderly, or debilitated patients who may be more sensitive to systemic effects.
If irritation or sensitivity occurs, or infection appears, discontinue treatment and institute appropriate therapy.
Do not use on traumatized mucosa or in the presence of secondary bacterial infection in the area of proposed application.

Uses:

Temporary relief of local itching and discomfort associated with hemorrhoids
Temporary relief of pain, soreness, and burning
Relief of discomfort due to pruritus ani, and anal fissures

Usual Adult Dose for Postherpetic Neuralgia

5% patch: Apply patch(es) to intact skin to cover the most painful area for up to 12 hours in a 24 hour period
Maximum dose: 3 patches, 12 out of 24 hours

Comments:

Apply only to intact skin.
May cut patches to smaller sizes with scissors prior to removal of release liner, if needed.
Clothing may be worn over patches.
Smaller areas of treatment are recommended in debilitated patients or patients with impaired elimination.
If irritation or burning sensations occur, remove patches and do not reapply until irritation subsides.
Placing heat sources (electric blankets, heating pads, etc.) over the patches is not recommended.

Use: Relief of pain associated with post-herpetic neuralgia

Usual Pediatric Dose for Hemorrhoids

3% lotion or cream: Apply a thin film to affected area 2 to 3 times daily as needed.
Maximum dose: 4.3 mg/kg (2 mg/lb)

3% gel: Apply to affected area 2 to 3 times daily as needed
Maximum dose: A single application should not exceed 4 pumps; do not exceed 12 pumps in 24 hours

4%, 5% lotion or cream: Children 12 years and older: Apply thin film to affected area up to 6 times daily as needed

Comments:

When practical, cleanse the affected area before applying medication.
Gently dry by patting or blotting with toilet tissue or a soft cloth before application of this product.
The onset of action is 3 to 5 minutes.
Use with caution; children may be more sensitive to systemic effects.
Reduce dose in pediatric patients commensurate with age, body weight, and physical condition.
Children under 10 years with normal lean body mass and development: determine maximum dose using one of the standard pediatric drug formulas (e.g. Clark's rule).
If irritation or sensitivity occurs, or infection appears, discontinue treatment and institute appropriate therapy.
Do not use on traumatized mucosa or in the presence of secondary bacterial infection in the area of application.

Uses:

Temporary relief of local itching and discomfort associated with hemorrhoids.
Temporary relief of pain, soreness, and burning,
Relief of discomfort due to pruritus ani, and anal fissures.

Usual Pediatric Dose for Pain

Lidocaine 0.5% spray: 2 years and older: Apply thin film to affected area up to 3 to 4 times daily as needed

3% lotion or cream: Apply a thin film to affected area 2 to 3 times daily as needed

3% gel: Apply thin film to affected area 2 to 3 times daily as needed
Maximum dose: 12 pumps in 24 hours

4% cream, gel, solution: Apply thin film to affected area 3 to 4 times daily as needed
Maximum dose: 4.5 mg/kg (2 mg/lb)

5% ointment: Apply topically for adequate control of symptoms.
Maximum dose: 4.5 mg/kg (2 mg/lb)

Comments:

Adjust dose based on patient's age, weight, and physical condition.
It is difficult to recommend a maximum dose of any drug for children since this varies as a function of age and weight.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Usual Pediatric Dose for Pruritus

Adjust dose based on patient's age, weight, and physical condition.
It is difficult to recommend a maximum dose of any drug for children since this varies as a function of age and weight.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Usual Pediatric Dose for Burns - External

Adjust dose based on patient's age, weight, and physical condition.
It is difficult to recommend a maximum dose of any drug for children since this varies as a function of age and weight.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).
To apply spray to face, spray in palm of hand and gently apply.
Do not use in large quantities, particularly over raw or blistered areas.

Usual Pediatric Dose for Anesthesia

2% Oral solution (viscous):
Infants and children less than 3 years: One quarter teaspoon applied to area with a cotton tipped applicator no more frequently than every 3 hours
Maximum dose: 4 doses per 12 hour period
Children 3 years and older: No more than 4.5 mg/kg/dose (or 300 mg/dose), swished in the mouth and spit out no more frequently than every 3 hours
Comments:

Do not use for teething pain.
Adjust dose based on patients age, weight, and physical condition.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

Uses:

Topical anesthesia of irritated or inflamed mucous membranes of the mouth and pharynx.
Reducing gagging during dental x-rays and impressions

----
Pediatric LTA(R) 2% spray:
For laryngoscopy, bronchoscopy, and endotracheal intubation: Spray pharynx with 1 to 5 mL
Maximum dose: 4.5 mg/kg (2 mg/lb)
Comments:

Dosage in children should be reduced, commensurate with age, body weight and physical condition.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

2% jelly:
Endotracheal intubation: Apply a moderate amount of jelly to the external surface of the endotracheal tube shortly before insertion
Maximum dose: 4.5 mg/kg (2 mg/lb)
Comments:

Avoid introducing jelly into tube lumen due to possibility of inner lumen occlusion.
Do not use the jelly to lubricate endotracheal stylettes.
Avoid use of endotracheal tubes with dried jelly on the external surface due to lack of lubricating effect.

2%, 4%, or 5% solution: Spray on the desired area. May also be applied with cotton applicators or by instillation
Maximum Dose: 4.5 mg/kg (2 mg/lb)
Comments:

When spraying, transfer solution to an atomizer.
Dosage varies and depends on the area to be anesthetized, vascularity of the tissues, individual tolerance, and technique.
Reduce dose in children commensurate with age, body weight and physical condition.
Children under ten years with normal lean body mass and development: determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

5% ointment: Apply topically for adequate control of symptoms. Apply to the tube prior to intubation
Comments:

Adjust dose based on patient's age, weight, and physical condition.
In dentistry, apply to previously dried oral mucosa; subsequent saliva removal with cotton rolls or saliva ejector minimizes dilution, permits maximum penetration, and minimizes swallowing of the drug.
For insertion of new dentures, apply to all denture surfaces contacting mucosa; patients should consult a dentist at least every 48 hours throughout the fitting period.

