Pre-term new born infants born before the 37th full week of pregnancy.
4.4 Special warnings and precautions for use In acute inflammation of the middle ear when puncturing the eardrum is necessary, or in other surgical procedures in the auditory canal or inner ear, as there is a risk of damage to the inner ear.
Extensive use should be avoided in patients with serious underlying conditions; in particular impairment of cardiac conduction, non-compensated cardiac insufficiency or cardiogenic or hypovolaemic shock. Patients treated with antiarrhythmics class I and III (e.g. tocainide, mexiletine and amiodarone) should be closely supervised and ECG monitoring should be considered, as the cardiac effects of lidocaine and these antiarrhythmics can be additive.
There are currently no clinical studies of Lidokain Isdin in the treatment of wounds, mucous membranes and skin areas of atopic dermatitis. Lidokain Isdin should therefore only be used on undamaged skin.
Lidokain Isdin should be used with caution near the eyes, as lidocaine may cause eye irritation. In addition, with the loss of protective reflexes, corneal irritation or grazes may occur. If Lidokain Isdin comes into contact with the eyes, they should be rinsed immediately with water or sodium chloride solution and protected until sensation returns.
In order to prevent reduced efficacy of live vaccines, such as BCG, vaccines should not be administered in areas where Lidokain Isdin has already been applied.
Due to an increased risk of high plasma concentrations of lidocaine, Lidokain Isdin should be used with caution in patients with severe hepatic impairment.
Frequent use of high doses of lidocaine is not recommended.
Lidokain Isdin contains propylene glycol, which may cause skin irritations.
4.5 Interaction with other medicinal products and other forms of interaction Increased systemic toxicity should be taken into account if Lidokain Isdin is coadministered with lidocaine therapy given in high doses, as well as other local anaesthetics or substances with similar structure (e.g. class I antiarrhythmic agents such as tocainide and mexiletine).
Specific interaction studies of local anaesthetics and antiarrhythmic active substances class III (e.g. amiodarone) have not been performed but caution is advised.
4.6 Pregnancy and lactation Pregnancy
There are no adequate data of pregnant women treated with Lidokain Isdin. Animal studies are incomplete in regard to pregnancy, embryonic/foetal development, delivery and postnatal development (see section 5.3). Lidocaine crosses the placenta barrier and may be absorbed in amniotic fluid. The risk to humans is not known. With temporary use of Lidokain Isdin during pregnancy, the benefit is considered to outweigh the possible risks. The lowest possible dose of Lidokain Isdin should be used for the shortest possible time during pregnancy.
Lidocaine is excreted in breast milk in small quantities. It is thought unlikely, however, that Lidokain Isdin affects the child. Breast feeding can therefore continue during treatment.
4.7 Effects on ability to drive and use machines Lidokain Isdin has no influence on the ability to drive and use machines.
4.8 Undesirable effects Skin and subcutaneous tissue disorders:
Uncommon (≥1/1000 to <1/100)
Local skin reactions, such as pallor and redness in the treated area. These symptoms are caused by a direct effect of the local anaesthetic on the blood vessels and are usually transient and mild.
Allergic reactions (in severe cases, anaphylactic shock) to
- local anaesthetic of amide type
- hydrogenated soy lecithin
4.9 Overdose Systemic toxicity is extreme unlikely with normal use of Lidokain Isdin. However, if signs of an overdose are observed, it is to be expected that the symptoms are similar to those described for other local anaesthetics e.g. excitatory CNS symptoms and, in severe cases, CNS depression and myocardial depression. Topical administration of 8.6 – 17.2 mg/kg of lidocaine caused very severe intoxication in small children.
If signs of acute systemic toxicity should occur, administration of the local anaesthetic should be discontinued immediately. Severe neurological reactions (convulsions, CNS depression) require symptomatic treatment such as respiratory supportive and anticonvulsive therapy. In regard to chronic systemic absorption, a patient with symptoms of toxicity should be observed for several hours after treatment of these symptoms.
Accidental oral intake of the cream by children may cause toxic symptoms, depending on the dose.
There is no specific antidote for lidocaine.
Lidokain Isdin is a local anaesthetic for surface anaesthesia of the skin in topical surgical procedures.
The active substance, lidocaine, is a local anaesthetic of the amide type. Topical anaesthesia occurs after application through the release of lidocaine in the skin's epidermal and dermal layers, near the pain receptors in the skin and nerve endings. Blocking of the sodium ion channels subsequently occurs, preventing initiation and conduction of the nerve impulse.
The degree of anaesthesia depends on the application time and dose.
Lidokain Isdin causes a transient local peripheral vasoconstriction or vasodilatation in the treated area of skin.
Lidocaine has bactericidal and virus suppressing properties in concentrations above 0.5 – 2 %.
5.2 Pharmacokinetic properties There are no data on the bioavailability of lidocaine in Lidokain Isdin. The systemic absorption depends on the amount of cream, application time, skin thickness (varies in different parts of the body) and the general condition of the skin.
Absorption of lidocaine after application of Lidokain Isdin on intact skin is very low and increased absorption can therefore be expected after application on mucous membrane of previously damaged skin. There are also insufficient data on the use of Lidokain Isdin on wounds and mucous membranes.
In studies in which Lidokain Isdin was used in children of different ages (3-15 years), the plasma levels of the active substance were very low (0.3 micrograms/ml or less). This was well below toxic plasma levels of the active substance. There are no pharmacokinetics data for Lidokain Isdin in children under 2 years.
The plasma elimination half life of lidocaine is 1.5 – 2 hours after absorption from the tissues.
The distribution volume is 1.5 l/kg and the plasma protein binding is approx. 65 %.
90 – 95 % is metabolised in the liver to the main metabolite 4-hydroxy-2,6-dimethylaniline. The amount of formed 2,6-xylidine, the intermediate metabolite, has not been established. 5 – 10 % of the dose is excreted renally in unchanged form.
The elimination half life in patients with renal insufficiency is 2 – 3 hours and accumulation of active metabolites may occur. In hepatic impairment, the rate of metabolism may decrease from half to 1/10 of the normal.
5.3 Preclinical safety data Reproduction toxicology
In studies of embryonic/foetal development in which rats or rabbits were dosed during organ development, no teratogenic effects were observed. Embryotoxicity was seen in rabbits at a dose toxic to the mother. In rats, reduced postnatal survival was seen in the young of mothers treated during late pregnancy and lactation with doses which were toxic and influenced the length of the pregnancy.
Genotoxicity and carcinogenicity
Genotoxic studies of lidocaine were negative. 2,6-xylidine, a metabolite of lidocaine has, however, shown genotoxic potential in vitro. In a carcinogenicity study of rats exposed in utero, postnatally and throughout life to 2,6-xylidine, tumours were observed in the nasal cavity, the liver and subcutaneously. High doses of 2,6-xylidine were needed to induce tumours in animal studies. The clinical relevance of the tumour inducing effect of this lidocaine metabolite after intermittent use as a local anaesthetic is unknown.
6. PHARMACEUTICAL PARTICULARS 6.1 List of excipients Purified water
Hydrogenated soy lecithin
6.2 Incompatibilities Not applicable.
6.3 Shelf life 30 months
After first opening: 6 months
6.4 Special precautions for storage Do not store above 30C.