XYLOCAINE 1.5% W EPINEPHRINE 1:200000 TEST DOSE 5 MCG — DIN 00753149

What is XYLOCAINE 1.5% W EPINEPHRINE 1:200000 TEST DOSE?

XYLOCAINE 1.5% W EPINEPHRINE 1:200000 TEST DOSE 5 MCG contains EPINEPHRINE (EPINEPHRINE BITARTRATE) : 5 MCG LIDOCAINE HYDROCHLORIDE : 15 MG. It is listed in the Health Canada Drug Product Database under DIN 00753149, held by ASTRAZENECA CANADA INC, supplied as LIQUID for EPIDURAL administration. Health Canada currently lists it as cancelled post market, status dated 20-Jun-2014. This Drug Identification Number is no longer authorized for sale in Canada, so Nexara does not supply it. The record is kept here because buyers still meet the number on old formularies, purchase orders and tender documents; Nexara can help identify an authorized alternative.

What is XYLOCAINE 1.5% W EPINEPHRINE 1:200000 TEST DOSE used for?

XYLOCAINE Parenteral Solutions (lidocaine hydrochloride) are indicated for production of local or regional anesthesia by: • infiltration techniques including percutaneous injection, • peripheral nerve block techniques such as brachial plexus and intercostal blocks, and • central neural techniques including epidural and caudal blocks.

Authorized indication as written in the Health Canada product monograph. For healthcare professionals and licensed purchasers; this is not medical advice.

How is it administered?

LOCAL ANESTHETICS SHOULD ONLY BE EMPLOYED BY CLINICIANS WHO ARE WELL VERSED IN DIAGNOSIS AND MANAGEMENT OF DOSE-RELATED TOXICITY AND OTHER ACUTE EMERGENCIES. The lowest dosage of local anesthetic that results in effective anesthesia or analgesia should be used to avoid high plasma levels and serious adverse reactions. Injections should be made slowly or in incremental doses, with frequent aspirations before and during the injection to avoid intravascular injection. XYLOCAINE Parenteral Solutions (lidocaine hydrochloride) should only be used by or under the supervision of clinicians experienced in regional anesthesia. Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration, whenever solution and container permit. Solutions which are discoloured or which contain particulate matter should not be administered. Recommended doses serve only as a guide to the amount of anesthetic required for most routine procedures. The actual volumes and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. The lowest concentration of anesthetic and the lowest dosage needed to provide effective anesthesia should be administered. The rapid injection of a large volume of local anesthetic solution should be avoided and fractional doses should be used when feasible. The use of lidocaine with epinephrine will prolong the anesthetic action. When XYLOCAINE Parenteral Solutions are used concomitantly with other products containing lidocaine, the total dose contributed by all formulations must be kept in mind. Preservative containing solutions (i.e. those supplied in multidose vials) should not be used for epidural or spinal anesthesia or for any route of administration that would introduce solution into the cerebrospinal fluid. Local anesthetic solutions containing antimicrobial preservatives solutions should not be administered intra-ocularly or retro-ocularly. These solutions should not be used in doses greater than 15 mL for other types of blockades. For adults, refer to Table 2 for specific dosage recommendations for various types of anesthetic procedures. For children, the dosage should be calculated on a weight basis up to 5 mg/kg. With the addition of epinephrine, up to 7 mg/kg can be used. Individual variations occur. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on the ideal body weight. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements. The main dose should be injected slowly at a rate of 100-200 mg/min, or in incremental doses, while keeping in constant verbal contact with the patient. If toxic symptoms occur, the injection should be stopped immediately.

Included because it drives pack selection and wastage. Consult the monograph.

Contraindications

XYLOCAINE Parenteral Solutions (lidocaine hydrochloride) are contraindicated in: • patients with a known history of hypersensitivity to local anesthetics of the amide type or to other components of the solution (see DOSAGE FORMS, COMPOSITION AND PACKAGING). • Patients with a known history of hypersensitivity to sodium metabisulfite and/or citric acid (stabilizers used in solutions containing epinephrine). • Patients with a known history of hypersensitivity to methylparaben and/or propylparaben (preservatives used in multidose solutions), or to their metabolite para amino benzoic acid (PABA). Solutions of lidocaine containing parabens should also be avoided in patients with a history of allergic reactions to ester local anesthetics, which are metabolized to PABA. XYLOCAINE Parenteral Solutions containing antimicrobial preservatives (e.g. methylparaben) should not be used for epidural or spinal anesthesia, or for any route of administration that would introduce solution into the cerebrospinal fluid because the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental. These solutions should not be administered intra-ocularly or retro-ocularly. XYLOCAINE Parenteral Solutions containing antimicrobial preservatives should not be used in doses greater than 15 mL for other types of blockades.

