Xylocain (Lidocaine): Uses, Dosage & Side Effects
A widely used amide-type local anesthetic available as gel, injection, and eye drops for temporary numbing during medical procedures
Xylocain is a brand name for lidocaine (also known as lignocaine), one of the most widely used local anesthetics in the world. It belongs to the amide class of local anesthetics and works by temporarily blocking nerve signals in the area where it is applied or injected, resulting in numbness and pain relief. Xylocain is available as a topical gel, solution for injection, and eye drops, and is used for a wide range of medical procedures including endoscopy, catheterization, intubation, and minor surgical operations. Listed on the WHO Model List of Essential Medicines, lidocaine has been a cornerstone of local anesthesia since its introduction in 1948.
Quick Facts: Xylocain (Lidocaine)
Key Takeaways
- Xylocain (lidocaine) is one of the world's most commonly used local anesthetics, listed on the WHO Model List of Essential Medicines, and available as gel, injection, and eye drops for a wide range of medical procedures.
- Do not use Xylocain if you are allergic to lidocaine, other amide-type local anesthetics, or para-aminobenzoic acid (PABA); true allergic reactions are rare but can be serious.
- Higher doses or more frequent application than recommended can lead to systemic lidocaine toxicity, which may cause symptoms ranging from numbness around the mouth and dizziness to seizures and cardiovascular collapse in severe cases.
- Xylocain gel numbs mucous membranes when applied to the nose, throat, urethra, or rectum, and is commonly used to ease discomfort during endoscopy, catheterization, and intubation procedures.
- Occasional use during pregnancy may be considered when the healthcare provider determines the benefit outweighs the risk; lidocaine passes into breast milk in small amounts but is unlikely to affect the nursing infant at normal doses.
What Is Xylocain (Lidocaine) and What Is It Used For?
Xylocain is the original and most widely recognized brand name for lidocaine (also known internationally as lignocaine), a synthetic amide-type local anesthetic that was first developed by Swedish chemists Nils Löfgren and Bengt Lundqvist in 1943 and introduced into clinical practice in 1948. Lidocaine was the first amide-type local anesthetic to be synthesized, representing a major advance over the older ester-type local anesthetics (such as procaine and cocaine) that were more likely to cause allergic reactions and had a shorter duration of action.
Lidocaine works by blocking voltage-gated sodium channels in nerve cell membranes. Under normal conditions, sodium ions flow through these channels to generate electrical impulses (action potentials) that transmit pain signals along nerve fibers. When lidocaine binds to the intracellular portion of the sodium channel, it prevents the channel from opening, thereby inhibiting the generation and propagation of nerve impulses. This produces a reversible loss of sensation (anesthesia) in the area where the drug is applied or injected. Importantly, this blockade is temporary and fully reversible once the drug is metabolized and cleared from the tissue.
The Xylocain gel formulation (2% lidocaine, equivalent to 20 mg/g) is specifically designed for topical application to mucous membranes. When applied to the lining of the nose, throat, urethra, rectum, or other mucous membrane surfaces, it produces localized numbness that typically begins within 1 to 5 minutes and lasts for approximately 20 to 30 minutes. The gel formulation also provides lubrication, which facilitates the passage of medical instruments during diagnostic and therapeutic procedures.
Xylocain is indicated for temporary anesthesia (numbing) of parts of the body in adults and children. Its principal clinical uses include:
- Endoscopic procedures: Providing anesthesia and lubrication during gastroscopy (examination of the stomach), bronchoscopy (examination of the airways and lungs), cystoscopy (examination of the bladder and urethra), and anoscopy (examination of the anal canal and lower rectum).
- Urological procedures: Catheterization (insertion of a urinary catheter), urethral probing, and other instrumentation of the urinary tract. Also used for the topical treatment of painful cystitis (bladder inflammation) and urethritis (urethral inflammation).
- Airway management: Facilitating endotracheal intubation (insertion of a breathing tube) by numbing the mouth, throat, and larynx to suppress the gag reflex and reduce discomfort.
- Ear, nose, and throat (ENT) procedures: Minor operations and examinations of the nasal passages, pharynx (throat), and larynx (voice box).
- Injectable formulations: Lidocaine solution for injection is used for local infiltration anesthesia, nerve blocks (regional anesthesia), epidural anesthesia, and as an antiarrhythmic agent for the acute management of ventricular arrhythmias (irregular heart rhythms).
