Brand names: Xylocaine, Xylocaine Dental
Drug class: Local Anesthetics

Medically reviewed by Drugs.com on Jan 22, 2024. Written by ASHP.

Introduction

Intermediate-acting local anesthetic (amide type).^{211 213 214 a}

Uses for Lidocaine (Local)

Local or Regional Anesthesia

Local or regional anesthesia in surgical procedures (including oral surgery), diagnostic and therapeutic procedures, and obstetrical procedures.^{211 213 214}

Lidocaine (Local) Dosage and Administration

General

• Determine dosage based on type and extent of surgical procedure, area to be anesthetized, vascularity of tissues, depth and duration of anesthesia, degree of muscular relaxation, and condition of the patient.^{211 213} Use lowest concentration and smallest dose required to produce the desired effect.^{211 213 214}

Administration

Injection

For solution and drug compatibility information, see Compatibility under Stability.

Administer by local infiltration, peripheral nerve block, paracervical block, sympathetic nerve block, central neural block (e.g., epidural block), caudal block, or subarachnoid (spinal) block.^{211 213 214} Has been administered by continuous intra-articular infusion^{† [off-label]} (e.g., for control of postoperative pain); however, such use associated with chondrolysis.^{200 201 202 203 204 205 206 207 208 209 211 212} (See Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics under Cautions.)

Consult specialized references for specific techniques and procedures for administering local anesthetics.^{211 213 214}

For IV regional anesthesia, use 50-mL single-dose vials containing lidocaine hydrochloride 0.5% only.²¹¹

For paracervical block, inject slowly; allow a 5-minute interval between sides.²¹¹

For caudal or lumbar epidural block, avoid rapid injection of large volumes; when feasible, administer in fractional (incremental) doses.²¹¹

For epidural or spinal block, avoid using preparations containing antimicrobial preservatives (e.g., methylparaben), since safety of intrathecal administration using these preparations not established.²¹¹

For spinal block, inject slowly.²¹⁴

Aspirate prior to injections to avoid inadvertent intravascular administration.^{211 212 213 214}

For dental anesthesia, lidocaine hydrochloride 2% solution with epinephrine 1:100,000 preferred for most routine procedures; when greater depth and a more pronounced hemostasis are required, use preparation containing epinephrine 1:50,000.²¹³

For chemical disinfection of container surface, moisten cotton or gauze with isopropyl (rubbing) alcohol (91%) or ethyl alcohol (70%) and wipe surface thoroughly just prior to use.^{211 213} Do not use alcohol brands that are not of USP grade, since these preparations may contain denaturants that may be injurious to rubber.^{211 213}

Dilution

Dilute with 0.9% sodium chloride injection to obtain desired concentration.²¹¹

Dosage

Available as lidocaine hydrochloride, as fixed combination containing lidocaine hydrochloride and epinephrine bitartrate or epinephrine hydrochloride, and as lidocaine hydrochloride in dextrose injection.^{211 213 214} Dosage expressed in terms of lidocaine hydrochloride.^{211 213 214}

When larger dosages (volumes) are required, use preparations containing epinephrine (unless contraindicated).²¹¹

Pediatric Patients

Local or Regional Anesthesia

Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block

Use lower dosages than those suggested for healthy adults (see Adults under Dosage and Administration).²¹¹

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

Children <10 years of age: 18–20 mg (0.9–1 mL) of lidocaine hydrochloride 2% solution is adequate for a procedure involving 1 tooth (local infiltration), 2–3 teeth (maxillary infiltration), or teeth in an entire quadrant (mandibular block).²¹³

Adults

Local or Regional Anesthesia

Local Infiltration

Percutaneous: 5–300 mg (1–60 mL) of lidocaine hydrochloride 0.5 or 1% solution (without epinephrine).²¹¹

IV regional: 50–300 mg (10–60 mL) of lidocaine hydrochloride 0.5% solution (without epinephrine).²¹¹

