- 2%, 5ml (20mg/ml, 100mg total) ampoules (subcutaneous, IV)

- 4% spray (mucosa, topical)

- 4% gel, cream (topical)

- 5% patches (transdermal)

- 2% drops (ophthalmic and otic formulations)

Executive Summary

(Updated February 2023)

Lidocaine is a synthetic local anesthetic of intermediate potency, and one of the most frequently used drugs in the ED.  It has a reversible blocking effect on voltage-gated sodium channels, resulting in two main clinical usages: (i) interrupting nerve impulse propagation to achieve local or regional anesthesia, and (ii) inhibition of cardiac ion channels as a class IB antiarrhythmic drug (10). 

Adult dose

Adult dose for local anesthesia (6, 12, 19, 17)
Up to 4.5 mg/kg (max 300mg per dose) subcutaneous infiltration within 2 hours.

Adult dose for ventricular tachycardia (8, 9)

1-1.5mg/kg IV.


US FDA-Labeled (16, 17, 18)


Lidocaine + epinephrine for subcutaneous infiltration

There are commercially available pre-mixed formulations that combine lidocaine and epinephrine (18). 

Lidocaine for ventricular arrhythmias

Lidocaine, as a class IB antiarrhythmic agent, is approved by the US-FDA for treatment of ventricular arrhythmias associated with myocardial infarction and cardiac manipulation such as cardiac surgery (16). 


Pregnancy and Lactation

Pregnancy (17)

Lactation (21)


DailyMed (antiarrhythmic label)

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