- Ophthalmic use: Xylocain eye drops are used to provide surface anesthesia of the eye for diagnostic procedures such as tonometry (measurement of intraocular pressure), removal of foreign bodies, and minor ophthalmic surgical procedures.
Lidocaine is classified as an essential medicine by the World Health Organization (WHO) and is included on the WHO Model List of Essential Medicines in multiple categories: as a local anesthetic, as a topical anesthetic, and as an antiarrhythmic agent. It has been in continuous clinical use for over 75 years and has one of the most extensively documented safety profiles of any local anesthetic. Lidocaine is available globally under numerous brand names including Xylocain, Lidocaine Accord, Versatis (a medicated plaster for neuropathic pain), Xyloproct (combined with hydrocortisone for hemorrhoids), and Instillagel (a urethral gel containing lidocaine and chlorhexidine).
In addition to its well-known role as a local anesthetic, lidocaine has several other important clinical applications. Intravenous lidocaine is used as a Class IB antiarrhythmic drug for the acute treatment of ventricular tachycardia and ventricular fibrillation. Lidocaine patches (Versatis 5%) are licensed for the treatment of neuropathic pain associated with postherpetic neuralgia (pain after shingles). Research is also investigating the potential role of intravenous lidocaine infusions for perioperative pain management and for the treatment of chronic neuropathic pain conditions.
What Should You Know Before Using Xylocain?
Contraindications
There are specific situations where Xylocain must not be used. Understanding these absolute contraindications is essential for patient safety.
- Lidocaine allergy: Do not use Xylocain if you have a known allergy (hypersensitivity) to lidocaine hydrochloride or any other ingredient in the product. True allergy to amide-type local anesthetics is extremely rare (estimated at less than 1% of all reported adverse reactions to local anesthetics), but when it occurs, it can be serious.
- Allergy to other amide-type local anesthetics: If you have a confirmed allergy to other amide-type local anesthetics such as bupivacaine, mepivacaine, prilocaine, ropivacaine, or articaine, you should not use lidocaine, as cross-reactivity within the amide class is possible.
- Allergy to para-aminobenzoic acid (PABA): The Xylocain gel formulation contains preservatives (methylparaben and propylparaben) that are metabolized to PABA in the body. Patients with a known allergy to PABA or to ester-type local anesthetics (which are also metabolized to PABA) should not use the preserved gel formulation.
Warnings and Precautions
Lidocaine absorbed from mucous membranes can reach significant blood levels, particularly when applied to large areas, inflamed or traumatized tissue, or when used in higher-than-recommended doses. Systemic lidocaine toxicity affects the central nervous system and cardiovascular system and can be life-threatening. Always adhere to the recommended maximum doses and avoid using higher concentrations or more frequent applications than directed.
You should inform your doctor before using Xylocain if any of the following conditions apply to you:
- Illness or debilitation: If you are ill, have a generally reduced state of health, or are elderly, you may be more sensitive to the effects of lidocaine. Reduced doses may be necessary.
- Heart disease: Lidocaine affects cardiac conduction and should be used with caution in patients with conduction disturbances (such as heart block), heart failure, or bradycardia (slow heart rate). Although significant cardiovascular effects are uncommon with topical use at recommended doses, caution is warranted in patients with severe cardiovascular disease.
- Liver disease: Lidocaine is primarily metabolized in the liver by cytochrome P450 enzymes (mainly CYP1A2 and CYP3A4). Patients with significant hepatic impairment may have reduced clearance of lidocaine, leading to increased blood levels and a higher risk of systemic toxicity. Dose reduction may be necessary.
- Kidney disease: Although lidocaine itself is not significantly excreted by the kidneys, its active metabolites (monoethylglycinexylidide, MEGX, and glycinexylidide, GX) are renally cleared. Patients with severe renal impairment may accumulate these metabolites, particularly with repeated dosing.
- Porphyria: Lidocaine may trigger attacks of acute porphyria and should be avoided in patients with a personal or family history of this rare metabolic disorder.
- Application to damaged tissue: Exercise caution when applying Xylocain gel to open wounds, inflamed mucous membranes, or areas of damaged skin, as absorption may be significantly increased, raising the risk of systemic toxicity.
When Xylocain is used in the mouth or throat (e.g., before endoscopy or intubation), the resulting numbness makes swallowing difficult and increases the risk of aspiration (food or drink entering the airway). Numbness of the tongue or mouth also increases the risk of bite injuries. Do not eat or drink until normal sensation has fully returned, typically 1 to 2 hours after application.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before using Xylocain.
