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Ventricular arrhythmias
Adult: For cases that occur after MI or during cardiac manipulation (e.g. cardiac surgery): 50-100 mg or 1-1.5 mg/kg via IV bolus inj given at a rate of approx 25-50 mg/min. If the desired effect is not achieved, a 2nd dose may be given 5 minutes after completion of the 1st dose. Max: 200-300 mg during a 1-hour period. For prevention of recurrent arrhythmia, if oral antiarrhythmic therapy is not feasible: 1-4 mg/min (20-50 mcg/kg/min) as continuous IV infusion following initial bolus inj. Discontinue infusion as soon as there is a stable cardiac rhythm or at the earliest signs of toxicity. For patients with heart failure, dosage reduction may be necessary. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: For cases that occur after MI or during cardiac manipulation (e.g. cardiac surgery): Loading dose: 0.5-1 mg/kg via IV bolus inj; may be repeated as necessary according to patient's response (Max total dose: 3-5 mg/kg). Maintenance dose: 10-50 mcg/kg/min as IV infusion via infusion pump. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: For cases that occur after MI or during cardiac manipulation (e.g. cardiac surgery): Loading dose: 0.5-1 mg/kg via IV bolus inj; may be repeated as necessary according to patient's response (Max total dose: 3-5 mg/kg). Maintenance dose: 10-50 mcg/kg/min as IV infusion via infusion pump. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Intravenous
Intravenous regional anaesthesia
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. As 0.5% solution: 10-60 mL (50-300 mg). Max: 4 mg/kg/dose. Use the lowest dose and concentration that will produce the desired effect. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Mouth/Throat, Nasal
Surface anaesthesia
Adult: For the prevention of pain associated with various procedures: As 10 mg/actuation (10%) metered-dose spray: For dentistry: 1-5 actuations (10-50 mg) to the oral mucous membranes. For otorhinolaryngology: 3 actuations (30 mg) for puncture of the maxillary sinus or other minor procedures. For the introduction of instruments into the respiratory and gastrointestinal tracts: Up to 20 actuations (200 mg) for procedures in pharynx, larynx, and trachea. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Mouth/Throat
Topical anaesthesia
Adult: For painful conditions (irritated or inflamed mucous membranes) of the mouth and pharynx: As 2% viscous solution: Usual dose: 15 mL (Max: 120 mL or 2.4 g within 24 hours). Dose intervals must not be less than 3 hours. If used in the mouth, the solution can be swished around and then spat out. If used in the pharynx, the solution can be gargled and slowly swallowed. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Ophthalmic
Ocular anaesthesia
Adult: As 3.5% ophthalmic gel: Apply 2 drops to the ocular surface in the area of the planned procedure. Doses may be re-applied to maintain the anaesthetic effect. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Otic/Aural
Otic pain
Adult: As 4% otic drops: Instil 2-3 drops to the affected ear not more than 3-4 times daily. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Parenteral
Percutaneous infiltration anaesthesia
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. As 0.5% solution: 1-60 mL. As 1% solution: 0.5-30 mL. Alternative recommendation as 0.5% or 1% solution: 1-60 mL (5-300 mg). Use the lowest dose and concentration that will produce the desired effect. Recommendations may vary among countries and between individual products (refer to local or specific produce guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Parenteral
Epidural anaesthesia
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. Administer a test dose of 2-3 mL at least 5 minutes before giving the total dose. Usual dose: 2-3 mL of the indicated concentration for each dermatome. For thoracic epidural anaesthesia: As 1% solution (preservative free): 20-30 mL (200-300 mg). For lumbar epidural analgesia: As 1% solution (preservative free): 25-30 mL (225-300 mg). For lumbar epidural anaesthesia: As 1.5% solution (preservative free): 15-20 mL (225-300 mg). As 2% solution (preservative free): 10-15 mL (200-300 mg). Use the lowest dose and concentration that will produce the desired effect. The Max recommended dose must not be administered at intervals of <1.5 hours. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Parenteral
Obstetric analgesia
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. As 1% solution: For paracervical nerve block (each side): 10 mL (100 mg). Use the lowest dose and concentration that will produce the desired effect. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Parenteral
