Lidocaine and epinephrine (Injection)

Lidocaine and epinephrine combination injection is used to create numbness or loss of feeling for patients undergoing specific medical procedures (by blocking certain nerves using the brachial plexus, intercostal, lumbar, or epidural blocking techniques).

This medicine is to be given only by your doctor or under their direct supervision.

It is very important for your doctor to closely monitor your or your child's progress while receiving this medicine to ensure it is working properly. Blood tests may be needed to check for unwanted effects.

This medicine may cause a rare but serious blood problem called methemoglobinemia. The risk may be higher in children younger than 6 months, elderly patients, or patients with certain genetic conditions. It is more likely to happen if you receive too much of the medicine, but it can also occur with small amounts. Contact your doctor immediately if you or your child experience any of the following symptoms after receiving this medicine: pale, gray, or blue-colored skin, lips, or nails; confusion; headache; lightheadedness; fast heartbeat; or unusual tiredness or weakness.

If you receive this medicine into your lower back (epidural), you may temporarily lose sensation and movement, usually in the lower half of your body. Discuss any concerns with your doctor.

Make sure any doctor or dentist treating you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

Do not take other medicines unless your doctor has discussed them with you. This includes prescription and nonprescription (over-the-counter [OTC]) medicines as well as herbal or vitamin supplements.

In deciding to use a medicine, you and your doctor need to consider the risks of taking the medicine compared to the benefits it will provide. The following points should be taken into account for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, let your healthcare professional know if you have any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Due to the potential toxicity of this medicine, it should be used very carefully in children younger than 6 months old. Do not exceed the recommended doses, and the patient should be closely monitored during treatment.

Geriatric

There is no information available on how age affects the use of lidocaine and epinephrine combination injection in older patients. However, because of this medicine's toxicity, it should be used cautiously. Do not exceed the recommended doses, and the patient should be carefully monitored during treatment.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before using this medication while breastfeeding.

Studies suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Some medicines should never be used together, while in other cases, two different medicines may be used together even if an interaction might happen. In these situations, your doctor may need to adjust the dose or take other precautions. When receiving this medicine, it is particularly important that your healthcare professional knows if you are taking any of the medicines listed below. The following interactions are significant and are not all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Dihydroergotamine
• Dronedarone
• Isocarboxazid
• Linezolid
• Phenelzine
• Saquinavir
• Tranylcypromine
• Vernakalant

Using this medicine with any of the following medicines is typically not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both medicines.

• Amifampridine
• Amineptine
• Amiodarone
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Amprenavir
• Arbutamine
• Atazanavir
• Benperidol
• Bromperidol
• Bucindolol
• Bupivacaine
• Bupivacaine Liposome
• Bupropion
• Carteolol
• Carvedilol
• Clomipramine
• Cobicistat
• Darunavir
• Dasabuvir
• Delavirdine
• Desipramine
• Dibenzepin
• Digoxin
• Dilevalol
• Disopyramide
• Dixyrazine
• Donepezil
• Doxepin
• Droperidol
• Encainide
• Entacapone
• Ergonovine
• Etravirine
• Fexofenadine
• Flecainide
• Fluphenazine
• Fosamprenavir
• Fosphenytoin
• Fospropofol
• Furazolidone
• Haloperidol
• Halothane
• Hyaluronidase
• Imipramine
• Iobenguane I 123
• Iproniazid
• Lacosamide
• Levalbuterol
• Levobunolol
• Lofepramine
• Lopinavir
• Loxapine
• Melitracen
• Melperone
• Methdilazine
• Methotrimeprazine
• Methylene Blue
• Methylergonovine
• Metipranolol
• Metopimazine
• Metoprolol
• Mexiletine
• Milnacipran
• Moperone
• Moricizine
• Nadolol
• Nialamide
• Nortriptyline
• Ombitasvir
• Opicapone
• Opipramol
• Oxprenolol
• Paritaprevir
• Penbutolol
• Perazine
• Periciazine
• Perphenazine
• Phenytoin
• Pindolol
• Pipamperone
• Piperazine
• Pipotiazine
• Practolol
• Procainamide
• Procarbazine
• Prochlorperazine
• Promazine
• Promethazine
• Propafenone
• Propiomazine
• Propofol
• Propranolol
• Protriptyline
• Quinidine
• Rasagiline
• Safinamide
• Selegiline
• Sotalol
• St John's Wort
• Succinylcholine
• Telaprevir
• Terfenadine
• Tertatolol
• Thiethylperazine
• Thioproperazine
• Thioridazine
• Tianeptine
• Timolol
• Tocainide
• Trifluoperazine
• Trifluperidol
• Triflupromazine
• Trimipramine
• Zavegepant

Using this medicine with any of the following medicines may increase the risk of certain side effects, but using both drugs may be necessary for your treatment. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Cimetidine
• Labetalol
• Penbutolol

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken during or around mealtime because interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions. Talk to your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical issues may affect the use of this medicine. Be sure to inform your doctor if you have any other medical conditions, especially:

• Blood vessel disease or
• Heart disease or
• Hypertension (high blood pressure) or
• Liver disease—Use with caution. The chance of side effects may be increased.

• Brain or nerve disease or
• Heart block or
• Severe hypertension (high blood pressure) or
• Sepsis or
• Severe shock or
• Spine problems—Use with caution.

• Glucose-6-phosphate dehydrogenase deficiency (G6PD) or
• Heart problems or
• Lung or breathing problems or
• Methemoglobinemia (blood disorder), hereditary or idiopathic (unknown cause)—Use with caution. May increase risk of methemoglobinemia.

• Sulfite allergy—Lidocaine with epinephrine injection contains sodium metabisulfite, which may cause allergic reactions.

Along with its useful effects, a medicine may cause some unwanted effects. Not all of these side effects may happen, but if they do, they may need medical attention.

Check with your doctor or nurse right away if any of the following side effects happen:

Incidence not known

• Bluish-colored lips, fingernails, or palms
• Blurred or double vision
• Chest pain or discomfort
• Cold, clammy, pale skin
• Confusion
• Continuing ringing, buzzing, or other unexplained noise in the ears
• Cough
• Dark urine
• Difficulty breathing
• Difficulty swallowing
• Dizziness or lightheadedness
• Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• Drowsiness
• Fast heartbeat
• Fever
• Headache
• Hearing loss
• Hives, itching, skin rash
• Irregular heartbeat
• Irregular, fast or slow, or shallow breathing
• Loss of consciousness
• Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• Rapid or slow heart rate
• Seizures
• Slow or irregular heartbeat
• Sore throat
• Sweating
• Tightness in the chest
• Tremor
• Twitching
• Unusual bleeding or bruising
• Unusual tiredness or weakness

Some side effects may happen that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Your health care professional may also be able to tell you how to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

Incidence not known

• Cold or numb feeling
• False or unusual sense of well-being
• Feeling of heat
• Loss of bladder and bowel control
• Loss of genital sensation and sexual function
• Nervousness
• Vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Pharmacologic Class: Sympathomimetic

Chemical Class: Amino Amide

A nurse or other trained health professional will give you this medicine in a medical facility. It is given through a needle placed into one of your veins, into your upper arm, into the head and neck area, or into the space around the spinal nerves in your lower back.