Lignocaine (Lidocaine) Injection is a Class Ib anti-arrhythmic drug and a local anesthetic. It is used in spinal and local anesthesia and life-threatening arrhythmias.

Indications of Lidocaine (Lignocaine):

• It is used for local and regional anesthesia by infiltration, nerve block, epidural, or spinal techniques;
• Acute treatment of ventricular arrhythmias from myocardial infarction or cardiac manipulation (eg, cardiac surgery).

Note:

• It is not recommended to use lidocaine prophylactically to prevent arrhythmia associated with fibrinolytic administration or to suppress isolated ventricular premature beats, couplets, runs of accelerated idioventricular rhythm, and nonsustained ventricular tachycardia.

• Off Label Use of Lidocaine in Adults:

  • Interstitial cystitis (bladder pain syndrome) (alkalinized lidocaine)
  • ACLS guidelines: Drug-induced monomorphic VT
  • Hemodynamically stable monomorphic ventricular tachycardia (VT) (preserved ventricular function)
  • Polymorphic VT (preserved ventricular function)
  • An alternative to amiodarone for pulseless VT or ventricular fibrillation (VF) (unresponsive to CPR, defibrillation, and vasopressor therapy)

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Lidocaine (Lidocaine) dose in adults:

Lignocaine dose in the treatment of Arrhythmic (off-label):

• Ventricular fibrillation or pulseless ventricular tachycardia (after defibrillation attempts, CPR, and epinephrine):

  • IV, intraosseous (IO):
  • Initial: 1 to 1.5 mg/kg bolus.
  • If refractory ventricular fibrillation or pulseless ventricular tachycardia, repeat 0.5 to 0.75 mg/kg bolus every 5 to 10 minutes.
  • The maximum cumulative dose: 3 mg/kg.
  • Follow with continuous infusion (1 to 4 mg/minute) after the return of perfusion.
  • The reappearance of arrhythmia during constant infusion: 0.5 mg/kg bolus and reassessment of infusion.

• Endotracheal (loading dose only):

  • 2 to 3.75 mg/kg (2 to 2.5 times the recommended IV dose);
  • Dilute in 5 to 10 ml NS or sterile water.
  • Note: Absorption is greater with sterile water and results in less impairment of PaO2.

• Hemodynamically stable monomorphic VT:

  • IV: 1 to 1.5 mg/kg;
  • Repeat with 0.5 to 0.75 mg/kg every 5 to 10 minutes as necessary.
  • The maximum cumulative dose: 3 mg/kg.
  • Follow with continuous infusion of 1 to 4 mg/minute (or 14 to 57 mcg/kg/minute).

Note:

• In patients with congestive heart failure, shock, or hepatic disease, maintenance infusion should be reduced.
• The infusion should be started at 10 mcg/kg/minute.
• The maximum dose: 1.5 mg/minute or 20 mcg/kg/minute.

Lignocaine Dose as a local injectable anesthetic:

The dose depends on the procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of the patient.

• Cutaneous infiltration:

  • Maximum: 4.5 mg/kg/dose not to exceed 300 mg;
  • Do not repeat within 2 hours.

• Intraosseous line or infusion pain:

  • Lidocaine 1% or 2% preservative-free solution:
  • Initial dose: 40 mg over 1 to 2 minutes.
  • The usual adult dose range and maximum: 20 to 50 mg/dose.
  • Flushing with normal saline should be done after allowing lidocaine to dwell for up to 1 minute.
  • Some centers administer a second lower (50% dose reduction) lidocaine dose over 30 to 60 seconds (usual adult maximum repeat dose: 20 mg/dose) immediately after flushing with saline.
  • Repeat doses at a maximum frequency of every 45 minutes during intraosseous access can be given in case of recurring discomfort, maximum total dose not established.
• Note:
  • Intraosseous access devices have a minimum weight and age for a particular device in addition to specific instruction for insertion and validation.
  • Consult product-specific information for more detail.

Lignocaine dose in the treatment of Interstitial cystitis (bladder pain syndrome) (off-label): Intravesical:

Various dosage regimens of alkalinized lidocaine alone or with heparin (20,000 to 50,000 units) have been used. Improper alkalinization can increase the risk of precipitation. Lidocaine stability and pH should be determined after the components have been mixed, prior to administration.

• Single instillation:

  • Single intravesical administration of lidocaine (200 mg)/heparin (50,000 units)/sodium bicarbonate (420 mg) in 15 ml of sterile water, instilled into the bladder via the catheter and allowed to dwell for 30 minutes before drainage.

