Lidocaine and Epinephrine

Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) and Epinephrine (Lidocaine and Epinephrine) combination injection is used to cause numbness or loss of feeling for patients having certain medical procedures (by blocking certain nerves using the brachial plexus, intercostal, lumbar, or epidural blocking techniques).

Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) and Epinephrine (Lidocaine and Epinephrine) is to be given only by or under the direct supervision of your doctor.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Injection, solution:

Lidocaine and Epinephrine:

0.5% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 0.5% [5 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (50 mL) [contains methylparaben]

1% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1% [10 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (10 mL, 20 mL, 50 mL) [contains methylparaben]

2% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (10 mL, 20 mL, 50 mL) [contains methylparaben]

Generic:

0.5% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 0.5% [5 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (50 mL)

1% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1% [10 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (20 mL, 30 mL, 50 mL)

1.5% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1.5% [15 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (5 mL) [contains sodium metabisulfite]

2% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (30 mL, 50 mL)

Injection, solution [preservative free]:

Xylocaine-MPF with Epinephrine (Lidocaine and Epinephrine):

1% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1% [10 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (5 mL, 10 mL, 30 mL) [contains sodium metabisulfite]

1.5% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1.5% [15 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (5 mL, 10 mL, 30 mL) [contains sodium metabisulfite]

2% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (5 mL, 10 mL, 20 mL) [contains sodium metabisulfite]

Generic:

1.5% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1.5% [15 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (5 mL, 30 mL)

2% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000 (20 mL)

Injection, solution [for dental use]:

Lignospan Forte: 2% / 1:50,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:50,000 (1.7 mL) [contains edetate disodium, potassium metabisulfite]

Lignospan Standard: 2% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (1.7 mL) [contains edetate disodium, potassium metabisulfite]

Xylocaine Dental with Epinephrine (Lidocaine and Epinephrine):

2% / 1:50,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:50,000 (1.7 mL; 1.8 mL [DSC]) [contains sodium metabisulfite]

2% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (1.7 mL; 1.8 mL [DSC]) [contains sodium metabisulfite]

Generic:

2% / 1:50,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:50,000 (1.7 mL, 1.8 mL)

2% / 1:100,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 2% [20 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:100,000 (1.7 mL, 1.8 mL)

Kit, Injection:

D-Care 100X: 1% / 1:200,000: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) hydrochloride 1% [10 mg/mL] and Epinephrine (Lidocaine and Epinephrine) 1:200,000

Dosing: Adult

Anesthesia:

Dental:

Oral infiltration/mandibular block: Initial: 1 to 5 mL (Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 20 mg to 100 mg). Note: For most routine dental procedures, Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 2% with Epinephrine (Lidocaine and Epinephrine) 1:100,000 is preferred. When a more pronounced hemostasis is required, use a 1:50,000 Epinephrine (Lidocaine and Epinephrine) concentration. Do not exceed 7 mg/kg body weight, up to a maximum range of 300 mg (usual dental practice) to 500 mg (approved product labeling) of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) and 3 mcg (0.003 mg) of Epinephrine (Lidocaine and Epinephrine)/kg of body weight or 0.2 mg Epinephrine (Lidocaine and Epinephrine) per dental appointment.

Epidural: Administer a test dose (eg, 2 to 3 mL of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 1.5%) at least 5 minutes prior to injecting the total volume required for a lumbar or caudal block. Dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3 mL of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 1%, 1.5%, or 2% with Epinephrine (Lidocaine and Epinephrine) [1:200,000] per dermatome). For continuous epidural or caudal anesthesia, the maximum dose should not be administered at intervals of <90 minutes. Maximum total dose for paracervical block: 200 mg/90 minutes (50% of the total dose to each side, with 5 minutes between sides).

Local: Infiltration: Dosage varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient. Maximum dose of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)): 7 mg/kg (up to 500 mg). Use Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 1%, 1.5%, or 2% with Epinephrine (Lidocaine and Epinephrine) (1:200,000) as single dose units.

Dosing: Geriatric

Refer to adult dosing; use with caution and at reduced dosages.

Dosing: Pediatric

Note: Dose varies with procedure, depth of anesthesia, vascularity of tissues, duration of anesthesia, and condition of patient should only be administered under the supervision of a qualified physician experienced in the use of anesthetics. Dosing units variable (mL/kg, mg/kg); use extra precaution to ensure accuracy.

Note: Dosing should be based on lean body mass (Cote 2013). Due to shorter duration of action and potential toxicity with repeat dosing, Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) is not typically used for central (spinal) or regional (epidural/caudal) anesthesia (Cote 2013; Miller 2015).

Local anesthesia; dermal/cutaneous infiltration: Infants, Children, and Adolescents: Usual concentration ≤2% (eg, 1% or 2%) solution: Infiltrate area locally; maximum dose is 7 mg/kg, not to exceed adult maximum dose of 500 mg (Cote 2013; Kliegman 2016). Note: Aspiration should be performed prior to each injection; however, absence of blood in the syringe does not guarantee that intravascular injection has been avoided (Mulroy 2010).

