- Loading Lidocaine IV 1-2 mg/kg and can repeat at 1 mg/kg every 5 minutes (two more boluses as needed), maintenance 1-4 mg/min
Distribution and metabolism
- Lidocaine is only parenterally administered because of significant hepatic metabolism and production of toxic metabolites when given PO
Therapeutic drug monitoring
- Can obtain daily lidocaine level, more frequent if concern for toxicity
Therapeutic plasma concentrations
- 1-5 mcg/mL
- Hepatic clearance
- Initial dose depends on severity of arrhythmia and weight (volume of distribution)
- Maintenance dose should be decreased in liver disease and heart failure or cardiogenic shock (because of decreased hepatic blood flow)
- Zipes, et al. Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine, 11 th edition, Chapter 36, Therapy of Cardiac Arrhythmias.
- Campbell TJ, Williams KM. Therapeutic drug monitoring: antiarrhythmic drugs. J Clinical Pharmacol. 2001;52:21S-35S.