Xylocaine

Adult Dosing .

Dosage forms:  INJ (0.5%): 250 mg per 50 mL; INJ (1%): 10 mg per mL; INJ (1.5%): 15 mg per mL; INJ (2%): 20 mg per mL

Special Note

[formulation clarification]

Info: some concentrations methylparaben-free (MPF)

ventricular arrhythmias

[1-4 mg/min IV]

Start: 1-1.5 mg/kg/dose IV x1, may repeat dose x1 after 5min; Max: 300 mg/total bolus dose

ACLS, VF/pulseless VT

[0.5-0.75 mg/kg/dose IV/IO q5-10min prn]

Start: 1-1.5 mg/kg/dose IV/IO x1; Max: 3 mg/kg/total dose; Info: see ACLS: VF/Pulseless VT table

local anesthesia

[infiltration]

Dose: 5-300 mg/total dose (0.5% or 1%) via infiltration; Max: 4.5 mg/kg/dose, 300 mg/total dose

regional anesthesia

[peripheral nerve block, brachial plexus]

Dose: 225-300 mg/total dose (1.5%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[peripheral nerve block, dental]

Dose: 20-100 mg/total dose (2%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[peripheral nerve block, intercostal]

Dose: 30 mg/total dose (1%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[peripheral nerve block, paravertebral]

Dose: 30-50 mg/total dose (1%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[peripheral nerve block, pudendal]

Dose: 100 mg/total dose (1%) each side perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[peripheral nerve block, paracervical]

Dose: 100 mg/total dose (1%) each side perineurally; Max: 4.5 mg/kg/dose, 200 mg/total dose

[sympathetic nerve block, cervical]

Dose: 50 mg/total dose (1%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[sympathetic nerve block, lumbar]

Dose: 50-100 mg/total dose (1%) perineurally; Max: 4.5 mg/kg/dose, 300 mg/total dose

[caudal block]

Dose: 200-300 mg/total dose (1% MPF or 1.5% MPF) intracaudally; Max: 4.5 mg/kg/dose no more frequently than q90min, 300 mg/total dose

[central neural block]

Dose: 200-300 mg/total dose (1% MPF, 1.5% MPF, or 2% MPF) epidurally; Max: 4.5 mg/kg/dose no more frequently than q90min, 300 mg/total dose; Info: dosing varies w/ number of dermatomes anesthetized

status epilepticus (off-label)

[1 mg/kg/dose IV x1]

Info: may give 0.5 mg/kg/dose IV x1 2min after 1st dose, then 30 mcg/kg/min IV

renal dosing

[see below]

eGFR <30: decr. usual dose by 50% if prolonged infusion; Info: metabolite accumulation possible

HD/PD: not defined

hepatic dosing

[see below]

hepatic impairment: consider decr. usual dose

Peds Dosing .

Dosage forms:  INJ (0.5%): 250 mg per 50 mL; INJ (1%): 10 mg per mL; INJ (1.5%): 15 mg per mL; INJ (2%): 20 mg per mL

Special Note

[formulation clarification]

Info: some concentrations methylparaben-free (MPF)

ventricular arrhythmias

[20-50 mcg/kg/min IV]

Start: 1 mg/kg/dose IV x1, may repeat dose q10-15min x2 up to 3-5 mg/kg/total dose in 1st hour; Max: 20 mcg/kg/min if in shock or CHF

PALS, VF/pulseless VT

[20-50 mcg/kg/min IV]

Start: 1 mg/kg/dose IV/IO x1; Info: may repeat 1 mg/kg/dose IV/IO x1 if maint. infusion started >15min after initial bolus; see PALS: VF/Pulseless VT table

local anesthesia

[infiltration]

Dose: varies by procedure; Info: max dose varies by age and weight; use lowest effective concentration and dose

regional anesthesia

[nerve block]

Dose: varies by procedure (0.25-0.5%); Max: 3 mg/kg/total dose; Info: use lowest effective concentration and dose

renal dosing

[see below]

eGFR <30: decr. usual dose by 50% if prolonged infusion; Info: metabolite accumulation possible

HD/PD: not defined

hepatic dosing

[see below]

hepatic impairment: consider decr. usual dose