Lidocaine spray 10%, 38g

• in dentistry for terminal (surface) anesthesia: anesthesia of the injection area before local anesthesia; opening of superficial abscesses; before suturing the mucous membrane;

• before fixing crowns and bridges;

• in the treatment of gum disease, periodontopathies; extirpation of milk teeth; removal of tartar;

• in otorhinolaryngology: operations on the nasal septum and removal of nasal polyps;

• electrocoagulation in the treatment of nosebleeds;

• elimination of the pharyngeal reflex and anesthesia of the injection site before removing the tonsils;

• opening of peritonsillar abscesses;

• in obstetrics and gynecology: episiotomy and incision processing;

• removal of seams;

• small operations on the vagina and cervix;

• breakthrough of the hymen;

• treatment of filamentous suppuration;

• for instrumental and endoscopic studies: before the introduction of the probe through the nose or mouth (duodenal intubation and fractional study of gastric secretion);

• with rectoscopy, intubation;

• X-ray examination: elimination of nausea and pharyngeal reflex;

• as an analgesic drug for burns (including sunburn);

• bites;

• contact dermatitis (including those caused by irritating plants);

• small wounds (including scratches);

• surface anesthesia of the skin with minor surgical interventions.

Locally, externally.

The dose may vary depending on the indication and the size of the area to be anesthetized. One spray dose, released by pressing the metering valve, contains 4.8 mg of lidocaine. In order to avoid reaching high concentrations of the drug in blood plasma, the lowest doses should be used at which a satisfactory effect is observed. Usually 1-2 valve strokes are sufficient, but in obstetric practice 15-20 or more doses are applied (maximum 40 doses per 70 kg).

The drug can also be applied using a cotton swab soaked in it.

Children.

When carrying out dental procedures and operations in children, Lidocaine spray is preferably used with a cotton swab, which avoids fear when spraying the drug, as well as a tingling sensation (a common side effect).

• hypersensitivity.

• With caution: hemorrhoidal bleeding (with rectal examination), local infection in the area of ??application, trauma of the mucous membrane or skin in the area of ??application, concomitant acute diseases, debilitated patients, younger children, old age, pregnancy, lactation.

pharmachologic effect

The local anesthetic effect is due to the inhibition of nerve conduction due to the blockade of sodium channels in the nerve endings, which prevents the generation of impulses in the endings of the sensory nerves and the conduction of pain impulses along the nerve fibers. When applied topically, it dilates blood vessels, does not have a local irritating effect. The effect develops within 1-5 minutes after application to the mucous membranes or skin and lasts for 10-15 minutes.

Pharmacokinetics

It is rapidly absorbed from the mucous membranes (especially the pharynx and respiratory tract), the degree of absorption of the drug is determined by the degree of blood supply to the mucous membrane, the total dose of the drug, site localization and duration of application. After application to the mucous membrane of the upper respiratory tract, it is partially swallowed and inactivated in the gastrointestinal tract. TCmax in plasma when applied to the mucous membrane of the oral cavity and upper respiratory tract - 10-20 minutes. The connection with proteins depends on the concentration of the drug and is 60-80% at a drug concentration of 1-4 ?g / ml (4.3-17.2 ?mol / L). It is distributed quickly (T1 / 2 phase of distribution - 6-9 minutes), first it enters well-perfused tissues (heart, lungs, brain, liver, spleen), then into adipose and muscle tissues. Penetrates the blood-brain and placental barriers,secreted in breast milk (40% of the concentration in the mother's plasma). It is metabolized in the liver (90-95%) with the participation of microsomal enzymes by dealkylating the amino group and breaking the amide bond with the formation of metabolites less active than lidocaine (monoethylglycinexylidine and glycinexylidine), T1 / 2 of which is 2 hours and 10 hours, respectively. With liver diseases, the metabolic rate decreases and ranges from 50% to 10% of the normal value. It is excreted in the bile and kidneys (up to 10% unchanged). In chronic renal failure, the accumulation of metabolites is possible. Acidification of urine increases the excretion of lidocaine.It is metabolized in the liver (90-95%) with the participation of microsomal enzymes by dealkylating the amino group and breaking the amide bond with the formation of metabolites less active than lidocaine (monoethylglycinexylidine and glycinexylidine), T1 / 2 of which is 2 hours and 10 hours, respectively. With liver diseases, the metabolic rate decreases and ranges from 50% to 10% of the normal value. It is excreted in the bile and kidneys (up to 10% unchanged). In chronic renal failure, the accumulation of metabolites is possible. Acidification of urine increases the excretion of lidocaine.It is metabolized in the liver (by 90-95%) with the participation of microsomal enzymes by dealkylating the amino group and breaking the amide bond with the formation of metabolites less active than lidocaine (monoethylglycinexylidine and glycinexylidine), T1 / 2 of which is 2 hours and 10 hours, respectively. With liver diseases, the metabolic rate decreases and ranges from 50% to 10% of the normal value. It is excreted in the bile and kidneys (up to 10% unchanged). In chronic renal failure, the accumulation of metabolites is possible. Acidification of urine increases the release of lidocaine.With liver diseases, the metabolic rate decreases and ranges from 50% to 10% of the normal value. It is excreted in the bile and kidneys (up to 10% unchanged). In chronic renal failure, the accumulation of metabolites is possible. Acidification of urine increases the excretion of lidocaine.With liver diseases, the metabolic rate decreases and ranges from 50% to 10% of the normal value. It is excreted in the bile and kidneys (up to 10% unchanged). In chronic renal failure, the accumulation of metabolites is possible. Acidification of urine increases the excretion of lidocaine.