• Weekly instillation:

  • Weekly bladder instillations for 12 consecutive weeks with lidocaine 4% (5 mL)/heparin (20,000 units)/sodium bicarbonate 7% (25 mL), instilled into an empty bladder via the catheter and allowed to dwell for 30 minutes before drainage.

• Daily instillation:

  • Daily bladder instillations for 5 days with lidocaine (200 mg)/sodium bicarbonate 8.4% solution (final volume of 10 mL), instilled into an empty bladder and allowed to dwell for 1 hour before drainage.

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Lidocaine (Lignocaine) dose in children:

Lignocaine dose in the treatment of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia:

• Infants, Children, and Adolescents:

  • IV, Intraosseous:

    • Loading dose:
      • 1 mg/kg/dose; follow with continuous IV infusion,if delay between initial bolus and start of infusion is >15 minutes,second bolus might be given.
    • Continuous IV infusion:
      • 20 to 50 mcg/kg/minute. Dose should not exceed 20 mcg/kg/minute in patients with shock, hepatic disease, cardiac arrest, or CHF as per manufacturer.

  • Endotracheal:

    • Loading dose: 2 to 3 mg/kg/dose; flush with 5 ml of NS and follow with 5 assisted manual ventilations.

Lignocaine Dose in the Anesthesia as local anesthetic:

The dose depends on the procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of the patient.

• Cutaneous infiltration:

  • Children and Adolescents:
  • Typically solutions with concentration <2% should be used (allow for larger volumes).
  • The maximum dose: 5 mg/kg/dose not to exceed the recommended adult maximum dose of 300 mg/dose;
  • Do not repeat within 2 hours.

• Intraosseous line or infusion pain:

  • Infants, Children, and Adolescents:
    • Lidocaine 1% or 2 % preservative-free solution:
    • Initial dose: 0.5 mg/kg over 1 to 2 minutes.
    • The usual adult dose range and maximum: 20 to 50 mg/dose follow with NS flush.
    • Some centers administer a second lower (50% dose reduction) lidocaine dose over 30 to 60 seconds (usual adult maximum repeat dose: 20 mg/dose) after flushing with saline.
    • Doses at a maximum frequency of every 45 minutes during intraosseous access should be given in case of recurring discomfort, maximum total dose not established, Dose should not exceed: 3 mg/kg/24 hours according to some centers.

Note:

• Intraosseous access devices have a minimum weight and age for a particular device in addition to specific instruction for insertion and validation;
• Consult product-specific information for more detail.

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Lignocaine Pregnancy Risk Category: B

• Lidocaine and its metabolites can cross the placenta. They can be detected in fetal circulation after maternal injections for anesthesia prior to delivery.
• Lidocaine injections have been approved for obstetric pain relief, including before epidural or spinal surgery.
• Lidocaine via local infiltration can provide analgesia prior to episiotomy or during repair of obstetric lesions.
• Administration via the perineal route can result in higher absorption than administration via the epidural route.
• All routes of administration must be considered for cumulative exposure.
• Pregnant females should never be denied surgery, regardless of the trimester.
• Elective surgeries might be delayed until after delivery.
• Similar drugs are recommended for the treatment of cardiac arrest in both pregnant and unpregnant women.
• Follow the current Advanced Cardiovascular Life Support Guidelines for indications and dosages.
• Appropriate medications should not be withheld due to the possibility of adverse effects in the fetus.

Lidocaine use during breastfeeding:

• Breast milk contains licocaine. Lidocaine metabolites have been found in breast milk.
• Breast milk contains a lower amount of lidocaine after dental procedures, liposuction and infusions for arrhythmias.
• Based on the highest breastmilk concentration, the relative infant dose (RID), of lidocaine was 4.9%. This is compared to an epidural dose of 183mg for epidural.
• When the RID of the medication is less than 10%, breastfeeding is generally acceptable.
• The RID of lidocaine was calculated based on a 0.86 mcg/mL mean milk concentration, giving an estimated daily infant dose via breastmilk of 129 mg/kg/day.
• After maternal lidocaine had been administered via regional anesthesia to 22 cesarean-assisted women, this milk concentration was achieved.
• Two hours after injection, milk sampling was performed. The breast milk concentration of licoaine decreased over 12 hours.
• The oral bioavailability of breastfeeding infants is expected to be very low.
• Recent guidelines have shown that Lidocaine can be used as an antiarrhythmic local anesthetic and compatible with breastfeeding.
• All routes of administration must be considered for cumulative exposure.

