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INTRODUCTION to Lidocaine Side Effects.

Lidocaine, administered intravenously to treat of ventricular arrhythmias, is generally well tolerated. The major side effects of Lidocaine primarily involve the central nervous system, the gastrointestinal tract and the cardiovascular system.

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USES of Lidocaine: Injectable lidocaine is used to numb an area before surgery or before another medical procedure.

HOW TO USE Lidocaine: Lidocaine is injected into the body (e.g., into a muscle or under the skin) as directed by your doctor. The dosage and location of the injection depends on your condition and response to this drug. Before using Lidocaine, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn all preparation and usage instructions in the product package in advance. If any of the information is unclear, consult your pharmacist. Learn how to store and discard needles and medical supplies safely. Consult your doctor if you need it.

SIDE EFFECTS of Lidocaine: Nausea may occur. If this effect persists or worsens, contact your pharmacist. Tell your doctor immediately if any of these unlikely but serious side effects occur: dizziness, fever, drowsiness, mental/mood changes, vision changes, ringing in the ears, tremors, numbness, headache, trouble breathing, seizures, backache.

An allergic reaction to Lidocaine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing.

PRECAUTIONS: Tell your doctor your medical history, especially: heart problems (e.g., heart block, heart failure), high or low blood pressure, liver problems, kidney problems, any allergies. Lidocaine is not recommended for use if you have nerve disease or spine problems. Lidocaine may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Avoid alcoholic beverages. Depending on how and where Lidocaine is injected into the body, you may experience temporary weakness. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. Notify your doctor if weakness or problems with muscle control persist. Caution is advised when using Lidocaine in the elderly because they may be more sensitive to the effects of the drug. Also caution is advised when using Lidocaine in children because they may be more sensitive to the effects the drug. Tell your doctor if you are pregnant before using Lidocaine. This medication passes into breast milk. Consult your doctor before breast-feeding.

Lidocaine INTERACTIONS:
Lidocaine is not recommended for use with: arbutamine, dofetilide, pimozide, halofantrine. Tell your doctor or pharmacist of all prescription and nonprescription drugs you may use, especially: other anesthetics (e.g., bupivacaine), procainamide, cimetidine, tocainide, beta-blockers (atenolol, metoprolol,propranolol), amiodarone, mexilitine, succinylcholine, vasopressor drugs (e.g., dobutamine), ergot-type oxytocic (e.g., ergonovine). Tell your doctor if you take drugs that cause drowsiness such as: medicine for sleep, tranquilizers, anti-anxiety drugs (e.g., diazepam), sedatives, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines or tricyclics), anti- seizure drugs (e.g., carbamazepine), muscle relaxants, antihistamines that cause drowsiness (e.g., diphenhydramine). Check the labels on all your drugs (e.g., cough-and-cold products) because they may contain drowsiness-causing ingredients. Ask your doctor about the safe use of those products. This product can interfere with certain lab tests. Inform laboratory personnel that you are using this medication. Do not start or stop any medicine without doctor or pharmacist approval.

Lidocaine OVERDOSE: If overdose of Lidocaine is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include restlessness, anxiety, ringing in the ears, blurred vision, tremors; or severe dizziness or drowsiness.

NOTES: Do not share Lidocaine with others. Laboratory and/or medical tests may be performed to monitor for side effects and response to treatment.

MISSED DOSE: If the dose of Lidocaine is interrupted, contact your doctor or pharmacist immediately to establish new dosing.

STORAGE: Store Lidocaine at room temperature between 59 and 77 degrees F (15 to 25 degrees C) away from light and moisture. Discard any unused liquid.

NEUROLOGIC TOXICITY

The most common adverse effect of intravenous lidocaine is central nervous system (CNS) toxicity . The symptoms are usually mild, dose-dependent, and always resolve with a decrease in the infusion rate or discontinuation of Lidocaine. These side effects may be particularly frequent in older adults or in those with heart failure, settings in which CNS levels are increased due to a reduced volume of distribution, and in patients with significant liver impairment in whom the metabolism of lidocaine is reduced.

Tremor is a useful sign of toxicity. Other neurologic side effects include insomnia, lightheadedness or drowsiness, dysarthria and slurred speech,depression, ataxia, agitation, change in sensorium, a change in personality, nystagmus, hallucinations, memory impairment, and emotional lability.

High plasma concentrations of lidocaine can also provoke seizures that are usually generalized . This can also occur at lower drug concentrations if lidocaine is given to patients receiving oral tocainide or mexiletine, which are congeners of lidocaine.