Peripheral Nerve Block

Brachial: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).²¹¹

Dental: 20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution (without epinephrine).²¹¹

Intercostal: 30 mg (3 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Paravertebral: 30–50 mg (3–5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Pudendal: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).²¹¹

Paracervical Block

Obstetrical analgesia: 100 mg (10 mL) of lidocaine hydrochloride 1% solution (without epinephrine) on each side (for a total dose of 200 mg).²¹¹

Sympathetic Nerve Block

Cervical (stellate ganglion): 50 mg (5 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Lumbar: 50–100 mg (5–10 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Retrobulbar Block

120–200 mg (3–5 mL) or 1.7–3 mg/kg of lidocaine hydrochloride 4% solution is suggested; a portion of the dose is injected retrobulbarly and the remainder may be used to block the facial nerve.²¹²

Transtracheal Injection

80–120 mg (2–3 mL) of lidocaine hydrochloride 4% solution is administered rapidly.²¹²

If both transtracheal injection and topical application (oropharyngeal spray) are needed to achieve complete analgesia, combined total dose from transtracheal injection and oropharyngeal spray should be ≤200 mg (5 mL) of 4% solution or ≤3 mg/kg.²¹²

Central Neural Block

Prior to lumbar epidural block, administer test dose to detect accidental intravascular injection.²¹¹ Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.²¹¹ Repeat test dose if patient is moved in a manner that could displace catheter.²¹¹

Thoracic epidural: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹ Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).²¹¹

Lumbar epidural (for analgesia): 250–300 mg (25–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Lumbar epidural (for anesthesia): 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine) or 200–300 mg (10–15 mL) of lidocaine hydrochloride 2% solution (without epinephrine).²¹¹ Dosage is determined by number of dermatomes to be anesthetized (generally 2–3 mL per dermatome).²¹¹

Caudal Block

Prior to caudal block, administer test dose to detect accidental intravascular injection.²¹¹ Test doses containing 10–15 mcg epinephrine and 30–45 mg (2–3 mL) of 1.5% lidocaine hydrochloride have been suggested.²¹¹ Repeat test dose if patient is moved in a manner that could displace catheter.²¹¹

Obstetrical analgesia: 200–300 mg (20–30 mL) of lidocaine hydrochloride 1% solution (without epinephrine).²¹¹

Surgical anesthesia: 225–300 mg (15–20 mL) of lidocaine hydrochloride 1.5% solution (without epinephrine).²¹¹

Subarachnoid (Spinal) Block

Vaginal delivery: Approximately 50 mg (1 mL) of lidocaine hydrochloride 5% in dextrose 7.5% injection.²¹⁴

Cesarean section or delivery requiring intrauterine manipulations: 75 mg (1.5 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.²¹⁴

Surgical anesthesia (abdominal): 75–100 mg (1.5–2 mL) of lidocaine hydrochloride 5% in dextrose 7.5%.²¹⁴

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

20–100 mg (1–5 mL) of lidocaine hydrochloride 2% solution with epinephrine 1:50,000 or 1:100,000.²¹³

Prescribing Limits

Pediatric Patients

Local or Regional Anesthesia

Local Infiltration, Peripheral/Sympathetic Nerve Block, Epidural/Caudal Block

For children >3 years of age with normal lean body mass and normal development, maximum dose is determined by child’s age and weight.²¹¹ For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).²¹¹ For IV regional anesthesia, maximum 3 mg/kg (1.4 mg/lb), using more dilute solutions (e.g., lidocaine hydrochloride 0.25 or 0.5% solution).²¹¹ (See Dilution under Dosage and Administration: Administration.)