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Lignocaine Dose adjustment in renal disease:

• No dosage adjustment provided in the manufacturer’s labeling.
• Renal impairment can lead to increased accumulation of metabolites.
• Not dialyzable (0% to 5%) by hemodialysis or peritoneal dialysis.
• A supplemental dose is not necessary.

Lignocaine Dose adjustment in liver disease:

Use with caution. The maintenance infusion dose should be reduced.

• Initial: 0.75 mg/minute or 10 mcg/kg/minute.
• maximum dose: 1.5 mg/minute or 20 mcg/kg/minute.
• Lidocaine concentrations should be monitored closely and infusion rates should be adjusted accordingly, alternate regimes should be considered.

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Effects vary with the route of administration. Many effects are dose-related.

Side Effects of Lidocaine (Lignocaine):

• Central nervous system:

  • Headache
  • Shivering
  • Radiculopathy

Uncommon Side effects of Lignocaine (Lidocaine):

• Cardiovascular:

  • Bradycardia
  • Cardiac Arrhythmia
  • Circulatory Shock
  • Coronary Artery Vasospasm
  • Edema
  • Flushing
  • Heart Block
  • Hypotension (Including Following Spinal Anesthesia)
  • Local Thrombophlebitis
  • Vascular Insufficiency (Periarticular Injections)

• Central Nervous System:

  • Agitation
  • Anxiety
  • Apprehension
  • Cauda Equina Syndrome (Following Spinal Anesthesia)
  • Coma
  • Confusion
  • Disorientation
  • Dizziness
  • Drowsiness
  • Euphoria
  • Hallucination
  • Hyperesthesia
  • Hypoesthesia
  • Intolerance To Temperature
  • Lethargy
  • Loss Of Consciousness
  • Metallic Taste
  • Nervousness
  • Paresthesia
  • Peripheral Neuropathy (Following Spinal Anesthesia)
  • Psychosis
  • Seizure
  • Slurred Speech
  • Twitching

• Gastrointestinal:

  • Nausea (Including Following Spinal Anesthesia)
  • Vomiting

• Hypersensitivity:

  • Anaphylactoid Reaction
  • Anaphylaxis
  • Hypersensitivity Reaction

• Neuromuscular & Skeletal:

  • Tremor
  • Weakness

• Otic:

  • Tinnitus

• Respiratory:

  • Bronchospasm
  • Dyspnea
  • Respiratory Depression
  • Respiratory Insufficiency (Following Spinal Anesthesia)

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Contraindications to Lidocaine (Lignocaine):

• Hypersensitivity to any component of the formulation or lidocaine; hypersensitivity other local anesthetics of the amide-type
• Corn allergy or corn-related products
• Patients with an artificial pacemaker that is in use must have severe levels of SA, AV or intraventricular block.
• Wolff Parkinson White syndrome
• Stokes Adam syndrome

Canadian labeling: Additional contraindications not in US labeling

• Hypersensitivity to ester local anesthetics (paraben-containing only solutions)
• antimicrobial preservative-containing solutions should not be used intra-or retro-ocularly or for epidural or spinal anesthesia or any route that would introduce the solution into the cerebrospinal fluid or in doses >=15 mL for other types of blockades.

Warnings and precautions

• Infusion-related intra-articular chondrolysis

  • It is not recommended to continue intra-articular injections of local anesthetics following arthroscopic, or other surgical procedures.
  • Chondrolysis can be seen most commonly in the shoulder joint and requires arthroplasty or shoulder replacement.

• Methemoglobinemia:

  • Methemoglobinemia can be caused by local anesthetics. It can happen immediately after exposure or later.
  • The risk is increased in patients< 6 months of age,glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, exposure to oxidizing agents or their metabolites, therefore strict monitoring is required.
  • If there are clinical signs or symptoms, it is important to stop therapy immediately and get the necessary treatment.

• Hepatic dysfunction

  • Patients with severe hepatic dysfunction may be at greater risk of developing toxic effects from lidocaine. Therefore, it is important to exercise caution.

• Pseudocholinesterase deficiency:

  • Patients with pseudocholinesterase deficiencies may be at greater risk of toxicity from Lidocaine. Therefore, caution should be exercised.

