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Intranasal Lidocaine for Treatment of Migraine-Reply

Morris Maizels, MD
JAMA. 1996;276(19):1554. doi:10.1001/jama.1996.03540190026024.
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In Reply.  —Dr Diamond raises concerns about the toxicity of lidocaine. Blood levels of lidocaine greater than 26 μmol/L (5 μg/mL), which occasionally develop in patients receiving intravenous infusions of lidocaine administered at 2 to 4 mg per minute, may be associated with central nervous system toxicity. The bioavailability of intranasal lidocaine is 0.05 to 0.48 with a mean of 0.26.1 The maximum dose used in our study was 80 mg (2 mL of a 4% solution), yielding a level well below that which might cause concern of toxicity. One patient (outside the study) who claimed to use a nasal spray of lidocaine every 2 hours had a level of 0.043 μmol/L (0.01 μg/mL) determined immediately after her last dose.Our patients were not evaluated for the presence of nasal abnormalities, as Dr Lane suggests. In a study of intranasal lidocaine as a prognostic aid for preoperative assessment of facial pain


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