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Lidocaine should be used with caution in patients receiving agents structurally related to local anaesthetics, e.g. antiarrhythmics such as mexiletine and tocainide, since the toxic effects are additive.
Specific interaction studies with lidocaine and anti-arrhythmic drugs class III (e.g. amiodarone) have not been performed, but caution is advised.
Drugs that reduce the clearance of lidocaine (e.g. cimetidine or beta blockers) may cause potentially toxic plasma concentrations when lidocaine is given in repeated high doses over a long time period. Such interactions should therefore be of no clinical importance following short term treatment with lidocaine (e.g. Xylocaine spray) at recommended doses.
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