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3/25/2024

Lidocaine Injection

Products Affected - Description

    • Xylocaine-MPF injection, Fresenius Kabi, 1%, 10 mL sterile-pack ampule, 5 count, NDC 63323-0492-97
    • Xylocaine-MPF injection, Fresenius Kabi, 1.5%, 10 mL ampule, 5 count, NDC 63323-0493-97
    • Xylocaine-MPF injection, Fresenius Kabi, 1.5%, 20 mL ampule, 5 count, NDC 63323-0493-91
    • Xylocaine-MPF injection, Fresenius Kabi, 2%, 10 mL ampule, 5 count, NDC 63323-0496-97
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 2 mL ampule, 10 count, NDC 55150-0158-72 - discontinued
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 5 mL ampule, 10 count, NDC 55150-0159-74 - discontinued
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 2 mL ampule, 10 count, NDC 55150-0160-72 - discontinued
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 5 mL vial, 10 count, NDC 55150-0165-05
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 50 mL vial, 25 count, NDC 55150-0256-50
    • Lidocaine Hydrochloride injection, Hikma, 1%, 50 mL vial, 10 count, NDC 00143-9577-10
    • Lidocaine Hydrochloride injection, Hikma, 2%, 5 mL preservative-free vial, 25 count, NDC 00143-9594-25
    • Lidocaine Hydrochloride injection, Hikma, 2%, 50 mL vial, 10 count, NDC 00143-9575-10
    • Lidocaine Hydrochloride injection, Pfizer, 0.5%, 50 mL SD Flip Top vial, 25 count, NDC 00409-4275-01
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 5 mL emergency Ansyr syringe, 10 count, NDC 00409-9137-05
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 5 mL LifeShield syringe, 10 count, NDC 00409-4904-34
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 5 mL LifeShield syringe, 10 count, NDC 00409-4903-34
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 5 mL preservative-free vial, 10 count, NDC 00409-2066-05

Reason for the Shortage

    • Afaxys has lidocaine vials available.
    • Amphastar had lidocaine syringes on shortage due to increased demand.
    • Eugia has lidocaine on shortage due to increased demand. The lidocaine ampules were discontinued in mid-2023.
    • Fresenius Kabi has lidocaine on shortage due to increased demand.
    • Pfizer has lidocaine presentations on shortage due to manufacturing delays and increased demand.

