Dental injection side effects

Lidocaine injection

Generic Name: lidocaine injection (LYE doe kane)
Brand Name: UAD Caine, Xylocaine HCl, …show all 13 brand namesXylocaine-MPF, Lidoject 1, Xylocaine Dental Cartridges, Lidoject 2, Xylocaine Duo-Trach Kit, Xylocaine HCl For Spinal, L-Caine, Dilocaine, Nervocaine, Truxacaine, Anestacaine

Medically reviewed by on Jun 12, 2018 – Written by Cerner Multum

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What is lidocaine injection?

Lidocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body.

Lidocaine injection is used to numb an area of your body to help reduce pain or discomfort caused by invasive medical procedures such as surgery, needle punctures, or insertion of a catheter or breathing tube.

Lidocaine injection is sometimes used to treat irregular heart rhythms that may signal a possible heart attack.

Lidocaine injection is also given in an epidural (spinal block) to reduce the discomfort of contractions during labor.

Lidocaine injection may also be used for purposes not listed in this medication guide.

Important Information

You should not receive lidocaine injection if you have severe heart block, or a heart rhythm disorder called Stokes-Adams syndrome or Wolff-Parkinson-White Syndrome.

Before taking this medicine

You should not receive this medicine if you are allergic to lidocaine injection or any other type of numbing medicine, or if you have:

  • severe heart block;

  • a heart rhythm disorder called Stokes-Adams syndrome (sudden slow heart beats that can cause you to faint); or

  • a heart rhythm disorder called Wolff-Parkinson-White Syndrome (sudden fast heartbeats that can cause you to faint or become easily tired).

Tell your doctor if you have ever had:

  • an allergy to corn products;

  • liver disease;

  • kidney disease;

  • heart disease (unless you are being treated with lidocaine injection for a heart condition);

  • coronary artery disease, circulation problems; or

  • malignant hyperthermia.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

It may not be safe to breast-feed while using this medicine. Ask your doctor about any risk.

How is lidocaine injection given?

A healthcare provider will give you this injection.

When used to treat heart rhythm problems, lidocaine is given as an infusion into a vein.

When used as a local anesthetic, lidocaine is injected through the skin directly into the body area to be numbed.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving lidocaine injection in a hospital setting.

If you are being treated for irregular heart rhythm, your heart rate will be constantly monitored using an electrocardiograph or ECG (sometimes called an EKG). This will help your doctor determine how long to treat you with lidocaine injection.

What happens if I miss a dose?

Since lidocaine injection is used only when needed in a clinical setting, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid after receiving lidocaine injection?

Lidocaine injection can cause side effects that may impair your thinking or reactions. Unless absolutely necessary, do not drive after receiving lidocaine injection.

Avoid eating or chewing within 1 hour after lidocaine injection is used to numb your mouth or throat. You may have trouble swallowing which could lead to choking. You may also accidentally bite the inside of your mouth if you are still numb an hour after treatment with lidocaine injection.

Lidocaine injection side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Tell your caregiver right away if you have:

  • twitching, tremors, seizure (convulsions);

  • a light-headed feeling, like you might pass out;

  • slow heart rate, weak pulse, weak or shallow breathing;

  • sudden feeling of warmth with muscle stiffness and pain;

  • dark urine;

  • blue appearance of the skin; or

  • severe anxiety, unusual fear or uneasy feeling.

Common side effects may include:

  • drowsiness, dizziness;

  • vomiting;

  • feeling hot or cold;

  • confusion, ringing in your ears, blurred vision, double vision; or

  • numbness in places where the medicine is accidentally applied.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect lidocaine injection?

Tell your doctor about all your other medicines, especially:

  • cimetidine, fluvoxamine, nefazodone, St John’s wort;

  • antibiotic or antifungal medicine;

  • antiviral medicine to treat hepatitis or HIV/AIDS;

  • heart or blood pressure medicine–amiodarone, digoxin, nicardipine, procainamide, propranolol;

  • seizure medicine–carbamazepine, phenytoin; or

  • tuberculosis medicine–isoniazid, rifampin.

