Lidocaine Infusion Management for Acute Ventricular Tachycardia

Timing and Dose Reduction

The American College of Cardiology recommends administering an initial IV bolus of 1 mg/kg, not to exceed 100 mg, for ventricular tachycardia treatment 5, 6
Additional bolus injections of 0.5 mg/kg can be given every 8-10 minutes if necessary, to a total maximum of 4 mg/kg, as per the American College of Cardiology guidelines 5, 6
In cardiac arrest with VF/VT, only bolus therapy should be used (100 mg initially), which may be repeated every 2-3 minutes as needed, according to the American College of Cardiology 6, 7

The standard maintenance infusion dose is 20-50 μg/kg/min (1.4-3.5 mg/min in a 70 kg patient), as recommended by the American College of Cardiology 5, 6
Higher maintenance doses (40-50 μg/kg/min) may be required for patients who needed more than one bolus dose to suppress arrhythmias, according to the American College of Cardiology guidelines 5, 6

For hemodynamically stable VT, the American College of Cardiology recommends beginning with a standard loading dose followed by maintenance infusion 8
For unstable VT, the American College of Cardiology suggests considering immediate cardioversion first; lidocaine can be used if the patient is somewhat stable 8
For VT resistant to defibrillation, the American College of Cardiology indicates that lidocaine is part of the treatment algorithm 5, 6

The American College of Cardiology recommends reducing infusion rates in patients over 70 years of age, patients with congestive heart failure or cardiogenic shock, patients with hepatic dysfunction, patients with severe renal dysfunction, and patients with preexisting neurologic dysfunction 6, 7, 9

The half-life of lidocaine increases after 24-48 hours of infusion, as noted by the American College of Cardiology 6
The American College of Cardiology recommends reducing the dose by 1 mg/min preferably at 12 hours but at least by 24 hours 6
Monitoring for subtherapeutic plasma concentrations should occur at 30-120 minutes after initiation, according to the American College of Cardiology 6

The American College of Cardiology advises monitoring for CNS symptoms such as nausea, drowsiness, perioral numbness, dizziness, confusion, slurred speech, muscle twitching, respiratory depression, double vision, tremor, and altered consciousness 6, 7
The American College of Cardiology also recommends watching for cardiovascular effects like bradycardia, sinus arrest, and hypotension 6, 7

The American College of Cardiology notes that increasing maintenance infusion without an additional bolus results in a very slow increase in plasma concentration (>6 hours to reach new plateau) 6
The American College of Cardiology advises avoiding prophylactic use beyond 24 hours unless specifically indicated 6