CARDIOVASCULAR TOXICITY

Cardiac side effects are an infrequent complication of intravenous lidocaine therapy which is generally well tolerated even by patients with significant underlying heart disease. The primary cardiovascular side effects include sinus slowing, asystole, hypotension, and shock. These problems are most often associated with overdosing or with the overly rapid administration of lidocaine. The elderly and those with significant preexisting heart disease are at greatest risk.

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Antidepressants are medicines that are used to treat depression. Your doctor can prescribe them for you. They can improve your sleep, mood, appetite and concentration. It may take several weeks for them to start working. There are several types of antidepressants. You and your doctor may have to try several before finding what will work best for you.

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Antidepressants sometimes cause unwanted side effects. For example, when you first start your antidepressant you may feel tired, have trouble sleeping or even feel sick to your stomach. The side effects usually go away in a short period. Tell your doctor if you have any side effects. You should also let your doctor know if you take any other drugs, vitamins or any herbal supplements.

It is important to keep taking your medicines, even after you feel better. Do not stop taking your antidepressants without talking to your pharmacist. You often need to stop antidepressants gradually.

Most typical antidepressants have a delayed action (2–6 weeks) and are usually administered for anywhere from months to years. Antidepressants are often used to treat other conditions, such as obsessive compulsive disorder, anxiety disorders, chronic pain, eating disorders, and some hormone-mediated disorders as dysmenorrhea. Alone or together with anticonvulsants (e.g., Depakote or Tegretol), antidepressants can be used to treat attention-deficit hyperactivity disorder (ADHD) and substance abuse by addressing underlying depression. Also, antidepressants have been used for hypercytorism, with mixed reviews, and are sometimes used to treat migraines or snoring.

Here is a list of different types of antidepressants.

1) TCAs (Tricyclic antidepressants)

Tricyclic antidepressants are the oldest class of antidepressant drugs. Tricyclics block the reuptake of neurotransmitters as serotonin and noradrenaline (norepinephrine). Tricyclic antidepressants are used less commonly now due to the development of safer and more selective drugs.

Tricyclic antidepressants include: Secondary Amine Tricyclic Antidepressants as Protriptyline (Vivactil), Desipramine (Norpramin), Nortriptyline (Pamelor, Aventyl) and Tertiary Amine Tricyclic Antidepressants as Imipramine (Tofranil), Clomipramine (Anafranil), Trimipramine (Surmontil), Amitriptyline (Elavil, Endep) and Doxepin (Adapin, Sinequan)

Side effects of Tricyclic antidepressants include increased drowsiness, heart rate, dry mouth, blurred vision, constipation, urinary retention, confusion, dizziness, and sexual dysfunction. Toxicity occurs at approximately ten times normal dosages; !!ATTENTION!! these drugs are often lethal in overdoses, as they lead to a fatal arrhythmia. However, tricyclic antidepressants are still used because of their effectiveness, especially in severe cases of major depression.

2) SSRIs(Selective serotonin reuptake inhibitors)

SSRIs are a family of antidepressants that consider the current standard of drug treatment. This family of drugs includes: Sertraline (Zoloft), Fluoxetine (Prozac), Paroxetine (Paxil), Citalopram (Celexa), Fluvoxamine (Luvox) and Escitalopram (Lexapro, Cipralex).

Within side effects of Selective serotonin reuptake inhibitors there should be mentioned: anxiety, drowsiness, dry mouth, decreased appetite, nervousness, insomnia, agitation, headaches and decreased ability to function sexually such as loss of libido, failure to reach orgasm and erectile dysfunction. Though safer than first generation antidepressants, SSRIs may not work on as many patients as previous classes of antidepressants, suggesting the role of norepinephrine in depression is still important. The Food and Drug Administration requires Black Box warnings on all SSRIs, which state that they double suicidal rates (from 2 in 1,000 to 4 in 1,000) in children and adolescents. The increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents.

3) SNRIs (Serotonin-norepinephrine reuptake inhibitors) are a newer form of antidepressants. They work on both norepinephrine and 5-HT. They are:

Duloxetine (Cymbalta), Venlafaxine (Effexor), Desvenlafaxine (Pristiq) and Milnacipram (Ixel).
Theese antidepressants usually have similar side effects to the SSRIs, though there may be a withdrawal syndrome on discontinuation that may necessitate dosage tapering.

4) NaSSAs (Noradrenergic and specific serotonergic antidepressants)

Noradrenergic and specific serotonergic antidepressants (NaSSAs) work to increase norepinephrine (noradrenaline) and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors. And at the same time they block certain serotonin receptors. NaSSAs include Mirtazapine (Remeron, Zispin, Avanza) and Mianserin (Tolvon). Side effects of Noradrenergic and specific serotonergic antidepressants include drowsiness, increased appetite, and weight gain.