Warnings and precautions

LOCAL ANESTHETICS SHOULD ONLY BE EMPLOYED BY CLINICIANS WHO ARE WELL VERSED IN DIAGNOSIS AND MANAGEMENT OF DOSE-RELATED TOXICITY AND OTHER ACUTE EMERGENCIES THAT MIGHT ARISE FROM THE BLOCK TO BE EMPLOYED AND THEN ONLY AFTER ENSURING THE IMMEDIATE AVAILABILITY OF OXYGEN, OTHER RESUSCITATIVE DRUGS, CARDIOPULMONARY EQUIPMENT AND THE PERSONNEL NEEDED FOR PROPER MANAGEMENT OF TOXIC REACTIONS AND RELATED EMERGENCIES. DELAY IN PROPER MANAGEMENT OF DOSE-RELATED TOXICITY, UNDERVENTILATION FROM ANY CAUSE, AND/OR ALTERED SENSITIVITY MAY LEAD TO THE DEVELOPMENT OF ACIDOSIS, CARDIAC ARREST AND POSSIBLY, DEATH. AN INTRAVENOUS CANNULA MUST BE INSERTED BEFORE THE LOCAL ANESTHETIC IS INJECTED FOR NERVE BLOCKS WHICH MAY RESULT IN HYPOTENSION OR BRADYCARDIA, OR WHERE ACUTE SYSTEMIC TOXICITY MAY DEVELOP FOLLOWING INADVERTENT INTRAVASCULAR INJECTION. THE LOWEST DOSAGE OF LOCAL ANESTHETIC THAT RESULTS IN EFFECTIVE ANESTHESIA OR ANALGESIA SHOULD BE USED TO AVOID HIGH PLASMA LEVELS AND SERIOUS ADVERSE REACTIONS. INJECTIONS SHOULD BE MADE SLOWLY OR IN INCREMENTAL DOSES, WITH FREQUENT ASPIRATIONS BEFORE AND DURING THE INJECTION TO AVOID INTRAVASCULAR INJECTION. Reports of Irreversible Chondrolysis with Intra-articular Infusions of Local Anesthetics Following Surgery: Intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have been post-marketing reports of irreversible chondrolysis in patients receiving such infusions. XYLOCAINE should not be used for post-operative intra-articular infusion. Major Peripheral Nerve Blocks: May imply administration of large volume of local anesthetic in areas of high vascularity, often close to large vessels where there is an increased risk of intravascular injection and/or rapid systemic absorption which can lead to high plasma concentrations. Repeat Dosing: Repeated doses may cause significant increases in blood levels due to slow accumulation. Use of Parenteral Solutions Containing Epinephrine: Should not be used in areas of the body supplied by end arteries, such as digits, nose, ears or penis, or otherwise having a compromised blood supply. Inflammation and Sepsis: Local anesthetic procedures should not be used when there is inflammation and/or sepsis in the region of the proposed injection. Malignant Hyperthermia: While amide local anesthetics are safe in malignant hyperthermia patients, a standard protocol for management should be available. Acute Porphyria: Only use in patients with acute porphyria when no safer alternative is available. Cardiovascular: Use with caution in patients with bradycardia or impaired cardiovascular function, partial or complete heart block, severe shock, severe hypertension (for lumbar and caudal epidural anesthesia), and hypovolemia (for central nerve blocks). Solutions containing epinephrine should be used with caution in patients with untreated hypertension, ischemic heart disease, heart block, cerebral vascular insufficiency, peripheral vascular disorder, and any other pathological condition that may be aggravated by the effects of epinephrine. Patients treated with antiarrhythmic drugs (e.g., amiodarone, mexiletine) should be under close surveillance and ECG monitoring. Peri-Operative Considerations: Aspiration for blood or cerebrospinal fluid is essential prior to injection. Resuscitative equipment, oxygen, and other resuscitative drugs should be available. Careful and constant monitoring of cardiovascular and respiratory vital signs and the patient's state of consciousness should be performed. Head/Neck: Small doses injected into head and neck area may produce adverse reactions due to inadvertent arterial injection. Ophthalmic Surgery: Retrobulbar injections may cause temporary blindness, cardiovascular collapse, apnea, convulsions. Epidural Anesthesia: A test dose should be administered initially and the patient monitored for CNS and cardiovascular toxicity, and unintended intrathecal administration. Pa