What is the role of lidocaine in the treatment of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Although some animal data indicate that lidocaine can reverse the ECG effects of cocaine and protect against death, others indicate that lidocaine may lower the seizure threshold and potentiate cocaine toxicity. Derlet, Tseng, and Albertson caution that lidocaine potentiates the CNS toxicity of cocaine. [52] Noting this small "safety window," Derlet states that lidocaine may be used, but advises precautions, such as double- or triple-checking the total dose, solution concentration, and any infusion pump. [53]

Cocaine and lidocaine have similar pharmacologic effects. Therefore, the possibility that lidocaine may increase toxicity by potentiating the effects of cocaine on the cardiovascular system has been a concern.

The AHA Textbook of Advanced Cardiac Life Support for the Experienced Provider cites this similarity for the therapeutic role that lidocaine, as a IB sodium channel blocker, may play in competing with cocaine, which is a (more dangerous) IC sodium channel blocker, thereby decreasing the effects of cocaine that are mediated through the sodium channel.

In the setting of cocaine toxicity, the decision as to whether or not to use lidocaine must be carefully considered, weighing its potential benefit on ventricular rhythm disturbances versus the synergistic toxic effects of lidocaine on seizure risk.

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