Lidocaine (systemic): Drug Interaction

Risk Factor C (Monitor therapy)
Amiodarone	May increase the serum concentration of Lidocaine (Systemic).
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Beta-Blockers	May increase the serum concentration of Lidocaine (Systemic).
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Broccoli	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Cannabis	May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers).
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
CYP1A2 Inducers (Moderate)	May decrease the serum concentration of Lidocaine (Systemic).
CYP1A2 Inhibitors (Strong)	May increase the serum concentration of Lidocaine (Systemic).
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dapsone (Topical)	May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Disopyramide	May enhance the arrhythmogenic effect of Lidocaine (Systemic). Disopyramide may increase the serum concentration of Lidocaine (Systemic). Specifically, the unbound/free fraction of lidocaine.
Duvelisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Erdafitinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Etravirine	May decrease the serum concentration of Lidocaine (Systemic).
Fosaprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Hyaluronidase	May enhance the adverse/toxic effect of Local Anesthetics.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Lacosamide	Lidocaine (Systemic) may enhance the adverse/toxic effect of Lacosamide. Specifically the risk for bradycardia, ventricular tachyarrhythmias, or a prolonged PR interval may be increased.
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Local Anesthetics	Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased.
Methemoglobinemia Associated Agents	May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Neuromuscular-Blocking Agents	Local Anesthetics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents.
Nitric Oxide	May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia.
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Prilocaine	Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Simeprevir	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Sodium Nitrite	Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia.
Technetium Tc 99m Tilmanocept	Local Anesthetics may diminish the diagnostic effect of Technetium Tc 99m Tilmanocept. Management: Avoid mixing and simultaneously co-injecting technetium Tc 99m tilmanocept with local anesthetics. This interaction does not appear to apply to other uses of these agents in combination.
Tobacco (Smoked)	May decrease the serum concentration of Lidocaine (Systemic).
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Risk Factor D (Consider therapy modification)
Bupivacaine (Liposomal)	Lidocaine (Systemic) may enhance the adverse/toxic effect of Bupivacaine (Liposomal). Management: Liposomal bupivacaine should not be administered with topical lidocaine. Liposomal bupivacaine may be administered 20 minutes or more after the administration of lidocaine.
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inhibitors (Strong)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
Risk Factor X (Avoid combination)
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Saquinavir	May enhance the arrhythmogenic effect of Lidocaine (Systemic). Saquinavir may increase the serum concentration of Lidocaine (Systemic).

 

Monitoring parameters:

• ECG
• LFTs
• Lidocaine concentrations in patients requiring drug >24 hrs, consult individual institutional policies and procedures.

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How to administer Lidocaine?

• Intravenous:

  • Bolus:
    • Bolus should be given at a rate of 25 to 50 mg/minute as per manufacturer.
    • The rapid infusion can be given via a peripheral vein in the setting of cardiac arrest (eg, ventricular fibrillation or pulseless ventricular tachycardia).
  • Continuous infusion:
    • The continuous infusion can be given after initial bolus dosing, refer to indication-specific infusion rates in dosing for detailed recommendations.
    • Following the return of spontaneous circulation resulting from lidocaine administration during cardiac arrest,infusion can be started.
    • The evidence to support subsequent continuous infusion to prevent recurrence is not established.
    • Prolonged IV infusions are known to cause local thrombophlebitis.

• Endotracheal (off-label administration route):

  • It should be diluted in NS or sterile water for greater absorption and less impairment of PaO.
  • Compressions should be held and the drug should be quickly sprayed down the tube. Flush with 5 mL of NS and follow immediately with several quick insufflations and continue chest compressions.

• Intraosseous (IO; off-label administration route):

  • If IV access is not readily available,intraosseous administration is a reasonable alternative.

• Intravesical (off-label use):

  • Various regimens of alkalinized lidocaine (with or without heparin) have been instilled into the bladder.
• The On-Q® infusion pump is used to slowly administer local anesthetics (eg, bupivacaine, lidocaine, ropivacaine) to or around surgical wound sites and/or in close proximity to nerves for pre- or postoperative regional anesthesia.
• Chondrolysis can occur due to direct infusion into the shoulder.
• Therefore, On-Q® pumps should never be placed directly into any joint.

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Mechanism of action of Lidocaine (Lignocaine):

• Lidocaine is an antiarrhythmic of class Ib. 
• It increases the electrical stimulation threshold in the ventricle, His–Purkinje system, and spontaneously depolarizes the ventricles during diastole.
• This direct action on tissues results in suppressed automaticity.
• It reduces the neuronal membrane’s permeability for sodium ions, causing blockage in initiation and conduction nerve impulses, thereby inhibiting depolarization.

The onset of action:

• Single bolus dose: 45 to 90 seconds

Duration:

• 10 to 20 minutes

alterable by many patient factors; decreased in CHF and liver disease; crosses blood-brain barrier. Protein binding:

• 60% to 80% to alpha acid glycoprotein.

