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July 19, 1976, Vol 236, No. 3 >
ARTICLE | July 19, 1976

Pharmacokinetic Approach to the Clinical Use of Lidocaine Intravenously FREE

David J. Greenblatt, MD; Victoria Bolognini, RN; Jan Koch-Weser, MD; Jerold S. Harmatz
[+] Author Affiliations

Reprint requests to the Clinical Pharmacology Unit, Massachusetts General Hospital, Boston, MA 02114 (Dr Greenblatt).


JAMA. 1976;236(3):273-277. doi:10.1001/jama.1976.03270030027023
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References

The time course of lidocaine plasma concentrations following various modes of administration were predicted by computer. Initiating therapy with a single intravenous bolus dose was unsatisfactory; plasma levels during the first hour were potentially toxic after a 200-mg bolus and subtherapeutic after a 50- to 100-mg bolus. After two bolus doses of 100 mg, separated by 20 to 30 minutes, or a rapid loading infusion over 15 to 60 minutes, therapeutic concentrations were achieved and maintained. Pharmacokinetic principles can be of value in devising rational approaches to lidocaine dosage.

(JAMA 236:273-277, 1976)

REFERENCES

1 +
Collinsworth KA, Kalman SM, Harrison DC:  The clinical pharmacology of lidocaine as an antiarrhythmic drug . Circulation 50:1217-1230, 1974;.
2 +
Bassan MM, Weinstein SR, Mandel WJ:  Use of lidocaine by continuous infusion . Am Heart J 87:302-303, 1974;.
3 +
Zito R, Reid P:  Lidocaine kinetics in man . Clin Pharmacol Ther 17:248, 1975;.
4 +
Boyes RN, Scott DB, Jebson PJ, et al:  Pharmacokinetics of lidocaine in man . Clin Pharmacol Ther 12:105-116, 1971;.
5 +
Benowitz NL:  Clinical applications of the pharmacokinetics of lidocaine , in Melmon KL (ed): Cardiovascular Drug Therapy . Philadelphia, FA Davis Co, 1974;, pp 77-101.
6 +
Rowland M, Thompson PD, Guichard A, et al:  Disposition kinetics of lidocaine in normal subjects . Ann NY Acad Sci 179:383-398, 1971;.
7 +
Thompson PD, Melmon KL, Richardson JA, et al:  Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in adults . Ann Intern Med 78:499-508, 1973;.
8 +
Greenblatt DJ, Koch-Weser J:  Drug therapy: Clinical pharmacokinetics . N Engl J Med 293:702-705, 964-970, 1975;.
9 +
Wagner JG:  A safe method for rapidly achieving plasma concentration plateaus . Clin Pharmacol Ther 16:691-700, 1974;.
10 +
Loo JCK, Riegelman S:  Assessment of pharmacokinetic constants from postinfusion blood curves after IV infusion . J Pharm Sci 59:53-55, 1970;.
11 +
Bigger JT:  Pharmacologic and clinical control of antiarrhythmic drugs . Am J Med 58:479-488, 1975;.
12 +
Shen D, Gibaldi M:  A hypothesis for the rapid attainment and maintenance of lidocaine plasma levels . J Clin Pharmacol 14:339-344, 1974;.
13 +
Zener JC, Harrison DC:  Serum enzyme values following intramuscular administration of lidocaine . Arch Intern Med 134:48-49, 1974;.
14 +
Schwartz ML, Meyer MB, Covino BG, et al:  Antiarrhythmic effectiveness of intramuscular lidocaine: Influence of different injection sites . J Clin Pharmacol 14:77-83, 1974;.
15 +
Evans EF, Proctor JD, Fratkin MJ, et al:  Blood flow in muscle groups and drug absorption . Clin Pharmacol Ther 17:44-47, 1975;.
16 +
Jelliffe R, Guicoechea F, Tuey D, et al:  An improved computer program for lidocaine infusion regimens . Clin Res 13:125A, 1975;.
17 +
Stenson RE, Constantino RT, Harrison DC:  Interrelationships of hepatic blood flow, cardiac output, and blood levels of lidocaine in man . Circulation 43:205-211, 1971;.
18 +
Prescott LF, Nimmo J:  Plasma lidocaine concentrations during and after prolonged infusions in patients with myocardial infarction , in Scott DB, Julian DG (eds): Lidocaine in the Treatment of Ventricular Arrhythmias . Edinburgh, E & S Livingstone Ltd, 1971;, pp 168-177.
19 +
Branch RA, Shand DG, Wilkinson GR, et al:  The reduction of lidocaine clearance by dl-propranolol: An example of hemodynamic drug interaction . J Pharmacol Exp Ther 184:515-519, 1973;.
20 +
 Doubts about lignocaine , editorial. Br Med J 1:473-474, 1975;.

