What is the preparation method for a gastrointestinal (GI) cocktail using viscous lidocaine (lidocaine hydrochloride)?

From the Guidelines

To prepare a GI cocktail with viscous lidocaine, mix 10-15 mL of viscous lidocaine 2%, 10-15 mL of liquid antacid, and 10-15 mL of diphenhydramine liquid (12.5 mg/5 mL) in a medication cup, creating a 30-45 mL mixture for temporary relief of gastrointestinal discomfort. This mixture is typically used for conditions like dyspepsia, gastritis, or esophagitis, and should be swished in the mouth before swallowing to maximize the topical effect on the esophagus 1. The viscous lidocaine provides local anesthesia to the esophageal and gastric mucosa, the antacid neutralizes stomach acid, and diphenhydramine adds an anticholinergic effect that may help reduce spasms. Some key points to consider when administering this cocktail include:

• The potential for viscous lidocaine to suppress the gag reflex, so patients should avoid eating or drinking for 30-60 minutes after administration to prevent aspiration
• The need for cautious use in elderly patients and those with cardiac conditions due to potential systemic absorption of lidocaine
• The importance of monitoring patients for any adverse effects, such as allergic reactions or worsening of symptoms. It's also important to note that relief of chest pain by the administration of a GI cocktail does not predict the absence of acute coronary syndrome (ACS) 1. Therefore, patients with chest pain should still be evaluated for ACS, even if their symptoms are relieved by the GI cocktail.

From the FDA Drug Label

Adult: The maximum recommended single dose of Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% for healthy adults should be such that the dose of lidocaine HCI does not exceed 4. 5 mg/kg or 2 mg/lb body weight and does not in any case exceed a total of 300 mg. For symptomatic treatment of irritated or inflamed mucous membranes of the mouth and pharynx, the usual adult dose is one 15 mL tablespoonful undiluted. The FDA drug label does not answer the question.

From the Research

Ingredients for a GI Cocktail with Viscous Lidocaine

• 30 cc of Maalox (antacid) 2, 3
• 10 cc of Donnatal (anticholinergic) 2
• Viscous lidocaine (topical anesthetic) 2, 4, 3

Preparation and Administration

• The GI cocktail can be prepared by mixing the ingredients together 2, 3
• The mixture can be administered orally, with the patient swallowing the mixture 2, 3
• The viscous lidocaine can be added to the mixture to provide topical anesthesia 2, 3

Efficacy of the GI Cocktail

• The GI cocktail has been shown to provide significant pain relief in patients with dyspepsia 2, 3
• The addition of viscous lidocaine to the antacid has been shown to provide greater pain relief than antacid alone 3
• The GI cocktail has also been used to treat other conditions, such as abdominal pain and chest pain 5

Potential Interactions

• The administration of antacids, such as Maalox, can interfere with the absorption of certain medications, such as moxifloxacin 6
• The viscous lidocaine can be administered as a swish and swallow, swish and spit, or by application with a swab 4