Metabolism:

• 90% hepatic;
• active metabolites monoethylglycinexylidide (MEGX) and glycinexylidide (GX) can accumulate and may cause CNS toxicity.

Half-life elimination:

• Biphasic: Prolonged with congestive heart failure, liver disease, shock, severe renal disease.
  • Initial: 7 to 30 minutes
  • Terminal: Infants, premature: 3.2 hours, Adults: 1.5 to 2 hours

Excretion:

• Urine (<10% as unchanged drug, ~90% as metabolites)

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International Brands of Lidocaine:

• P-Care X
• ReadySharp Lidocaine
• Xylocaine
• Xylocaine (Cardiac)
• Xylocaine-MPF
• Xylocaine Plain
• Xylocard
• Anocaine
• Chalocaine
• Dequaspray
• Dolocaine
• Ecocain
• Esracain
• Ke Ze Pu
• Lidocard
• Lignotox
• Lignox
• Locaine
• Locana
• Lox
• Lydocan
• Peterkaien
• Procomil
• Rapidocain
• Roxicaina
• Sensinal
• Sensinil
• Themicain
• Xilonest
• Xylo-Efa 10% Cardiologica
• Xylobex
• Xylocaine
• Xylocaine IV
• Xylocard
• Xylone

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Lignocaine Brands in Pakistan:

Lignocaine Injection 2 % w/w
Lignocain	Shifa Laboratories.(Pvt) Ltd.

 

Lignocaine Injection 10 Mg/Ml
Epocain	Epoch Pharmaceutical
Lacain	Pulse Pharmaceuticals
Lidex	Caraway Pharmaceuticals
Lidocaine	Amson Vaccines & Pharma (Pvt) Ltd.
Lignosel	Hansel Pharmacueutical Pvt (Ltd)
Locain	Saydon Pharmaceutical Industries (Pvt) Ltd.
Zecaine	Asian Agencies
Zylo	Crest Pharmaceuticals

 

Lignocaine Injection 20 Mg/Ml
Anacaine	Akson Pharmaceuticals (Pvt) Ltd.
Fist	Shaigan Pharmaceuticals (Pvt) Ltd
Km Lidocaine	Hoffman Health Pakistan Ltd.
Lacain	Pulse Pharmaceuticals
Licain	Epoch Pharmaceutical
Lidoject	Surge Laboratories (Pvt) Ltd.
Ligno Ans	Ipram International
Lignocain	Orient Laboratories
Lignocain	Orient Laboratories
Lignocaine	Elite Pharma
Lignocaine	Elite Pharma
Lignocaine	Elko Organization (Pvt) Ltd.
Lignol	Mass Pharma (Private) Limited
Ligocane	Global Pharmaceuticals
Ligocane	Global Pharmaceuticals
Mb-Cain	Multinational Buisness Link
Neusthetic	Neutro Pharma (Pvt) Ltd.
Xylex	Venus Pharma
Xylex	Venus Pharma
Xylocaine	Barrett Hodgson Pakistan (Pvt) Ltd.
Xylodos	Dosaco Laboratories

 

Lignocaine Solution 2 % W/V
Elkocaine	Elko Organization (Pvt) Ltd.

 

Lignocaine Solution 4 % W/V
Primadent Solution	Prime Labs. (Pvt) Ltd.
Xylocaine	Barrett Hodgson Pakistan (Pvt) Ltd.

 

Lignocaine Liquid 0.6 % W/V
Tripol	Davis Pharmaceutical Laboratories

 

Lignocaine Oint 5 % W/W
Xylocaine	Barrett Hodgson Pakistan (Pvt) Ltd.

 

Lignocaine Gel 2 % W/W
Anscon	Ophth-Pharma (Pvt) Ltd.
Grenocin	Gray`S Pharmaceuticals
Lignocaine	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Lignopar	Nimrall Laboratories
Lignozin	Trigon Pharmaceuticals Pakistan (Pvt) Ltd.
Logel	Elite Pharma
Primacaine	Prime Labs. (Pvt) Ltd.
Sylogel	Sapient Pharma
Xylocaine	Barrett Hodgson Pakistan (Pvt) Ltd.
Xylogel	Harmann Pharmaceutical Laboratories (Pvt) Ltd.
Zyocain	Pharmawise Labs. (Pvt) Ltd.

 

Lignocaine Gel 5 % W/W
Taufel	Lexicon Pharmaceuticals (Pvt) Ltd.

 

Lignocaine Gel 20 Mg/Ml
Lignocain	Safina Pharma (Pvt) Ltd