This list is not complete. Other drugs may affect lidocaine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 3.03.

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More about lidocaine

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  • During Pregnancy or Breastfeeding
  • Dosage Information
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  • Compare Alternatives
  • Support Group
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  • 9 Reviews
  • Drug class: group I antiarrhythmics
  • FDA Alerts (7)

Consumer resources

  • Lidocaine IV Solution
  • Lidocaine Injection Solution (Anesthetic)
  • Lidocaine Intradermal (Advanced Reading)

Other brands: UAD Caine, Xylocaine HCl

Professional resources

  • Lidocaine Hydrochloride (AHFS Monograph)
  • … +10 more

Related treatment guides

  • Arrhythmia
  • Ventricular Tachycardia
  • Anesthesia
  • Burning Mouth Syndrome
  • Costochondritis
  • Ventricular Fibrillation

Lidocaine injection

What is this medicine?

LIDOCAINE (LYE doe kane) is an anesthetic. It causes loss of feeling in the skin or other tissues. It is used to prevent and to treat pain from some procedures.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Xylocaine, Xylocaine MPF

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • infection

  • an unusual or allergic reaction to lidocaine, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

This medicine is for injection into the affected area. It is given by a health care professional in a hospital or clinic setting.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

  • dofetilide

  • MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate

This medicine may also interact with the following medications:

  • medicines for blood pressure, heart disease, or irregular heart beat

  • medicines for depression, anxiety, or psychotic disturbances

  • other anesthetics

  • phenytoin

  • procarbazine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine.

Be careful to avoid injury while the area is numb and you are not aware of pain.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • breathing problems

  • changes in vision

  • chest pain

  • feeling faint or lightheaded, falls

  • headache

  • seizures

  • slow, irregular heartbeat

  • trembling or shaking

  • unusually weak or tired

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • anxiety or nervousness

  • backache

  • feelings of cold, heat, or numb

  • irritation at site where injected

  • nausea, vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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What Are Some Possible Side Effects?

Generally, following the intravenous infusion of lidocaine, there are no side effects once the procedure has been completed. Because of the nature of this procedure, the maximum effects of the medicine are seen during the time you are being carefully observed by the physicians and staff of the Pain Management Center. Occasionally, patients do describe some peculiar feelings for hours following an intravenous lidocaine infusion. Such feelings can include, general fatigue, persistent dizziness or a headache.

All of these symptoms that have been previously reported, however, seem to dissapear within the first day following the procedure. While we would like to reassure you that such side effects are not dangerous, if you have concerns regarding any particular side effect, or potential complication to the lidocaine infusion that you received, we would appreciate you contacting the physicians and staff of the Pain Management Center to ask us specific questions.

What should I do if any problems develop after I leave the Pain Management Center?

Call the Pain Management Service at 650-723-6238 Monday through Friday, 9 a.m. – 5 p.m., or after hours dial the page operator at Stanford at 650-723-6661 and ask for the pain service physician on call.

Adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome

Sir, Fibromyalgia is poorly understood in neurobiological terms, with no general agreement about its aetiology and pathogenesis. The symmetry of the condition leads to the hypothesis of a central nervous system disturbance . In neuropathic pain states, it has been shown that inhibition of the pain pathway can be achieved by systemic administration of local anaesthetics such as intravenous lignocaine .

On this basis, intravenous lignocaine is also used for the management of the pain of fibomyalgia , particularly in patients who have not responded to more traditional therapeutic measures, such as physical therapy, analgesics and/or tricyclic antidepressants. The doses of lignocaine used range from 5 to 7 mg/kg by infusion over a period from 2 to 6 h. Such doses may be associated with adverse effects, particularly those of cardiac and neurological origin. Such side‐effects have been described but not quantified in a group of patients with neuropathic pain . No study has addressed the safety of intravenous lignocaine therapy in patients with fibromyalgia.