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

For children <10 years of age with normal lean body mass and normal development, maximum dose is determined by using standard pediatric drug formulas (e.g., Clark’s rule).²¹³ For example, dosage for a 5-year old child weighing 50 lbs should not exceed 75–100 mg (3.3–4.4 mg/kg or 1.5–2 mg/lb).²¹³

Maximum 4.5 mg/kg (2 mg/lb) of body weight (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (with epinephrine).²¹³

Adults

Local or Regional Anesthesia

Local Infiltration, Peripheral/Sympathetic Nerve Block

Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 300 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 500 mg) (with epinephrine).²¹¹

IV regional: Maximum 4 mg/kg.²¹¹

Paracervical Block

Obstetric or nonobstetric use: Maximum 200 mg (100 mg each side) per 90-minute period.²¹¹

Continuous Epidural/Caudal Block

Maximum recommended dosage should not be administered at intervals of <90 minutes.²¹¹

Subarachnoid (Spinal) Block

Dosages >100 mg not required if technique and needle placement are correct.²¹⁴

Anesthesia in Maxillary and Mandibular Area (for oral surgery)

Maximum 4.5 mg/kg (2 mg/lb) of body weight (up to 500 mg) (without epinephrine) or 7 mg/kg (3.2 mg/lb) of body weight (up to 300 mg) (with epinephrine).²¹³

Special Populations

Hepatic Impairment

Reduce dosage in patients with hepatic impairment.²¹¹

Geriatric Patients

Reduce dosage in geriatric patients.^{211 212 213 214}

Other Populations

Reduce dosage in patients with cardiac disease, debilitated patients, and acutely ill patients.^{211 212 213 214}

Related/similar drugs

amiodarone, lidocaine, fentanyl, verapamil, flecainide, ketamine, hyoscyamine

Cautions for Lidocaine (Local)

Contraindications

• Contraindications to spinal anesthesia: severe hemorrhage, shock, heart block, local infection at site of proposed puncture, and septicemia.²¹⁴

• Known hypersensitivity to local anesthetics of the amide type or to any ingredient in the formulation.^{211 213 214}

Warnings/Precautions

Warnings

Experience of Supervising Clinician

Should be used only by clinicians who are sufficiently knowledgeable in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise. ^{211 212 213 214} Oxygen, resuscitative equipment, drugs, and personnel required for treatment of adverse reactions must be immediately available.^{211 212 213 214} Delay in proper management of dose-related toxicity, underventilation, and/or altered sensitivity may result in acidosis, cardiac arrest, and, possibly, death.^{211 212 213 214}

Risk of Chondrolysis Associated with Intra-articular Infusions of Local Anesthetics

Chondrolysis (necrosis and destruction of articular cartilage) reported in patients receiving continuous intra-articular infusions of local anesthetics, administered for 48–72 hours via elastomeric infusion devices, for treatment of postoperative pain.^{200 201 202 203 204 205 206 207 208 209 211 212} Primarily observed in the shoulder joint following arthroscopic or other shoulder surgery.^{200 211 212} May result in long-term disability; often requires intervention (e.g., debridement, arthroplasty).^{200 202 203 204 205 206 209 211 212} Not known whether the drug, infusion device, and/or other factors contributed to the development of chondrolysis.^{200 201} Neither local anesthetics nor elastomeric infusion devices are approved for use for continuous intra-articular infusion therapy.^{200 201 211 212}

Accidental Intravascular Injection

Accidental intravascular injection may result in confusion, seizures, CNS excitement and/or depression, myocardial depression, coma, and/or respiratory arrest.^{211 213 214} (See Nervous System Effects and also see Cardiovascular Effects, under Cautions.)

Aspirate prior to administration to guard against intravascular injection.^{211 212 213 214}

Injection During Uterine Contractions

Do not inject spinal anesthetics during uterine contractions, since spinal fluid current may carry drug further cephalad than desired.²¹⁴

Epinephrine Administration

Some lidocaine hydrochloride preparations contain epinephrine, which may cause ischemic injury or necrosis.^{211 213} Consider usual precautions associated with epinephrine administration.^{211 213} (See Cardiovascular Effects under Cautions.)

