Viscous Lidocaine 2% Mucosal Use Instructions
For mucosal surface application, prescribe viscous lidocaine 2% solution at 15 mL per application, instructing patients to swish and spit (not swallow), used as needed up to every 3 hours, particularly before meals, with strict avoidance of eating or drinking for 30 minutes after application. 1
Standard Dosing and Administration
- Volume per application: 15 mL of 2% viscous lidocaine solution 1, 2
- Application technique: Swish in mouth for 1-2 minutes, then spit out—do not swallow 1, 2
- Frequency: Apply as needed, up to every 3 hours 1, 3
- Timing: Particularly useful before meals to facilitate eating 1, 4
- Post-application restriction: No food or drink for 30 minutes after use for maximum effectiveness 1, 2
Critical Safety Considerations and Maximum Dosing
The maximum daily dose must not exceed 9 mg/kg lean body weight total lidocaine per day from all sources. 1 For practical purposes:
- A 70 kg patient using 2% lidocaine should not exceed approximately 31.5 mL maximum per day 1
- Calculate dose based on lean body weight, not actual body weight 1
- Avoid prescribing for patients <40 kg without careful dose adjustment 1
- Warn patients explicitly about swallowing: viscous lidocaine should be spit out, not swallowed, to minimize systemic absorption and risk of toxicity 1
Monitoring for Toxicity
Watch for early signs of local anesthetic toxicity: 1
- Tingling of tongue or lips
- Light-headedness or dizziness
- Tinnitus (ringing in ears)
- Slurred speech
- Muscle twitching
If any of these symptoms occur, discontinue use immediately and seek medical attention. 1
Special Populations and Precautions
Pediatric Considerations
- Avoid use in children under 12 years unless specifically directed by a physician 3
- Pediatric patients have altered pharmacokinetics with increased absorption, decreased clearance, and prolonged half-life, making standard adult doses potentially toxic 5
- If absolutely necessary in children, provide very specific instructions regarding amount, frequency, maximum daily dose, and mode of administration—never prescribe on a "PRN" basis 5
General Precautions
- Avoid applying excessive doses to mucosal surfaces where systemic uptake and possible toxicity (seizures, methemoglobinemia) could result 6
- Remain within manufacturer's recommendations regarding allowable surface area application 6
- Avoid concurrent use of other local anesthetics 1
Alternative Formulations and Adjunctive Options
For refractory or severe cases, consider: 1
- Combination formulation: viscous lidocaine 2% plus nystatin oral suspension and sodium bicarbonate
- Benzydamine hydrochloride rinse every 3 hours for enhanced pain control 2, 4
Common Pitfalls to Avoid
- Do not prescribe with vague "use as needed" instructions—specify exact volume, frequency, and maximum daily dose 5
- Do not allow patients to swallow the solution—emphasize the swish-and-spit technique 1
- Do not exceed maximum daily dosing—calculate based on lean body weight and account for all lidocaine sources 1
- Do not use on large areas or for prolonged periods without medical supervision 3