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1 +
Collinsworth KA, Kalman SM, Harrison DC:  The clinical pharmacology of lidocaine as an antiarrhythmic drug . Circulation 50:1217-1230, 1974;.
2 +
Bassan MM, Weinstein SR, Mandel WJ:  Use of lidocaine by continuous infusion . Am Heart J 87:302-303, 1974;.
3 +
Zito R, Reid P:  Lidocaine kinetics in man . Clin Pharmacol Ther 17:248, 1975;.
4 +
Boyes RN, Scott DB, Jebson PJ, et al:  Pharmacokinetics of lidocaine in man . Clin Pharmacol Ther 12:105-116, 1971;.
5 +
Benowitz NL:  Clinical applications of the pharmacokinetics of lidocaine , in Melmon KL (ed): Cardiovascular Drug Therapy . Philadelphia, FA Davis Co, 1974;, pp 77-101.
6 +
Rowland M, Thompson PD, Guichard A, et al:  Disposition kinetics of lidocaine in normal subjects . Ann NY Acad Sci 179:383-398, 1971;.
7 +
Thompson PD, Melmon KL, Richardson JA, et al:  Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in adults . Ann Intern Med 78:499-508, 1973;.
8 +
Greenblatt DJ, Koch-Weser J:  Drug therapy: Clinical pharmacokinetics . N Engl J Med 293:702-705, 964-970, 1975;.
9 +
Wagner JG:  A safe method for rapidly achieving plasma concentration plateaus . Clin Pharmacol Ther 16:691-700, 1974;.
10 +
Loo JCK, Riegelman S:  Assessment of pharmacokinetic constants from postinfusion blood curves after IV infusion . J Pharm Sci 59:53-55, 1970;.
11 +
Bigger JT:  Pharmacologic and clinical control of antiarrhythmic drugs . Am J Med 58:479-488, 1975;.
12 +
Shen D, Gibaldi M:  A hypothesis for the rapid attainment and maintenance of lidocaine plasma levels . J Clin Pharmacol 14:339-344, 1974;.
13 +
Zener JC, Harrison DC:  Serum enzyme values following intramuscular administration of lidocaine . Arch Intern Med 134:48-49, 1974;.
14 +
Schwartz ML, Meyer MB, Covino BG, et al:  Antiarrhythmic effectiveness of intramuscular lidocaine: Influence of different injection sites . J Clin Pharmacol 14:77-83, 1974;.
15 +
Evans EF, Proctor JD, Fratkin MJ, et al:  Blood flow in muscle groups and drug absorption . Clin Pharmacol Ther 17:44-47, 1975;.
16 +
Jelliffe R, Guicoechea F, Tuey D, et al:  An improved computer program for lidocaine infusion regimens . Clin Res 13:125A, 1975;.
17 +
Stenson RE, Constantino RT, Harrison DC:  Interrelationships of hepatic blood flow, cardiac output, and blood levels of lidocaine in man . Circulation 43:205-211, 1971;.
18 +
Prescott LF, Nimmo J:  Plasma lidocaine concentrations during and after prolonged infusions in patients with myocardial infarction , in Scott DB, Julian DG (eds): Lidocaine in the Treatment of Ventricular Arrhythmias . Edinburgh, E & S Livingstone Ltd, 1971;, pp 168-177.
19 +
Branch RA, Shand DG, Wilkinson GR, et al:  The reduction of lidocaine clearance by dl-propranolol: An example of hemodynamic drug interaction . J Pharmacol Exp Ther 184:515-519, 1973;.
20 +
 Doubts about lignocaine , editorial. Br Med J 1:473-474, 1975;.

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