From the Guidelines
For ventricular tachycardia (VT), the recommended dose of lidocaine is an initial IV bolus of 1.0 to 1.5 mg/kg, followed by additional boluses of 0.5 to 0.75 mg/kg if required. The most recent and highest quality study 1 supports this dosing regimen, which prioritizes patient safety through weight-based dosing. Key points to consider when administering lidocaine for VT include:
- Initial dose: 1.0 to 1.5 mg/kg IV
- Additional doses: 0.5 to 0.75 mg/kg IV if required
- Maintenance infusion: 1 to 4 mg/min (20-50 mcg/kg/min) as needed
- Dose adjustments: necessary for patients with heart failure, liver disease, or those over 70 years old - reduce the dose by 50% in these populations
- Monitoring: for side effects including CNS toxicity (confusion, seizures), hypotension, and bradycardia
- Caution: when using lidocaine in patients with severe liver disease, heart block, or severe heart failure. Lidocaine works by blocking sodium channels in cardiac tissue, which stabilizes cell membranes and suppresses abnormal automaticity, making it a useful treatment option for VT associated with acute myocardial ischemia or infarction.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dose of Lidocaine for Ventricular Tachycardia (VT)
- The dose of lidocaine for VT is typically administered intravenously, with a dose of 1.5 mg/kg in 2 minutes, as seen in a study comparing procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia 2.
- Another study used 2 boluses of 100 mg lidocaine followed by a 24-hour infusion for the treatment of shock-resistant VT 3.
- A study evaluating the efficacy of intravenous lidocaine for the termination of sustained monomorphic ventricular tachycardia in patients with coronary artery disease used a mean dose of lidocaine, but the exact dose was not specified 4.
- The dosage of lidocaine was not consistently reported across studies, but it is generally administered in a bolus dose followed by an infusion.
Efficacy of Lidocaine for VT
- Lidocaine has been shown to be less effective than procainamide in terminating sustained monomorphic ventricular tachycardia, with a termination rate of 6 of 31 VTs compared to 38 of 48 VTs for procainamide 2.
- A study comparing intravenous lidocaine versus intravenous amiodarone for incessant ventricular tachycardia found that lidocaine had a 91% drug failure rate, whereas amiodarone had a 33% drug failure rate 3.
- Lidocaine was found to be ineffective in terminating stable VT not associated with acute myocardial infarction, with a response rate of only 8% 4.
- The efficacy of lidocaine for VT may vary depending on the specific patient population and clinical context, as seen in a study evaluating antiarrhythmic drug therapy for sustained ventricular arrhythmias complicating acute myocardial infarction 5.