Lidocaine crosses the placental barrier by passive diffusion and can reach the fetal circulation. However, occasional topical use of Xylocain gel during pregnancy can be considered when the healthcare professional determines that the potential benefit outweighs the potential risk. There is extensive clinical experience with lidocaine use during pregnancy (particularly for dental procedures and as an epidural anesthetic during labor), and it has not been associated with teratogenic effects or significant adverse outcomes at standard therapeutic doses. Nevertheless, systemic administration of high doses near the time of delivery can affect the fetus, and neonatal monitoring may be advisable in such situations.
Lidocaine is excreted into breast milk in small amounts, but at normal therapeutic doses for topical or local use, the concentration reaching the infant is considered negligible and unlikely to cause adverse effects. The European Medicines Agency and the BNF indicate that lidocaine is compatible with breastfeeding. Xylocain gel can therefore be used during breastfeeding as needed, but it is always prudent to inform your healthcare provider.
Important Information About Excipients
Xylocain gel in tube form contains the preservatives methylparahydroxybenzoate (E218) and propylparahydroxybenzoate (E216). These parabens can cause allergic reactions, which may be delayed in onset. In rare cases, they can trigger bronchospasm (tightening of the airways). Patients with a history of sensitivity to parabens should use the preservative-free formulations of lidocaine where available (e.g., Xylocain without preservatives, available in single-dose containers for injection).
Driving and Operating Machinery
Xylocain gel, when used topically at recommended doses, has no known effect on the ability to drive or operate machinery. The drug acts locally and does not typically produce central nervous system effects at therapeutic doses. However, if the gel is applied to areas where significant absorption may occur, or if higher-than-recommended doses are used, transient central nervous system effects (such as dizziness or lightheadedness) may occur. In such cases, refrain from driving or operating machinery until symptoms have resolved.
How Does Xylocain Interact with Other Drugs?
While drug interactions with topically applied lidocaine are less common than with systemic administration, several clinically significant interactions exist. These become particularly relevant when lidocaine is applied to large mucosal surfaces where significant absorption can occur, or when injectable formulations are used. Always inform your doctor, pharmacist, or nurse about all prescription and over-the-counter medications, herbal remedies, and supplements you are taking.
Major Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Mexiletine | Mexiletine is structurally similar to lidocaine and acts on the same sodium channels. Concurrent use produces additive cardiac and neurological effects, significantly increasing the risk of systemic toxicity | Avoid concurrent use of lidocaine and mexiletine. If combined use is unavoidable, close cardiac monitoring and dose reduction of both agents is required. |
| Amiodarone | Amiodarone inhibits the hepatic metabolism of lidocaine and may enhance its cardiac depressant effects. Concurrent use can lead to increased lidocaine blood levels and risk of bradycardia, sinus arrest, and seizures | Monitor cardiac rhythm closely. Reduce lidocaine dose if concurrent use is necessary. Watch for signs of lidocaine toxicity (perioral numbness, dizziness, tremor). |
| Beta-blockers (e.g., propranolol, metoprolol) | Beta-blockers reduce hepatic blood flow and inhibit CYP enzymes, thereby reducing the clearance of lidocaine. This can result in elevated lidocaine plasma concentrations, increasing the risk of toxicity | Use lower doses of lidocaine in patients receiving beta-blockers. Monitor for symptoms of lidocaine toxicity, particularly with repeated doses or application to large mucosal surfaces. |
| Other local anesthetics | The toxic effects of different local anesthetics are additive. Using multiple local anesthetic preparations concurrently (e.g., lidocaine gel plus bupivacaine injection) can result in combined toxicity exceeding the safe threshold | Account for the total dose of all local anesthetics being administered. The maximum safe dose should reflect the combined exposure from all sources. |
Minor Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Cimetidine | Cimetidine (an H2-receptor antagonist used for heartburn and ulcers) inhibits cytochrome P450 enzymes and reduces hepatic blood flow, decreasing the clearance of lidocaine by up to 30% | Consider using alternative acid-reducing agents (e.g., ranitidine, omeprazole) that do not affect lidocaine metabolism. If combined use is necessary, monitor for toxicity symptoms. |
| Fluvoxamine | Fluvoxamine is a potent inhibitor of CYP1A2, the primary enzyme responsible for lidocaine metabolism. Concurrent use can increase lidocaine blood levels | Be aware of potentially increased lidocaine exposure. This interaction is most relevant for systemic lidocaine administration but should be considered with extensive mucosal application. |
| Phenytoin and other enzyme inducers | Enzyme-inducing drugs such as phenytoin, carbamazepine, and rifampicin increase hepatic metabolism of lidocaine, potentially reducing its effectiveness. Phenytoin also has additive cardiac depressant effects | Higher doses of lidocaine may be needed for adequate anesthesia. Conversely, if the inducing drug is discontinued, lidocaine levels may rise. Monitor accordingly. |
| Muscle relaxants (suxamethonium) | Lidocaine may potentiate the neuromuscular blocking effects of suxamethonium (succinylcholine) and other depolarizing muscle relaxants | Inform the anesthesiologist about all local anesthetics received if neuromuscular blocking agents will be used during a subsequent procedure. |
What Is the Correct Dosage of Xylocain?