Peripheral nerve block; excluding digital or penile: Infants ≥6 months, Children, and Adolescents: Usual concentrations ≤1%: Dosage (concentration [0.25, 0.5 or 1%]) and volume varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient. Maximum dose of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)): 7 mg/kg, not to exceed adult maximum of 500 mg (Cote 2013; Kliegman 2016). For infants <6 months, maximum doses should be reduced by 30% (Cote 2013; Miller 2015).

Dental anesthesia; oral infiltration/mandibular block: Note: For most routine dental procedures, Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 2% with Epinephrine (Lidocaine and Epinephrine) 1:100,000 is preferred. When a more pronounced hemostasis is required, a 1:50,000 Epinephrine (Lidocaine and Epinephrine) concentration should be used.

Children <10 years: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 2% with Epinephrine (Lidocaine and Epinephrine) solution: ≤0.9 to 1 mL (Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 18 mg to 20 mg) per procedure; maximum dose: 4.4 mg/kg not to exceed 300 mg (AAPD 2009); dosing is for procedures involving a single tooth, maxillary infiltration for 2 to 3 teeth, or mandibular block of an entire quadrant; it is rare that a patient would require a higher dose (ie, >1 mL)

Children ≥10 years and Adolescents: Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 2% with Epinephrine (Lidocaine and Epinephrine) solution: Initial: 1 to 5 mL (Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) 20 mg to 100 mg). Do not exceed usual dental guideline recommended maximum dose of 4.4 mg/kg up to a maximum total dose of 300 mg (AAPD 2009); some suggest a higher maximum of 7 mg/kg up to total maximum of 500 mg (approved product labeling) of Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)) and 3 mcg (0.003 mg) of Epinephrine (Lidocaine and Epinephrine)/kg of body weight or 0.2 mg Epinephrine (Lidocaine and Epinephrine) per dental appointment.

Hypersensitivity to Lidocaine (Lidocaine and Epinephrine (Lidocaine and Epinephrine)), other local anesthetics of the amide type, Epinephrine (Lidocaine and Epinephrine), or any component of the formulation.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to para amino benzoic acid (PABA).

Use: Labeled Indications

Anesthesia, local: Production of local anesthesia by nerve block or infiltration for dental procedures.

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Benperidol: May diminish the therapeutic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Monitor therapy

Benzylpenicilloyl Polylysine: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Consider therapy modification

Beta-Blockers (Beta1 Selective): May diminish the therapeutic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Monitor therapy

Beta-Blockers (Nonselective): May enhance the hypertensive effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Exceptions: Arotinolol; Carvedilol; Labetalol. Monitor therapy

Beta-Blockers (with Alpha-Blocking Properties): May diminish the therapeutic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Monitor therapy

Blonanserin: May diminish the therapeutic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Avoid combination

Bretylium: May enhance the therapeutic effect of Alpha-/Beta-Agonists (Direct-Acting). Monitor therapy

Bromperidol: May diminish the therapeutic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Avoid combination

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy

Chloroprocaine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Monitor therapy

CloZAPine: May diminish the therapeutic effect of Alpha-/Beta-Agonists. Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification

COMT Inhibitors: May decrease the metabolism of COMT Substrates. Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy

Hyaluronidase: May enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Management: Avoid the use of hyaluronidase to enhance dispersion or absorption of alpha-/beta-agonists. Use of hyaluronidase for other purposes in patients receiving alpha-/beta-agonists may be considered as clinically indicated. Consider therapy modification

Inhalational Anesthetics: May enhance the arrhythmogenic effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Management: Administer Epinephrine (Lidocaine and Epinephrine) with added caution in patients receiving, or who have recently received, inhalational anesthetics. Use lower than normal doses of Epinephrine (Lidocaine and Epinephrine) and monitor for the development of cardiac arrhythmias. Consider therapy modification

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

Lurasidone: Epinephrine (Lidocaine and Epinephrine) (Systemic) may enhance the hypotensive effect of Lurasidone. Avoid combination

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Monitor therapy

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Consider therapy modification

Promethazine: May diminish the vasoconstricting effect of Epinephrine (Lidocaine and Epinephrine) (Systemic). Management: When vasoconstrictive effects are desired in patients receiving promethazine, consider alternatives to Epinephrine (Lidocaine and Epinephrine). Consider use of norepinephrine or phenylephrine, and avoid Epinephrine (Lidocaine and Epinephrine), when treating hypotension associated with promethazine overdose. Consider therapy modification

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Consider therapy modification

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Monitor therapy

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Consider therapy modification

See also:
What are the possible side effects of Lidocaine and Epinephrine?

Adverse Reactions

Also see individual agents.

<1%, postmarketing, and/or case reports: Methemoglobinemia