Side effect

At the site of application of the drug: a slight burning sensation, which stops after the onset of anesthesia (within 1 minute), erythema. Allergic reactions are possible: allergic contact dermatitis (hyperemia at the site of application, skin rash, urticaria, itching), angioedema, anaphylactic shock. From the side of the central nervous system, systemic reactions can be observed: headache, dizziness, convulsions, tremors, blurred vision, tinnitus, excitement and / or depression, fear, euphoria, anxiety, fever, feeling of coldness, respiratory depression. From the side of the cardiovascular system: increased blood pressure, bradycardia. Others: urethritis (after topical application).

Application during pregnancy and lactation

With care: pregnancy, lactation.

Application in children

With care: younger children. In dental practice in children, it is preferable to apply it in the form of lubrication (in order to avoid frightening the child when spraying) by pre-impregnating a cotton swab.

Use in elderly patients

With care: old age.

special instructions

The bottle should be kept upright during use. Avoid contact with eyes and respiratory tract (risk of aspiration). Application of the drug to the posterior pharyngeal wall requires special care.

Influence on the ability to drive vehicles and use mechanisms

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Overdose

Symptoms: increased sweating, pallor of the skin, nausea, vomiting, dizziness, headache, blurred vision, ringing in the ears, diplopia, decreased blood pressure, bradycardia, arrhythmia, drowsiness, chills, numbness, tremor, anxiety, agitation, convulsions methemoglobinemia, cardiac arrest. Treatment: when the first signs of intoxication appear (dizziness, nausea, vomiting, euphoria), the patient is transferred to a horizontal position and oxygen inhalation is prescribed; with psychomotor agitation - intravenous 10 mg of diazepam; with convulsions - in / in a 1% solution of hexobarbital or sodium thiopental; with bradycardia - in / in 0.5-1 mg of atropine, sympathomimetic drugs. Dialysis is ineffective.

Drug interactions

Cimetidine and propranolol reduce the hepatic clearance of lidocaine (a decrease in metabolism due to inhibition of microsomal oxidation and a decrease in hepatic blood flow) and increase the risk of developing toxic effects (including a state of stunnedness, drowsiness, bradycardia, paresthesia, etc.). Barbiturates, phenytoin, rifampicin (inducers of liver microsomal enzymes) reduce the effectiveness (an increase in dose may be required). When administered with aymalin, phenytoin, verapamil, quinidine, amiodarone, the negative inotropic effect may be enhanced. Co-administration with beta-blockers increases the risk of developing bradycardia. Cardiac glycosides weaken the cardiotonic effect, curariform drugs enhance muscle relaxation. Procainamide increases the risk of developing arousal of the central nervous system, hallucinations.With the simultaneous appointment of lidocaine and hypnotics and sedatives, it is possible to enhance their inhibitory effect on the central nervous system. With intravenous administration of hexobarbital or sodium thiopental against the background of the action of lidocaine, respiratory depression is possible. Under the influence of monoamine oxidase inhibitors, it is possible to enhance the local anesthetic effect of lidocaine. Patients taking monoamine oxidase inhibitors should not be given parenteral lidocaine. With the simultaneous use of lidocaine and polymyxin, it is possible to increase the inhibitory effect on neuromuscular transmission, therefore, in this case, it is necessary to monitor the patient's respiratory function.With intravenous administration of hexobarbital or sodium thiopental against the background of the action of lidocaine, respiratory depression is possible. Under the influence of monoamine oxidase inhibitors, it is possible to enhance the local anesthetic effect of lidocaine. Patients taking monoamine oxidase inhibitors should not be given parenteral lidocaine. With the simultaneous use of lidocaine and polymyxin, it is possible to increase the inhibitory effect on neuromuscular transmission, therefore, in this case, it is necessary to monitor the patient's respiratory function.With intravenous administration of hexobarbital or sodium thiopental against the background of the action of lidocaine, respiratory depression is possible. Under the influence of monoamine oxidase inhibitors, it is possible to enhance the local anesthetic effect of lidocaine. Patients taking monoamine oxidase inhibitors should not be given parenteral lidocaine. With the simultaneous use of lidocaine and polymyxin, it is possible to increase the inhibitory effect on neuromuscular transmission, therefore, in this case, it is necessary to monitor the patient's respiratory function.therefore, in this case, it is necessary to monitor the patient's respiratory function.therefore, in this case, it is necessary to monitor the patient's respiratory function.