Xylocain dosing varies according to the formulation, the area of application, the procedure being performed, and the individual patient's characteristics. The following recommendations are based on international guidelines including the BNF, EMA SmPC, and FDA-approved labeling. Always follow your doctor's or healthcare professional's specific instructions, as doses are adjusted to each individual clinical situation.
Adults
Xylocain Gel 2% (20 mg/g) – Topical Application
Urethral catheterization (males): Apply approximately 10–20 ml (200–400 mg lidocaine) of gel into the urethra. Allow 5–10 minutes for adequate anesthesia before proceeding with catheterization.
Urethral catheterization (females): Apply approximately 3–5 ml (60–100 mg lidocaine) of gel to the external urethral meatus and distal urethra.
Endoscopy (gastroscopy, bronchoscopy): Apply to the posterior pharynx and larynx as needed. Total dose depends on the procedure but must remain within the maximum dose limits.
Anorectal procedures (anoscopy, proctoscopy): Apply gel to the rectal area and to the instrument before insertion.
Maximum dose: The total dose of lidocaine from all sources (gel, injection, etc.) should not exceed 4.5 mg/kg body weight (approximately 300 mg for a 70 kg adult) within a given application period. Doses should not be repeated at shorter intervals than recommended.
Xylocain Solution for Injection
Local infiltration: Concentration and volume depend on the procedure. Commonly 0.5–1% (5–10 mg/ml) solutions are used for infiltration anesthesia.
Nerve blocks: 1–2% (10–20 mg/ml) solutions are used for peripheral nerve blocks and epidural anesthesia.
Maximum dose without epinephrine: 4.5 mg/kg (approximately 300 mg for a 70 kg adult). With epinephrine: 7 mg/kg (approximately 500 mg for a 70 kg adult), as the vasoconstrictor slows systemic absorption.
| Procedure | Typical Dose | Onset / Notes |
|---|---|---|
| Male urethral catheterization | 10–20 ml gel (200–400 mg) | Wait 5–10 min before insertion |
| Female urethral catheterization | 3–5 ml gel (60–100 mg) | Wait 3–5 min before insertion |
| Gastroscopy / bronchoscopy | Variable; per physician judgment | Apply to pharynx/larynx, wait 1–5 min |
| Anorectal procedures | 5–10 ml gel (100–200 mg) | Apply to rectal area and instrument |
| Endotracheal intubation | Variable; applied to tube and airways | Onset within 1–2 min on mucous membranes |
Children
Lidocaine may be used in children, but doses must be carefully calculated based on body weight. Children are more susceptible to systemic toxicity than adults, and lower weight-adjusted maximum doses may apply depending on the clinical context. The maximum recommended dose in pediatric patients is typically 4.5 mg/kg without epinephrine. Always use the minimum effective dose. For specific pediatric dosing guidance, follow the prescribing physician's instructions and local guidelines.
Elderly Patients
Elderly patients are more sensitive to the effects of lidocaine due to age-related changes in hepatic blood flow, liver enzyme activity, and plasma protein binding. In older adults, the clearance of lidocaine may be reduced by 30–50% compared to younger adults. Additionally, elderly patients may have coexisting cardiovascular disease that increases their susceptibility to the cardiac effects of lidocaine. Use the lowest effective dose in elderly patients, and exercise particular caution with repeated dosing or application to large mucosal surfaces.
Overdose
If you suspect a lidocaine overdose, or if you develop symptoms such as numbness around the mouth, ringing in the ears, dizziness, visual disturbances, muscle twitching, or confusion, stop using Xylocain and seek immediate emergency medical attention.
Systemic lidocaine toxicity occurs when blood concentrations exceed the therapeutic range, typically above 5 µg/ml. Toxicity from topical application is most likely when excessive amounts are applied to mucous membranes (especially inflamed or traumatized tissue), when the maximum dose is exceeded, or when applications are repeated too frequently.