Uses:

Production of anesthesia of accessible mucous membranes of the oropharynx.
Anesthetic lubricant for endotracheal intubation (oral and nasal).

Usual Pediatric Dose for Gastrointestinal Surgery

Do not use for teething pain.
Adjust dose based on patients age, weight, and physical condition.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

Uses:

Topical anesthesia of irritated or inflamed mucous membranes of the mouth and pharynx.
Reducing gagging during dental x-rays and impressions

----
Pediatric LTA(R) 2% spray:
For laryngoscopy, bronchoscopy, and endotracheal intubation: Spray pharynx with 1 to 5 mL
Maximum dose: 4.5 mg/kg (2 mg/lb)
Comments:

Dosage in children should be reduced, commensurate with age, body weight and physical condition.
Children under ten years with normal lean body mass and development; determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

2% jelly:
Endotracheal intubation: Apply a moderate amount of jelly to the external surface of the endotracheal tube shortly before insertion
Maximum dose: 4.5 mg/kg (2 mg/lb)
Comments:

Avoid introducing jelly into tube lumen due to possibility of inner lumen occlusion.
Do not use the jelly to lubricate endotracheal stylettes.
Avoid use of endotracheal tubes with dried jelly on the external surface due to lack of lubricating effect.

2%, 4%, or 5% solution: Spray on the desired area. May also be applied with cotton applicators or by instillation
Maximum Dose: 4.5 mg/kg (2 mg/lb)
Comments:

When spraying, transfer solution to an atomizer.
Dosage varies and depends on the area to be anesthetized, vascularity of the tissues, individual tolerance, and technique.
Reduce dose in children commensurate with age, body weight and physical condition.
Children under ten years with normal lean body mass and development: determine the maximum dose by the applying of one of the standard pediatric drug formulas (e.g., Clark's rule).

5% ointment: Apply topically for adequate control of symptoms. Apply to the tube prior to intubation
Comments:

Adjust dose based on patient's age, weight, and physical condition.
In dentistry, apply to previously dried oral mucosa; subsequent saliva removal with cotton rolls or saliva ejector minimizes dilution, permits maximum penetration, and minimizes swallowing of the drug.
For insertion of new dentures, apply to all denture surfaces contacting mucosa; patients should consult a dentist at least every 48 hours throughout the fitting period.

Uses:

Production of anesthesia of accessible mucous membranes of the oropharynx.
Anesthetic lubricant for endotracheal intubation (oral and nasal).

Usual Pediatric Dose for Local Anesthesia

0.5% powder injection system:
Ages 3 to 18 years: Apply one 0.5 mg lidocaine topical to the site of intact skin planned for venipuncture or peripheral intravenous cannulation, 1 to 3 minutes prior to needle insertion

Comments:

Perform procedure within 10 minutes after administration.
Use only on intact skin.
Perform procedure within 10 minutes after administration.
One additional application at a new location may be used after a failed attempt at venous access.
Multiple administrations at the same location are not recommended.

Use: Topical anesthesia prior to venipuncture or peripheral intravenous cannulation in children ages 3 to 18.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Use with caution.

Patients with severe hepatic disease are at greater risk of toxic blood concentrations, due to an inability to metabolize lidocaine normally.

Precautions

US BOXED WARNING:

Do Not Use Lidocaine to Treat Teething Pain in Children.
Prescription oral viscous lidocaine 2% solution is not approved for, and should not be used for, treating infants & children with teething pain.
Its use for this purpose has resulted in serious harm and deaths.
Rubbing topical pain relievers on gums is not useful or effective because they wash out of the baby's mouth within minutes, and when too much is swallowed, it can result in seizures, severe brain injury, and cardiac toxicity.
The American Academy of Pediatrics recommends the use of chilled teething rings or rubbing the child's gums with a finger to relieve the symptoms of teething pain, instead of the use of topical medications.

5% Patch: Safety and efficacy have not been established in patients younger than 18 years.

0.5% Intradermal injection system: Safety and efficacy have not been established in patients younger than 3 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

For topical use only.
Avoid contact with eyes.
Wash hands after handling patch.
Apply patch immediately after removal from protective envelope.

Storage requirements:

Do not store patch outside the sealed envelope.

General:

Keep out of reach of children.
Even a used patch contains a large amount of lidocaine (at least 665 mg)
Store and dispose of patches out of the reach of children, pets, and others.
When using with other local anesthetics, the amount absorbed from all formulations must be considered.

Patient advice:

Strictly adhere to dosing instructions.
Keep medicines away from children.
When used in the mouth, be aware that topical anesthesia may impair swallowing and enhance the danger of aspiration.
Food should not be ingested for 60 minutes following use in the mouth or throat area; this is particularly important in children because of their frequency of eating.
Numbness of the tongue or buccal mucosa enhances the danger of unintentional biting trauma: food and chewing gum should not be taken while the mouth or throat area is anesthetized.
Do not use over the counter lidocaine products for more than a week unless directed by a physician.
Fold used patches so the adhesive side sticks to itself; discard where children or pets cannot get to them.
Hemorrhoids: Stop use and ask a doctor for rectal bleeding, condition worsening or not improving within 7 days, allergic reactions, symptom being treated not subsiding, redness, irritation, swelling, pain, or other symptoms developing or increasing, or symptoms clear up and return within a few days.

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