Indications & Dose: LOCAL ANESTHESIA Adult Percutaneous infiltration anesthesia: 5-300mg (1-60 mL of 0.5% solution or 0.5 to 30 mL of 1% solution), epidural anesthesia: 225-300mg (15-20 mL, 1.5% solution) or 200-300mg (10-15mL, 2% solution), thoracic epidural anesthesia:200-300mg (20-30 mL, 1% solution), brachial plexus block: 225-300mg (15-20 mL, 1.5% solution), intercostal nerve block: 30 mg (3mL, 1% solution), paracervical block: 100mg (10 mL, 1% solution) on each side may be repeated not more frequently than every 90 min, paravertebral block: 30-50mg (3-5 mL, 1% solution), pudendal block: 100 mg (10 mL, 1% solution) on each side, retrobulbar block: 120-200mg (3-5 mL, 4% ), cervical block: 50mg (5 mL, 1% solution), lumbar block: 50-100mg (5-10 mL, 1% solution) Child Infiltration anesthesia: Inj: Neonate-12 yrs (according to nature of procedure): Up to 3mg/kg (0.3 mL/kg, 1% solution), repeated not more often than q4h, 12-18 yrs (according to weight of child & nature of procedure) max 200mg, repeated not more often than q4h | POSTHERPETIC NEURALGIA TP Adult Patch: Apply patch to most painful area. Up to 3 patches may be applied in a single application. Patch(es) may remain in place for up to 12h in any 24h period | PULSELESS VENTRICULAR TACHYCARDIA Adult Intratracheal: Loading dose only: 2-3.75mg/kg dilute in 5-10 mL NS or sterile water Child Intratracheal: 2-3mg/kg flush with 5 mL of NS & follow with 5 assisted manual ventilations | IV/IO Adult Initially 1-1.5 mg/kg, if refractory VF/pulseless VT occur, repeat 0.5-0.75 mg/kg bolus q5-10min, max cumulative dose 3mg/kg, then continuous infusion 1-4mg/min after return of perfusion. Reappearance of arrhythmia during constant inf 0.5 mg/kg bolus & reassessment of infusion Child Loading dose: 1mg/kg, may administer second bolus 0.5-1 mg/kg if delay between bolus & start of infusion is >15 min, then continuous infusion 20-50µg/kg/minIf amiodarone is not available; give after defibrillation attempts, CPR, and epinephrine | REGIONAL ANESTHESIA IV Adult 50-300mg without adrenaline (10-60 mL, 0.5% solution), max 4mg/kg | SPINAL ANESTHESIA Adult During labor for normal vaginal delivery: 50mg (1 mL, 5% solution) or 9-15mg (0.6-1 mL, 1.5% solution), caesarean section: Upto 75mg (1.5 mL, 5% solution), other surgical procedures: 75-100mg (1.5-2 mL, 5% solution)given with glucose solution (7.5%) | SURFACE ANESTHESIA TP Adult Skin & mucous membranes: Ointment max 20 g of 5% ointment in 24h, Urinary tract: gel 2% females 60 -100mg inserted into the urethra several minutes before examination, males 200mg instilled initially followed by 60 -100mg, Mucous membranes of mouth, throat & upper GIT: 300mg (15mL, 2% solution) may be rinsed & ejected and for pharyngeal pain the solution is gargled and swallowed if necessary, Dentistry & otorhinolaryngology procedures: 40-300mg (1-7.5 mL, 4% solution) or 10-50mg (10%), max 200mg/day, Laryngotracheal anesthesia: 160mg as 4% solution is sprayed/instilled as single dose into the lumen of the larynx & trachea. For procedures requiring needle puncture, surgical treatment of localised lesions, split skin grafting: Cream: lidocaine base 2.5% with prilocaine base 2.5% is applied beneath occlusive dressing prior to surgery, Warts: Cream: lidocaine base 2.5% with prilocaine base 2.5% is applied before removing warts, Major aphthae in immunocompromised: 20-30mg (1% gel) or 40-60mg (2% gel) | VENTRICULAR FIBRILLATION Adult Intratracheal: Loading dose: 2-3.75 mg/kg dilute in 5-10 mL NS or sterile water Child Intratracheal: 2-3 mg/kg flush with 5 mL of NS & follow with 5 assisted manual ventilations | IV/IO Adult Initially 1-1.5 mg/kg, if refractory VF/pulseless VT occur, repeat 0.5-0.75 mg/kg bolus q5-10 min, max cumulative dose 3mg/kg, then continuous infusion 1-4 mg/minute after return of perfusion. Reappearance of arrhythmia during constant inf 0.5 mg/kg bolus & reassessment of inf Child Loading dose: 1mg/kg , may administer second bolus 0.5-1 mg/kg if delay between bolus & start of infusion is >15 min , then continuous infusion 20-50µg/kg/min | VENTRICULAR TACHYCARDIA IV Adult 1-1.5 mg/kg, repeat with 0.5-0.75 mg/kg q5-10 min as necessary, max dose 3mg/kg, then continuous inf 1-4mg/min or 30-50µg/kg/minHemodynamically stable monomorphic

Precautions: CHF, bradycardia, respiratory depression, hepatic impairment, pseudocholinesterase deficiency

ADR: Serious: hypersensitivity reactions, corneal damage, myocardial depression, blurred vision, tinnitus, Hypotension, bradycardia, arrhythmias, cardiac arrest, Others: idiosyncrasy, restlessness, excitement, nervousness, paresthesias, dizziness, muscle twitching, tremors, convulsions, numbness of tongue, sedation, nausea, vomiting

DDI: Serious β-blockers causes additive cardiac depressant effects of drug, Midazolam/Barbiturates decreases drug levels, HIV protease inhibitors/Erythromycin/Itraconazole/Propranolol increases drug levels, Mexiletine increases drug toxicity, Phenytoin increases incidence of central toxic adverse effects, Propafenone increases severity, duration of CNS adverse effects of drug, Suxamethonium neuromuscular blockade increased & prolonged by drug