5) NRIs (Norepinephrine (noradrenaline) reuptake inhibitors)

Norepinephrine (noradrenaline) reuptake inhibitors (NRIs) act via norepinephrine (also known as noradrenaline). NRIs are used because of their positive effect on the concentration and motivation in particular. NRIs include: Mazindol (Sanorex, Mazanor), Viloxazine (Vivalan), Atomoxetine (Strattera) and Reboxetine (Edronax)

6) MAOIs (Monoamine oxidase inhibitor)

Monoamine oxidase inhibitors (MAOIs) are usually used when other antidepressant medications are ineffective.
MAOIs include: Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Selegiline (Emsam, Eldepryl)and Moclobemide (Manerix, Aurorix).

MAOIs are rarely prescribed anymore. The reason is that there are potentially fatal interactions between this class of antidepressants and certain foods (especially those containing tyramine), red wine, as well as certain drugs . However, this does not apply to Emsam, the transdermal patch form of selegiline, which due to its bypassing of the stomach has never been reported to induce such terrible side effects. MAOIs work by blocking the enzyme monoamine oxidase which breaks down the neurotransmitters serotonin, dopamine, and noradrenaline (norepinephrine). Monoamine oxidase inhibitors are as effective as tricyclic antidepressants, although they can have a higher incidence of dangerous side effects (as a result of inhibition of cytochrome P450 in the liver). Modern generation of Monoamine oxidase inhibitors has been introduced; moclobemide (Manerix), known as RIMA ( a reversible inhibitor of monoamine oxidase A), acts in a selective andmore short-lived manner and does not require a special diet. As one of the side effects is weight gain and could be extreme.

Side effects of MAOIs (monoamine oxidase inhibitors): Rare side effects of MAOIs like phenelzine (Nardil) and tranylcypromine (Parnate) include heart attack, hepatitis, stroke, and seizures. Serotonin syndrome is a side effect of MAOIs when combined with other certain drugs.

There are also some other groups of antidepressants: NDRIs (Norepinephrine-dopamine reuptake inhibitors ) such as Bupropion (Wellbutrin, Zyban). SSREs (Selective serotonin reuptake enhancers) such as Tianeptine ( Coaxil, Stablon, Tatinol). Melatonergic agonists such as Agomelatine ( Melitor, Valdoxan, Thymanax).

Some antidepressants were found to work better in some patients when used in combination with another drug. Theese drugs are called “Augmenter drugs” such as Trazodone (Desyrel), Nefazodone (Serzone), Gepirone (Ariza), Buspirone (Buspar), Tandospirone (Sediel).

Lithium is often used in conjunction with other medications, depending on whether mania or depression is being treated. Lithium’s potential side effects include nausea, tremors, thirst, light-headedness and diarrhea. Some of the anticonvulsants, such as lamotrigine (Lamictal),sodium valproate (Epilim) and carbamazepine (Tegretol) are also used as mood stabilizers, particularly in bipolar disorder.

Antipsychotics such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel) are prescribed as mood stabilizers and to treat anxiety. Their use as mood stabilizers is a recent phenomenon, and controversial among some patients. Antipsychotics may also be prescribed to augment an antidepressant, to increase the blood concentration of another drug, or to relieve the psychotic or paranoid symptoms that usually accompany clinical depression. However, they can cause serious side effects, especially if used at high dosages, wich include tardive dyskinesia, restlessness, blurred vision, muscle spasms or weight gain.

Tranquillizers and sedatives, typically the benzodiazepines, are usually prescribed to ease anxiety and to promote sleep. Because of the high risk of dependency, these drugs are intended only for short-term or occasional use. Tranquillizers are often used not for their primary functions, but to decrease side effects. Quetiapine fumarate (Seroquel) is designed primarily to treat bipolar disorder and schizophrenia, but frequently causes somnolence because of its affinity for histamine (H1 and H2) receptors, exploiting the same side effects as diphenhydramine (Benadryl).

Psychostimulants may be added to an antidepressant regimen if the patient suffers from hypersomnia, anhedonia and/or excessive eating as well as low motivation. These symptoms are common in atypical depression, and can be resolved by adding low to moderate doses of methylphenidate (Ritalin) or amphetamine (Adderall) because these chemicals can enhance motivation and social behavior, and also to suppress appetite and sleep. They can also restore sex drive. Stimulants are known to trigger manic episodes in people suffering from bipolar disorder. Close supervision is urged of those with substance abuse disorders.

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