Caudal anaesthesia
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. Administer a test dose of 2-3 mL at least 5 minutes before giving the total dose. For obstetrical analgesia: As 1% solution (preservative free): 20-30 mL (200-300 mg). For surgical anaesthesia: As 1.5% solution: 15-20 mL (225-300 mg). Use the lowest dose and concentration that will produce the desired effect. The Max recommended dose must not be administered at intervals of <1.5 hours. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Parenteral
Peripheral nerve block
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. As 1% solution: For intercostal nerve block: 3 mL (30 mg). For paravertebral nerve block: 3-5 mL (30-50 mg). For pudendal (each side) nerve block: 10 mL (100 mg). As 1.5% solution: For brachial plexus block: 15-20 mL (225-300 mg). As 2% solution: For dental nerve block: 1-5 mL (20-100 mg). Use the lowest dose and concentration that will produce the desired effect. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Parenteral
Sympathetic nerve block
Adult: Individualise dosage based on the procedure, degree or duration of anaesthesia required, vascularity of tissue, and the patient's weight and physical condition. As 1% solution: For cervical nerve block: 5 mL (50 mg). For lumbar nerve block: 5-10 mL (50-100 mg). Use the lowest dose and concentration that will produce the desired effect. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Rectal
Anorectal pain and itching
Adult: As 5% w/w cream: Apply to the affected area up to 6 times daily. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: ≥12 years As 5% w/w cream: Same as adult dose. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: ≥12 years As 5% w/w cream: Same as adult dose. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Topical/Cutaneous
Topical anaesthesia
Adult: For temporary relief of pain or skin irritation: As 3.88% or 4.12% cream: Apply thinly to the affected area 2-3 times daily. As 4% w/w cream (LMX4): Apply to the affected area up to 3-4 times daily. As 4% cream (Aspercreme): Apply thinly to the affected area every 6-8 hours (Max: 3-4 applications in 24 hours). As 4% spray: Spray to the affected area every 6-8 hours (Max: 3-4 applications in 24 hours). Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Child: Dosage recommendations may vary according to age, weight, and physical condition (refer to local or specific product guidelines).
Topical/Cutaneous
Surface anaesthesia
Adult: As local anaesthesia prior to superficial skin procedures (including venous cannulation or venepuncture): As 4% w/w cream (LMX4): Apply a thick layer (1-2.5 g) of cream to the small area (2.5 cm × 2.5 cm) of intact skin where the procedure will occur. Max application time: 5 hours. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: As local anaesthesia prior to superficial skin procedures (including venous cannulation or venepuncture): As 4% w/w cream (LMX4): <1 year Apply a thick layer (up to 1 g) of cream to the small area (2.5 cm × 2.5 cm) of intact skin where the procedure will occur. Max application time: 1-2 months 1 hour; 3-11 months 4 hours. ≥1 year Same as adult dose. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Child: As local anaesthesia prior to superficial skin procedures (including venous cannulation or venepuncture): As 4% w/w cream (LMX4): <1 year Apply a thick layer (up to 1 g) of cream to the small area (2.5 cm × 2.5 cm) of intact skin where the procedure will occur. Max application time: 1-2 months 1 hour; 3-11 months 4 hours. ≥1 year Same as adult dose. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Transdermal
Postherpetic neuralgia
Adult: For pain relief: As 1.8% patch (ZTlido) or 5% patch: Apply to intact skin covering the most painful area (Max: 3 patches in a single application) for up to 12 hours within a 24-hour period. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
Urethral
Surface anaesthesia
Adult: As 2% Jelly: For procedures involving the female urethra: Insert 3-5 mL (60-100 mg) slowly into the urethra several minutes before the procedure. For procedures involving the male urethra: 5-10 mL (100-200 mg) prior to catheterisation or a total dose of 30 mL (600 mg) prior to sounding or cystoscopy. Recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
Elderly: Dosage reduction may be necessary.
Elderly: Dosage reduction may be necessary.
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