We have conducted a prospective study of the nature and incidence of adverse effects of intravenous lignocaine therapy in a group of 110 patients with fibromyalgia having this therapy at our unit over a 6‐month period. All patients fulfilled classification criteria for fibromyalgia and had not achieved sufficient symptom relief using the more ‘traditional’ modes of treatment, either in the rheumatology or pain relief departments. The patients’ nurses completed a questionnaire addressing any side‐effects noted at the time of treatment. One hundred and six usable questionnaires were returned (96%) and adverse events were computed by a third party, not working on the ward. No patient was treated more than once in the study period. The mean (range) age of this sample was 51.4 (29–74) yr; 88 of the 106 patients were female (83%); 72 had primary fibromyalgia (68%) and the remainder had fibromyalgia secondary to osteoarthritis.

The intravenous infusion of lignocaine was given only to patients with normal electrocardiographic conduction and normal serum electrolyte concentrations, to minimize the risk of cardiac dysrhythmias. Patients had continuous electrocardiographic monitoring and measurements of pulse and blood pressure every 15 min by an automated device during infusion. They were kept under close observation by nursing staff taught to detect symptoms and signs of neurological side‐effects, such as tinnitus and tunnel vision. Serial infusions of intravenous lignocaine were given for six consecutive days. They were started at 5 mg/kg minus 100 mg and increased by 50 mg per day to 5 mg/kg plus 150 mg provided the maximum was no greater than 550 mg. The lignocaine was infused in 500 ml Hartman solution over 6 h. The infusion rate was reduced if there was bradycardia, tachycardia, hypotension, headaches, dizziness, arrythmias or tunnel vision. If slowing the infusion failed to correct these, the infusion was stopped.

There were 44 incidences of side‐effects (42%), of which two were serious (Table 1). The commonest side‐effect was hypotension, which required slowing or stopping of infusion; no incidence of hypotension required any other active measures. The most serious side‐effects were supraventricular tachycardia requiring pharmacological treatment and a case of pulmonary oedema requiring diuresis. The miscellaneous group included an infected cannula site, tissue infusion and reaction to ECG electrode pads. None had long‐term sequelae.

This prospective study suggests that intravenous lignocaine therapy in fibromyalgia is associated commonly with adverse effects that are mostly not serious and require no intervention other than reducing or stopping the infusion. However, potentially serious side‐effects requiring pharmacological intervention may occur rarely and are cardiovascular in origin. We suggest that cardiovascular monitoring of ECG and heart rate are prudent in order to prevent more serious sequelae, and that intravenous lignocaine for fibromyalgia should be delivered only in centres with relevant expertise. The benefits and side‐effects of this therapy should also be further assessed in prospective controlled trials, in order to judge whether any benefits offset the risk associated with it.

Table 1.

Side‐effects of intravenous lignocaine (n=106)

Side‐effect No. of incidents
Hypotension 17
Hypertension 5
Tachycardia 1
Arrythmia (SVT) 1
Pulmonary oedema 1
Headache 8
Nausea 1
Abdominal pain 1
Increased joint pain 1
Chest pain 1
Miscellaneous 7
Side‐effect No. of incidents
Hypotension 17
Hypertension 5
Tachycardia 1
Arrythmia (SVT) 1
Pulmonary oedema 1
Headache 8
Nausea 1
Abdominal pain 1
Increased joint pain 1
Chest pain 1
Miscellaneous 7

SVT, supraventricular tachycardia.

Table 1.

Side‐effects of intravenous lignocaine (n=106)

Side‐effect No. of incidents
Hypotension 17
Hypertension 5
Tachycardia 1
Arrythmia (SVT) 1
Pulmonary oedema 1
Headache 8
Nausea 1
Abdominal pain 1
Increased joint pain 1
Chest pain 1
Miscellaneous 7
Side‐effect No. of incidents
Hypotension 17
Hypertension 5
Tachycardia 1
Arrythmia (SVT) 1
Pulmonary oedema 1
Headache 8
Nausea 1
Abdominal pain 1
Increased joint pain 1
Chest pain 1
Miscellaneous 7

SVT, supraventricular tachycardia.

