Lidocaine may be given 1-1.5 mg/kg IV or IO in cardiac arrest from ventricular fibrillation and ventricular tachycardia. In refractory VF, an additional 0.5 to 0.75 mg/kg IV push may be given, and can be repeated to a maximum of 3 doses or total of 3 mg/kg.
If the patient has an arrhythmia like stable ventricular tachycardia, significant ectopy (PVC’s), or any wide complex tachycardia of unknown type, the dose of lidocaine should begin at 0.5 to 0.75 mg/kg and may total 1-1.5 mg/kg.
Maintenance infusions of lidocaine may be given to patients who regain a sinus rhythm with lidocaine. The dosage for a lidocaine infusion is normally 1-4 mg/minute, which is typically 30-50 mcg/kg/minute.
Prophylaxis against ventricular ectopy in acute myocardial infarction is contraindicated.
Discontinue use if signs of toxicity develop.
For patients with impaired liver function or left ventricular function, reduce the maintenance dose. However, the loading dose remains the same.
Lidocaine should not be used in heart block, including second or third degree or sinoatrial block, unless the patient has a pacemaker.
It should be used carefully with quinidine, flecainide, disopyramide, and procainamide, which are Class I antiarrhythmics.
Caution should be used in patients with hypotension that is not the result of their arrhythmia, and in patients with bradycardia.