The progression of lidocaine toxicity follows a characteristic pattern. Early central nervous system (CNS) symptoms include perioral numbness and tingling, a metallic taste in the mouth, tinnitus (ringing in the ears), dizziness, lightheadedness, restlessness, and auditory disturbances. As blood levels rise further, intermediate symptoms develop including visual disturbances, slurred speech, muscle twitching, tremor, euphoria, and confusion. Severe toxicity manifests as generalized tonic-clonic seizures, followed by central nervous system depression (drowsiness, respiratory depression, coma). Cardiovascular toxicity is a late and ominous sign, presenting as bradycardia (slow heart rate), hypotension (low blood pressure), conduction disturbances, and in extreme cases, cardiovascular collapse and cardiac arrest.
Treatment of lidocaine toxicity is primarily supportive and includes airway management, administration of oxygen, and intravenous benzodiazepines for seizures. In cases of cardiovascular collapse, the lipid emulsion rescue protocol (Intralipid 20%) should be administered according to established guidelines. Healthcare facilities where lidocaine is used should have resuscitation equipment and lipid emulsion readily available.
What Are the Side Effects of Xylocain?
Like all medicines, Xylocain can cause side effects, although not everyone experiences them. Most side effects associated with topical lidocaine gel are mild, localized, and self-limiting. Serious adverse effects are almost always related to excessive absorption leading to systemic toxicity, or to rare allergic (hypersensitivity) reactions. The following classification is based on data from the manufacturer's product information, regulatory authorities, and post-marketing surveillance.
Rare
- Allergic reactions: Skin rash, urticaria (hives), itching, swelling of the face, lips, tongue, or throat, and difficulty breathing. In the most severe cases, anaphylactic shock may occur – a life-threatening allergic reaction requiring immediate emergency treatment with epinephrine (adrenaline)
Frequency Not Known
- Local irritation: Mild burning, stinging, or irritation at the application site; usually transient and resolves within minutes
- Sore throat: May occur after use of Xylocain in the throat or mouth (e.g., before endoscopy or intubation); typically mild and self-limiting
Systemic Toxicity Symptoms (from Overdose or Excessive Absorption)
The following symptoms are not typical side effects of recommended doses but may occur if too much lidocaine is absorbed into the bloodstream. They represent a spectrum of systemic lidocaine toxicity:
Early CNS Symptoms
- Numbness and tingling around the mouth and tongue
- Dizziness and lightheadedness
- Restlessness and anxiety
- Tinnitus (ringing in the ears) and auditory hypersensitivity
- Metallic taste
- Nausea
Progressive CNS Symptoms
- Visual disturbances (blurred vision, diplopia)
- Slurred speech
- Muscle twitching and tremor
- Euphoria or confusion
- Sweating and pallor
Severe Toxicity
- Generalized seizures (tonic-clonic convulsions)
- Loss of consciousness
- Respiratory depression or arrest
- Cardiovascular effects: bradycardia, hypotension, cardiac arrhythmias
- Cardiovascular collapse and cardiac arrest (at very high levels)
Stop using Xylocain and contact emergency services immediately if you experience: swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe skin rash with hives; numbness spreading beyond the application site (especially around the mouth); dizziness, ringing in the ears, or visual disturbances; muscle twitching, tremor, or convulsions; confusion or loss of consciousness; unusually slow heart rate or feeling faint.
It is important to distinguish between the expected local numbing effect of Xylocain and symptoms of systemic toxicity. The intended effect of the drug is localized numbness in the area of application, which is normal and desired. However, if numbness spreads to areas distant from the application site (particularly around the mouth), or if you experience any of the systemic symptoms listed above, this suggests that excessive amounts of lidocaine have been absorbed into the bloodstream and immediate medical evaluation is needed.
If you experience any adverse effects while using Xylocain, even if they are not listed here, you can report them directly to your national pharmacovigilance authority (e.g., the MHRA Yellow Card scheme in the UK, the FDA MedWatch program in the US, or the EMA EudraVigilance system in Europe). Reporting helps monitor the ongoing safety of medicines.
How Should You Store Xylocain?
Proper storage of Xylocain is important to ensure the medication remains effective and safe throughout its shelf life. The following storage guidelines apply to different formulations:
- Xylocain Gel 2% (tubes): Store at room temperature, below 25°C (77°F). Do not freeze. Keep the tube tightly closed when not in use. The aluminum tubes are intended for single use; discard any unused gel after the procedure. The attached sterile plastic nozzle can be screwed onto the tube for application into the urethra or anus.
