What is the recommended dose of lidocaine (Lidocaine) IV infusion for treating arrhythmias, specifically ventricular arrhythmias?

From the Guidelines

For treating ventricular arrhythmias, the recommended lidocaine IV infusion is typically 1-4 mg/min (or 20-50 mcg/kg/min) following an initial loading dose of 1-1.5 mg/kg, as supported by the most recent guidelines 1. The loading dose can be repeated at 5-10 minute intervals if needed, up to a maximum total dose of 3 mg/kg. The maintenance infusion should be adjusted based on the patient's response and continued for 24-48 hours after arrhythmia suppression. Key considerations include:

• Lidocaine dosing should be reduced in patients with heart failure, liver disease, or those over 70 years of age, as these conditions can affect drug metabolism and increase the risk of toxicity 1.
• The drug works by blocking sodium channels in cardiac tissue, which decreases the excitability of ventricular cells and suppresses abnormal automaticity.
• It's essential to monitor for signs of toxicity, including confusion, seizures, and bradycardia, and to maintain serum lidocaine levels between 1.5-5 mcg/mL for therapeutic effect without toxicity.
• Lidocaine should be administered with continuous cardiac monitoring and where resuscitation equipment is available, emphasizing the need for careful patient supervision during treatment 1. Overall, the use of lidocaine in ventricular arrhythmias is guided by its efficacy in suppressing abnormal heart rhythms while minimizing the risk of adverse effects, as outlined in clinical guidelines and supported by studies such as those referenced here 1.

From the Research

Recommended Dose of Lidocaine IV Infusion for Arrhythmias

The recommended dose of lidocaine IV infusion for treating arrhythmias, specifically ventricular arrhythmias, can be found in several studies:

• A study published in 1992 2 administered intravenous lidocaine as a 1-mg/kg bolus, a 0.5-mg/kg bolus, and a 2.8-mg/min constant infusion for 48 hours to patients with acute-onset and chronic ventricular arrhythmias.
• Another study from 1983 3 suggested the administration of prophylactic lidocaine through intravenous loading doses followed by a constant lidocaine infusion for patients with ventricular arrhythmia.
• A 2011 study 4 used lidocaine with an IV bolus of 2.5 mg/kg and a 2.5 mg/kg/hr infusion to reduce ischemia/reperfusion-induced arrhythmias.

Key Findings

Key findings from these studies include:

• The efficacy and safety of intravenous lidocaine compared to other antiarrhythmic agents, such as tocainide 5.
• The importance of monitoring lidocaine plasma concentrations to avoid toxicity, as seen in a case report from 2009 6.
• The comparison of lidocaine to other antiarrhythmic agents, such as ranolazine, in reducing ischemia/reperfusion-induced arrhythmias 4.

Dosage Considerations

When considering the dosage of lidocaine IV infusion, it is essential to take into account factors such as:

• The patient's weight, as the dosage is often calculated based on body weight 2, 4.
• The severity and type of arrhythmia being treated 5, 3.
• The risk of lidocaine toxicity, particularly in patients with hepatic dysfunction, cardiac dysfunction, advanced age, or other drug administration 6.