Lidocaine

Drug Levels and Effects:




Summary of Use during Lactation:


Lidocaine concentrations in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Lidocaine is not expected to cause any adverse effects in breastfed infants. No special precautions are required.[1][2][3]


Drug Levels:


Maternal Levels.A nursing mother who was 10 months postpartum was given intravenous lidocaine 75 mg, then 50 mg 5 minutes later, concurrent with starting a continuous lidocaine infusion at a rate of 2 mg/minute. After 7 hours the infusion was stopped a milk sample was provided. The breastmilk contained 800 mcg/L of lidocaine; metabolites were not measured.[1]

A woman received 20 mg of lidocaine with 5 mg of epinephrine (2 mL of a 2% lidocaine with 0.5% epinephrine) injected for a dental procedure 3 days postpartum. Milk levels 2 hours after the injection were 66 mcg/L of lidocaine and 35 mcg/L of its MEGX metabolite. At 6.5 hours after the dose, the levels were 44 mcg/L and 41 mcg/L, respectively.[4]

Twenty-two women received epidural lidocaine 2% andbupivacaine0.5% for pain control during cesarean delivery. Lidocaine dosage averaged 183 mg (range 60 to 500 mg). Average milk lidocaine concentrations were 860 mcg/L at 2 hours after delivery, 460 mcg/L at 4 hours after delivery and 220 mcg/L at 12 hours after delivery.[2]

A woman undergoing tumescent liposuction received 4.2 g of lidocaine into her fat. Seventeen hours after the procedure, a milk lidocaine level was 550 mcg/L. It was previously shown that maximum serum lidocaine concentrations occur at about this time.[3]

Six women were given 3.6 mL of lidocaine 2% without epinephrine and a seventh received lidocaine 2% without epinephrine 4.5 mL and 7.2 mL on 2 separate occasions for dental procedures. Milk lidocaine concentrations averaged 120.5 mcg/L at 3 hours after the dose and 58.3 mcg/L 6 hours after the dose. Milk MEGX levels were 97.5 and 52.7 mcg/L at 3 and 6 hours after the dose, respectively.[5] Using the average daily intake reported in this study, an exclusively breastfed infant would receive 0.9% of the maternal weight-adjusted dosage of lidocaine and another 0.8% in the form of the metabolite MEGX.

Infant Levels.Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:
Lidocaine in doses ranging from 60 to 500 mg administered to the mother by intrapleural or epidural routes during delivery had no effect on their 14 infants who were either breastfed or received their mother's breastmilk by bottle.[2]


Possible Effects on Lactation:
Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:
Bupivacaine,Ropivacaine


References:
1. Zeisler JA, Gaarder TD, De Mesquita SA. Lidocaine excretion in breast milk. Drug Intell Clin Pharm. 1986;20:691-3. PMID:3757781
2. Ortega D, Viviand X et al. Excretion of lidocaine andbupivacainein breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999;43:394-7. PMID:10225071
3. Dryden RM, Lo MW. Breast milk lidocaine levels in tumescent liposuction. Plast Reconstr Surg. 2000;105:2267-8. Letter. PMID:10839430
4. Lebedevs TH, Wojnar-Horton RE et al. Excretion of lignocaine and its metabolite monoethylglycinexylidide in breast milk following its use in a dental procedure. A case report. J Clin Peridontol. 1993;20:606-8. PMID:8408724
5. Giuliani M, Grossi GB et al. Could local anesthesia while breast-feeding be harmful to infants? J Pediatric Gastroenterol Nutr. 2001;32:142-4. PMID:11321382



Substance Identification:




Substance Name:Lidocaine

CAS Registry Number:137-58-6

Drug Class:
Antiarrhythmics
Local Anesthetics

Administrative Information:




LactMed Record Number:
363


Last Revision Date:
20120503

Disclaimer:Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.