1 Cohen ML, Quinter JL. Fibromyalgia syndrome: a problem of tautology. Lancet 1993;342:906–8. 2 Kastrup J, Peteren P, Dejgard A, Angelo HR, Hilsted J. Intravenous lidocaine infusion—a new treatment of chronic painful diabetic neuropathy. Pain 1987;28:69–75. 3 Rowbotham MC, Reisner‐Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology 1991;41:1024–8. 4 Sorenson J, Bengtsson A, Backman E, Henriksson KG, Bengtsson M. Pain analysis in patients with fibromyalgia. Effects of intravenous morphine, lidocaine and ketamine. Scand J Rheumatol 1995;24:360–5. 5 Bennett MI, Tai YM. Intravenous lignocaine in the management of primary fibromyalgia syndrome. Int J Clin Pharmacol Res 1995;15:115–9. 6 Edwards WT, Habib F, Burney RG, Begin G. Intravenous lidocaine in the management of various chronic pain states: a review of 211 cases. Reg Anaesth 1985;10:1–6. 7 Wolfe F, Smythe HA, Yunus MB et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72. © British Society for Rheumatology

FDA continues to monitor reports of toxicity with the use of prescription oral viscous lidocaine and over-the-counter (OTC) benzocaine to treat teething pain in infants and young children.

A search of FDA’s Adverse Event Reporting System (FAERS) database and the medical literature through December 2013 identified 22 cases of toxicity with the use of prescription oral viscous lidocaine 2 percent solution in infants and young children 5 months to 3.5 years of age. Fifteen cases were identified in FAERS and seven additional cases were noted in the literature.2-7

Of the 22 cases, 6 cases resulted in death, 3 were categorized as life-threatening, 11 required hospitalization, and 2 required medical intervention without hospitalization.

The root cause of the overdose in 7 of the 22 cases was the administration technique by caregivers, who did not follow prescriber directions for application of the product or gave additional doses beyond what was prescribed. Accidental ingestion occurred in seven additional cases, and four cases involved overdose due to a prescribing error. The root cause of the error could not be identified in the remaining four cases.

Of the 22 cases, multiple doses of lidocaine taken prior to the onset of the adverse event occurred in 11 cases. In six cases, the toxicity manifested following the accidental ingestion of a single dose. In five cases, it was not reported whether a single dose or multiple doses were taken prior to the onset of symptoms.

Viscous lidocaine solution continues to be dispensed for infants and young children 2 years and younger (see Table). In 2012, infants and young children 2 years and younger accounted for approximately 4 percent of all patients who received dispensed prescriptions in the outpatient retail setting for oral viscous lidocaine solution. The number of patients aged 2 years and younger decreased by approximately 28 percent between 2008 and 2012 as shown in the following table:8

Nationally estimated number of total patients and patients aged 0-2 years receiving dispensed prescriptions for lidocaine 2 percent oral viscous products from U.S. outpatient retail pharmacies8

Source: IMS Health, Vector One®: Total Patient Tracker (TPT). Years 2008-2012. Data extracted December 2013.

On April 7, 2011, FDA issued a Drug Safety Communication (DSC) warning that use of OTC benzocaine gels and liquids applied to the gums or mouth to reduce pain was associated with methemoglobinemia, mainly in children aged two years and younger. Since the issuance of that DSC, FDA has received reports of 6 new cases of methemoglobinemia in infants and young children, 2 years and younger, associated with OTC benzocaine gels and liquids, bringing the total to 27 cases. Hospitalization was required in all six new methemoglobinemia cases, and three were categorized as life-threatening. No new cases were identified in the literature.

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