Lidocaine Dosage Guidelines for Patients with Heart Problems

General Dosing Guidelines

The American Academy of Pediatrics recommends that the maximum dose of lidocaine as a local anesthetic should not exceed 4.4 mg/kg without epinephrine in patients with heart problems 1, 2
The maximum dose with epinephrine is 7.0 mg/kg in patients without severe cardiac dysfunction 1, 2
For intravenous administration in cardiac arrhythmias, an initial bolus of 1 mg/kg (not exceeding 100 mg) is recommended by the American College of Cardiology 3, 5
Maintenance infusion should be 20-50 μg/kg/min (1.4-3.5 mg/min in a 70 kg patient) 3, 5

Patients with myocardial infarction, heart failure, or cardiogenic shock require significant dose reductions due to altered pharmacokinetics, as recommended by the American College of Cardiology 3, 4
In patients with cardiac failure, lidocaine's half-life increases to >20 hours (compared to 1-2 hours in normal subjects) 3
In cardiogenic shock, the half-life is even longer, requiring appropriate reduction in dosing 3, 4

Monitor for cardiac toxicity signs: bradycardia, hypotension, sinus arrest, as recommended by the American College of Cardiology 3, 4
For lidocaine toxicity in cardiac patients, administer 1.5 mL/kg 20% lipid emulsion over ~1 minute 2
Avoid vasopressin, calcium channel blockers, and β-blockers in treatment of toxicity 2

Using standard doses in patients with heart failure or cardiogenic shock (requires significant reduction) 3, 4
Failure to calculate the maximum allowable safe dosage before administration 1, 2
Not recognizing enhanced sedative effects when combining local anesthetics with other sedatives or opioids 1, 2