Sensitivity Reactions

Hypersensitivity Reactions and Cross Hypersensitivity

Possible cutaneous lesions, urticaria, edema, or anaphylactoid reactions.^{211 213 214}

No cross hypersensitivity reported in patients allergic to para-aminobenzoic derivatives (e.g., benzocaine, procaine [no longer commercially available in the US], tetracaine).^{211 213 214}

Use with caution in patients with known drug sensitivities.^{211 213 214}

Sulfite Sensitivity

Some epinephrine-containing lidocaine preparations contain sodium metabisulfite, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.^{211 213}

General Precautions

Nervous System Effects

Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse CNS effects (e.g., lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, seizures, unconsciousness, respiratory arrest).^{211 214} Carefully monitor level of consciousness after each local anesthetic injection.^{211 213 214}

Spinal anesthesia may be associated with adverse neurologic effects (e.g., loss of perineal sensation and sexual function, persistent anesthesia, paresthesia, weakness and paralysis of the lower extremities, headache).²¹⁴

Risk of nerve injury with use of small-bore needles and microcatheters for spinal anesthesia; possibly a result of drug pooling and inconsistent distribution of concentrated anesthetic within the subarachnoid space.²¹⁴ If an incomplete or patchy block occurs and is not responsive to patient repositioning, the drug may be missplaced or inadequately distributed.²¹⁴ Use of a spinal needle of sufficient gauge may facilitate intrathecal distribution; in clinical trials, 22- and 25-gauge spinal needles were used safely for single-injection lidocaine spinal anesthesia.²¹⁴ Animal studies suggest that dilution of 5% lidocaine hydrochloride with an equal volume of CSF or preservative-free 0.9% sodium chloride may decrease risk of nerve injury from pooling of concentrated drug.²¹⁴

Cardiovascular Effects

Toxic plasma concentrations of local anesthetics (resulting from systemic absorption) associated with adverse cardiovascular effects (e.g., bradycardia, hypotension, and cardiovascular collapse, cardiac arrest).^{211 213 214} Carefully monitor cardiovascular and respiratory vital signs after each local anesthetic injection.^{211 213 214}

Use with caution in patients with impaired cardiovascular function, severe shock, or heart block.^{211 213 214}

Some lidocaine hydrochloride preparations contain epinephrine; risk of exaggerated vasoconstrictor response in patients with peripheral or hypertensive vascular disease.^{211 213} Use with caution and in carefully restricted quantities in areas of the body supplied by end arteries or having otherwise compromised blood supply (e.g., digits, nose, external ear, penis).^{211 213}

Familial Malignant Hyperthermia

Many drugs used during the conduct of anesthesia may trigger familial malignant hyperthermia; not known whether amide-type local anesthetics trigger this reaction.^{211 213 214} However, standard protocol for management should be available.^{211 213 214} Early unexplained signs of tachycardia, tachypnea, labile BP, and metabolic acidosis may precede temperature elevation.^{211 213 214} If familial malignant hyperthermia is confirmed, discontinue triggering agent and initiate appropriate therapy (e.g., oxygen, dantrolene) and other supportive measures.^{211 213 214}

Preexisting Conditions

Employ lumbar epidural and caudal block with extreme caution in patients with preexisting neurological disease, spinal deformities, septicemia, and severe hypertension.²¹¹

Conditions that may preclude the use of spinal anesthesia (depending upon the clinician’s evaluation of the situation and ability to manage potential complications) include preexisting CNS disease (e.g., disease associated with pernicious anemia, poliomyelitis, paralysis from nerve injuries and syphilis); hematological disorders predisposing to coagulopathies; current anticoagulant therapy; chronic backache; preoperative headache; hypotension or hypertension; technical problems (persistent paresthesias, persistent bloody spinal tap); arthritis or spinal deformity; extremes of age; and psychosis or other causes of poor patient cooperation.²¹⁴

Risks Associated with Various Administration Techniques

Paracervical block: Possible rapid systemic absorption.²¹¹ Maternal seizures and cardiovascular collapse reported following paracervical block with certain local anesthetics (used to induce anesthesia for elective abortion).²¹¹ Administer dose slowly; do not exceed recommended maximum dose.²¹¹ (See Administration and see Prescribing Limits, under Dosage and Administration and also see Labor and Delivery under Cautions.)