Available Products

    • Xylocaine injection, Fresenius Kabi, 0.5%, 50 mL vial, 25 count, NDC 63323-0484-57
    • Xylocaine injection, Fresenius Kabi, 1%, 20 mL vial, 25 count, NDC 63323-0485-27
    • Xylocaine injection, Fresenius Kabi, 1%, 50 mL vial, 25 count, NDC 63323-0485-57
    • Xylocaine injection, Fresenius Kabi, 2%, 10 mL vial, 25 count, NDC 63323-0486-17
    • Xylocaine injection, Fresenius Kabi, 2%, 20 mL vial, 25 count, NDC 63323-0486-27
    • Xylocaine injection, Fresenius Kabi, 2%, 50 mL vial, 25 count, NDC 63323-0486-57
    • Xylocaine-MPF injection, Fresenius Kabi, 0.5%, 50 mL vial, 25 count, NDC 63323-0491-57
    • Xylocaine-MPF injection, Fresenius Kabi, 1%, 2 mL vial, 25 count, NDC 63323-0492-27
    • Xylocaine-MPF injection, Fresenius Kabi, 1%, 30 mL vial, 25 count, NDC 63323-0492-37
    • Xylocaine-MPF injection, Fresenius Kabi, 1%, 5 mL vial, 25 count, NDC 63323-0492-57
    • Xylocaine-MPF injection, Fresenius Kabi, 2%, 2 mL vial, 25 count, NDC 63323-0495-27
    • Xylocaine-MPF injection, Fresenius Kabi, 2%, 5 mL vial, 25 count, NDC 63323-0495-07
    • Lidocaine Hydrochloride injection, Afaxys Pharma, 1%, 20 mL vial, 10 count, NDC 50102-0400-10
    • Lidocaine Hydrochloride injection, Amphastar, 2%, 5 mL Luer-Jet Emergency syringe, 10 count, NDC 76329-3390-01
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 10 mL vial, 25 count, NDC 55150-0251-10
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 2 mL vial, 10 count, NDC 55150-0161-02
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 20 mL vial, 25 count, NDC 55150-0252-20
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 30 mL vial, 1 count, NDC 55150-0163-30
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 5 mL vial, 10 count, NDC 55150-0162-05
    • Lidocaine Hydrochloride injection, Eugia US, 1%, 50 mL vial, 25 count, NDC 55150-0253-50
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 10 mL vial, 25 count, NDC 55150-0254-10
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 2 mL vial, 10 count, NDC 55150-0164-02
    • Lidocaine Hydrochloride injection, Eugia US, 2%, 20 mL vial, 25 count, NDC 55150-0255-20
    • Lidocaine Hydrochloride injection, Fresenius Kabi, 1%, 10 mL vial, 25 count, NDC 63323-0201-10
    • Lidocaine Hydrochloride injection, Fresenius Kabi, 1%, 2 mL vial, 25 count, NDC 63323-0201-02
    • Lidocaine Hydrochloride injection, Fresenius Kabi, 2%, 2 mL vial, 25 count, NDC 63323-0202-02
    • Lidocaine Hydrochloride injection, Fresenius Kabi, 2%, 5 mL Tear-top preservative-free vial, 25 count, NDC 63323-0208-05
    • Lidocaine Hydrochloride injection, Hikma, 1%, 5 mL preservative-free vial, 25 count, NDC 00143-9595-25
    • Lidocaine Hydrochloride injection, Pfizer, 0.5%, 50 mL SD Tear Top preservative-free vial, 25 count, NDC 00409-4278-01
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 2 mL preservative-free glass ampule, 50 count, NDC 00409-4713-32
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 20 mL vial, 25 count, NDC 00409-4276-01
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 30 mL preservative-free vial, 25 count, NDC 00409-4279-02
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 5 mL preservative-free glass ampule, 50 count, NDC 00409-4713-02
    • Lidocaine Hydrochloride injection, Pfizer, 1%, 50 mL vial, 25 count, NDC 00409-4276-02
    • Lidocaine Hydrochloride injection, Pfizer, 1.5%, 20 mL preservative-free ampule, 25 count, NDC 00409-4776-01
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 10 mL preservative-free glass ampule, 25 count, NDC 00409-4282-02
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 2 mL preservative-free glass ampule, 25 count, NDC 00409-4282-01
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 20 mL vial, 25 count, NDC 00409-4277-01
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 5 mL emergency Ansyr syringe, 10 count, NDC 00409-1323-05
    • Lidocaine Hydrochloride injection, Pfizer, 2%, 50 mL vial, 25 count, NDC 00409-4277-02
    • Lidocaine Hydrochloride injection, Pfizer, 4%, 5 mL preservative-free glass ampule, 25 count, NDC 00409-4283-01

Estimated Resupply Dates

    • Eugia has 2% lidocaine 5 mL vials on intermittent back order and the company is releasing product as it becomes available. The 2% lidocaine 50 mL vials are on long-term back order and the company cannot estimate a release date.
    • Fresenius Kabi has 1% Xylocaine-MPF 10 mL vials in sterile packs on back order and the company cannot estimate a release date. The 1.5% Xylocaine-MPF 10 mL and 20 mL ampules are on back order and the company cannot estimate a release date. The 2% Xylocaine-MPF 10 mL ampules are on back order and the company cannot estimate a release date.
    • Hikma has 1% lidocaine 50 mL vials on allocation. The 2% lidocaine 50 mL vials are on back order and the company estimates a release date of early-May 2024. The 2% lidocaine 5 mL vials are on allocation.
    • Pfizer has 0.5% lidocaine 50 mL flip top vials on back order and the company cannot estimate a release date. The 1% lidocaine 5 mL LifeShield syringes are on back order and the company estimates a release date of July 2024. The 2% lidocaine 5 mL vials and 5 mL LifeShield syringes are on back order and the company estimates a release date of April 2024 for the 5 mL vials and July 2024 for the 5 mL LifeShield syringes.

Alternative Agents & Management

    • Bupivacaine and lidocaine are amide-type local anesthetics commonly used in clinical practice. The following table compares their pharmacodynamic and pharmacokinetic properties. Key differences between the products are onset of action, duration of action, and dose. In general, bupivacaine is a longer-acting local anesthetic, while lidocaine has a more rapid onset, but shorter duration of action.[1-2]
    Table 1. Table. Comparison of Bupivacaine and lidocaine for Local Anesthesia1-6
    PropertyBupivacaineLidocaine
    *Duration of effect is prolonged by use of local anesthetics in combination with epinephrine, although magnitude of effect is not well-defined for all routes.
    Onset of actionInfiltration: 2-10 min
    Epidural: 4-7 min
    Spinal: 1-15 min
    		Not well-defined for anesthetic use as a single agent.
    In general local analgesia 1 to 3 min
    Spinal and Epidural rapid onset
    Duration of action:
    As a single agent    		Infiltration: 2-8 h
    Nerve block, minor: 3-6 h
    Epidural: 3-9 h
    Spinal: 1.5-3.5 h
    		Infiltration: 0.5-2 h
    Nerve block, minor: 1-2 h
    Epidural: 100 min
    Spinal: 0.5-2 h
    Duration of action: Combined with epinephrine*Infiltration: 3-4 h
    Nerve block, minor: 4-7 h
    		Infiltration: 2 h
    Nerve block, minor: 2-3 h
    Maximum doseSingle injections up to 175 mg without epinephrine or 225 mg with epinephrine; may repeat up to once every 3 hours.
    Maximum dosage: 400 mg/24 hours.    		Maximum: 4.5 mg/kg/dose not to exceed 300 mg without epinephrine or 7mg/kg/dose not to exceed 500 mg with epinephrine; do not repeat within 2 hours.
    Maximum dose for spinal anesthesia is 100 mg.
    Protein Binding82%-96%60%-80%
    Volume of distribution~2.5 L/kg1.5 + 0.6 L/kg
    Half-life, terminalAdults: 1.5-5 h
    Neonates: 8.1 h
    		Adults: 1.5-2 h
    Premature infants: 3.2 h
    MetabolismUndergoes N-dealkylation in the liver.Extensive hepatic metabolism (90%) with active metabolites.
    EliminationExcreted in urine as metabolites and 5% as unchanged drug. Excreted in urine as metabolites (90%) and unchanged drug (< 10 %).

References

    1. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders;2015:1028-1054.e4.
    2. Drasner K. Local anesthetics. In: Miller RD, Pardo MC, ed. Basics of Anesthesia. 6th ed. Philadelphia, PA: Elsevier Saunders;2011:130-142.
    3. Drugdex system. Micromedex 2.0 [database online]. http://www.micromedexsolutions.com. Updated March 13, 2018. Greenwood Village, CO: Truven Health Analytics; Accessed March 13, 2018.
    4. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc; 2018.
    5. Lidocaine hydrochloride and epinephrine injection, solution [package insert]. Lake Forest, IL: Hospira Inc; 2017.
    6. McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH, eds. AHFS DI (Lexi-Comp Online). Bethesda, MD: American Society of Health-System Pharmacists; 2018.

Updated

Updated March 25, 2024 by Michelle Wheeler, PharmD, Drug Information Specialist. Created June 23, 2015 by Jane Chandramouli, PharmD, Drug Information Specialist. © 2024, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

Drug Shortage Bulletins are copyrighted by the Drug Information Service of the University of Utah and provided by ASHP as its exclusive authorized distributor. ASHP and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this Bulletin. Neither ASHP nor the University of Utah endorses or recommends the use of any particular drug. Any application of this information for any purpose shall be limited to personal, non-commercial use.

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