Retrobulbar block: Possible permanent injury to extraocular muscles requiring surgical repair.^{211 213}

Serious Adverse Effects Associated with Local Anesthetics

Risk of serious adverse effects (e.g., seizures, coma, irregular heart beat, respiratory depression) with use of topical local anesthetics; generally reported following application of extemporaneously prepared topical preparations containing high concentrations of anesthetics.^e

Potential for life-threatening adverse effects (e.g., irregular heart beat, seizures, breathing difficulties, coma, death) when topical local anesthetics are applied to a large area of skin, when the area of application is covered with an occlusive dressing, if a large amount of topical anesthetic is applied, if the anesthetic is applied to irritated or broken skin, or if the skin temperature increases (from exercise or use of a heating pad).^{101 102}

Lidocaine 4% gel has been investigated to reduce discomfort during mammography.^{101 103} Whether such use could result in serious reactions has not been determined.^{101 103} Patients should speak with their clinician if they are considering using a topical anesthetic before obtaining a mammogram.¹⁰¹

When a topical anesthetic is needed for a procedure, use of an FDA-approved preparation has been recommended.^e Use a preparation containing the lowest concentration of anesthetic likely to be effective; apply a small amount of the preparation to the affected area for the shortest period necessary for the desired effect, and do not apply to broken or irritated skin.¹⁰¹

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category B.^{211 213 214}

Labor and Delivery

Maternal hypotension reported.^{211 214} To prevent decreases in BP, elevate patient’s legs and position patient on her left side.^{211 214} Monitor fetal heart rate continuously; electronic fetal monitoring highly advisable.^{211 214}

Accidental intravascular or fetal intracranial injection following paracervical and/or may result in unexplained neonatal depression at birth or seizures within 6 hours after birth.²¹¹

Paracervical block may decrease duration of first stage labor and facilitate cervical dilation.^{211 214} Possible fetal bradycardia and acidosis; always monitor fetal heart rate.²¹¹ For paracervical block in prematurity, toxemia of pregnancy, or presence of fetal distress, weigh benefit of therapy versus risk.²¹¹

Epidural and spinal anesthesia may prolong second stage of labor (by removing parturient’s reflex urge to bear down or by interfering with motor function); may increase need for forceps assistance.^{211 214}

Possible diminished muscle strength and tone on neonate’s first or second day of life.²¹¹

Lactation

Not known whether lidocaine is distributed into milk.^{211 213 214} Caution if used in nursing women.^{211 213 214}

Pediatric Use

Safety and efficacy of lidocaine hydrochloride in dextrose injection not established in pediatric patients <16 years of age.²¹⁴

Geriatric Use

Dosage reduction recommended.^{211 213 214}

Hepatic Impairment

Possible increased risk of toxicity, particularly in patients with severe hepatic impairment.^{211 213 214} Use with caution.^{211 214} Dosage adjustments recommended.²¹¹

Common Adverse Effects

Adverse nervous system and cardiovascular effects.^{211 213 214} (See Nervous System Effects and Cardiovascular Effects, under Cautions.)

Spinal block: Positional headache, hypotension, backache, shivering.^{211 214}

Drug Interactions

Consider usual drug interactions associated with epinephrine administration.^{211 213 214}

Specific Drugs and Laboratory Tests

Lidocaine (Local) Pharmacokinetics

Absorption

Bioavailability

Systemic absorption dependent upon route of administration, administration site, and presence or absence of epinephrine in formulation.^{211 213 214} Except for intravascular administration, intercostal nerve block results in highest blood levels, and sub-Q administration results in lowest blood levels.^{211 213 214}

Possible accumulation with repeated dosing.^{211 213 214}

Onset

More rapid onset of anesthesia compared with procaine hydrochloride (no longer commercially available in the US).^a

For dental anesthesia, onset <2 minutes following infiltration with 2% solution (with or without epinephrine).²¹³ Onset of 2–4 minutes following nerve block with 2% solution (with or without epinephrine).²¹³

Duration

Longer duration of anesthesia compared with procaine hydrochloride.^a

Duration of about 100 minutes following lumbar epidural block with 2% solution.^a

Duration of about 75–135 minutes following caudal block with 1 or 2% solution.^a

Following spinal block with 50 mg (1 mL) of 5% solution, duration of perineal anesthesia is about 100 minutes; analgesic effects continue for another 40 minutes.²¹⁴ Duration of surgical anesthesia is about 2 hours with 75–100 mg (1.5–2 mL) of 5% solution.²¹⁴

For dental anesthesia, pulp anesthesia persists for 5 minutes following infiltration with 2% solution without epinephrine.²¹³ Pulp anesthesia persists for at least 60 minutes following infiltration with 2% solution with epinephrine; average duration of soft tissue anesthesia is approximately 2.5 hours.²¹³ Following nerve block with the 2% solution with epinephrine, pulp anesthesia persists for at least 90 minutes, and soft tissue anesthesia persists for 3.25 hours.²¹³

Distribution

Extent

Crosses blood-brain and placental barriers.^{211 213 214}

Plasma Protein Binding

Protein binding dependent upon drug concentration and concentration of α-1-acid glycoprotein; fraction bound decreases with increasing drug concentration.^{211 213 214} At concentrations of 1–4 mcg/mL, 60–80% of drug is bound.^{211 213 214}

Elimination

Metabolism

Systemically absorbed lidocaine is rapidly metabolized in the liver.^{211 213 214}

Pharmacological or toxicological effects of metabolites are similar to but less potent than those of parent drug.^{211 213 214}

Elimination Route

Excreted principally in urine as metabolites (90%) and small amounts (<10%) of unchanged drug.^{211 213 214}

Half-life

1.5–2 hours following IV injection.^{211 213 214}

Special Populations

Prolonged half-life in patients with hepatic dysfunction.^{211 213}

Increased accumulation of metabolites in patients with renal impairment.^{211 213}

Stability

Storage

Parenteral

Injection

Room temperature (approximately 20–25°C).^{211 213 214} Protect epinephrine-containing solutions from light.^{211 213}

Compatibility

Parenteral

Syringe CompatibilityHID

With epinephrine HCl 1:80,000, 1:100,000, 1:200,000 added.

Actions

• Local anesthetics block the generation and conduction of nerve impulses by increasing the threshold for electrical excitation, slowing the propagation of the nerve impulse, and reducing the rate of rise of the action potential.^{211 213 214}

• Some preparations formulated with epinephrine to decrease lidocaine’s rate and extent of systemic absorption and to prolong its duration of action.^{a 211 213}

• Has intermediate duration of action.^a

Advice to Patients

• Prior to administration, advise patients of the possibility of temporary loss of sensation and muscle function (e.g., in lower half of body following lumbar epidural or subarachnoid block).^{211 213 214}

• Advise patients to avoid inadvertent trauma to the lips, tongue, cheek mucosae, or soft palate when these structures are anesthetized for dental procedures; postpone ingestion of food until normal function returns.²¹³ Advise patient to consult dentist if anesthesia persists or if rash develops.²¹³

• Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., cardiovascular or liver disease).^{211 213 214}

• Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.^{211 213 214}

• Importance of informing patients of other important precautionary information. ^{211 213 214} (See Cautions.)

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

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Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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