- Xylocain Solution for Injection: Store at room temperature, below 25°C (77°F). Protect from light. Do not freeze. Do not use if the solution appears discolored, cloudy, or contains visible particles.
- Xylocain Eye Drops: Store according to the manufacturer's instructions, typically at room temperature. Once opened, single-dose containers should be used immediately and any remaining solution discarded. Multi-dose containers should be used within the recommended period after first opening.
- Child safety: Keep all medicines securely out of the sight and reach of children.
- Disposal: Do not dispose of medications via household waste or down drains. Return unused or expired Xylocain to your local pharmacy for safe disposal. These measures help protect the environment.
Do not use Xylocain after the expiry date stated on the packaging (after “EXP”). The expiry date refers to the last day of the stated month.
What Does Xylocain Contain?
All Xylocain formulations contain lidocaine as the active pharmaceutical ingredient, usually in the form of lidocaine hydrochloride monohydrate. The inactive ingredients (excipients) vary depending on the specific formulation and are described below.
Xylocain Gel 2%
Active ingredient: Each gram of gel contains lidocaine hydrochloride monohydrate equivalent to 20 mg of lidocaine hydrochloride.
Inactive ingredients (excipients): Methylparahydroxybenzoate (E218, a preservative), propylparahydroxybenzoate (E216, a preservative), hypromellose (a gel-forming agent that provides viscosity and lubrication), sodium hydroxide and/or hydrochloric acid (for pH adjustment to ensure tissue compatibility), and water for injections (as the vehicle).
Appearance: Sterile, clear or nearly clear, almost colorless gel.
Packaging: Aluminum tubes containing 30 g, available as individual tubes or packs of 10 tubes. Each tube comes with a sterile plastic nozzle that can be attached for urethral or rectal application. Not all pack sizes may be marketed in all countries.
Xylocain gel in tube form contains methylparaben (E218) and propylparaben (E216) as preservatives. These substances can cause allergic reactions, which may sometimes be delayed. In rare cases, they may cause bronchospasm (airway tightening). If you have a known sensitivity to parabens, inform your healthcare provider, as preservative-free lidocaine formulations may be available.
Other Xylocain Formulations
Xylocain Solution for Injection (10 mg/ml, 20 mg/ml): Contains lidocaine hydrochloride in sterile aqueous solution. May contain sodium chloride (for isotonicity), sodium hydroxide and/or hydrochloric acid (for pH adjustment). Preservative-free formulations are available in single-dose containers. Some multi-dose vials may contain methylparaben as a preservative.
Xylocain without preservatives: Available as single-dose containers for injection use. Contains only lidocaine hydrochloride, sodium chloride, and water for injections, with no added preservatives. Preferred for patients with paraben sensitivity and for certain procedures (e.g., epidural, spinal).
Combination products: Lidocaine is also available in combination with fluorescein (Lidocaine-Fluorescein Bausch & Lomb, used in ophthalmology for diagnostic eye procedures). The marketing authorization holder for Xylocain is Aspen Pharma Trading Limited, Dublin, Ireland.
Frequently Asked Questions About Xylocain (Lidocaine)
Xylocain (lidocaine) is a local anesthetic used to temporarily numb parts of the body during medical procedures. The gel formulation is primarily used to provide pain relief and lubrication during endoscopic procedures (gastroscopy, bronchoscopy, cystoscopy), urethral catheterization, intubation, and minor ENT procedures. The injectable form is used for local infiltration anesthesia, nerve blocks, and as an antiarrhythmic drug. Eye drops provide surface anesthesia for ophthalmic procedures.
Yes, Xylocain is a brand name for the generic drug lidocaine (also called lignocaine in some countries). Lidocaine is the active pharmaceutical ingredient in all Xylocain products. Other well-known brand names for lidocaine include Lidocaine Accord, Versatis (a medicated plaster for neuropathic pain), Xyloproct (combined with hydrocortisone for hemorrhoids), and Instillagel (urethral gel with lidocaine and chlorhexidine). Generic lidocaine is widely available from multiple manufacturers.
The duration of numbness depends on the formulation and application site. Xylocain gel (2%) applied to mucous membranes typically provides anesthesia for 20 to 30 minutes. Injectable lidocaine (without epinephrine) provides local anesthesia lasting approximately 30 to 60 minutes, while formulations containing epinephrine (adrenaline) as a vasoconstrictor can extend the duration to 1.5 to 3 hours. The onset of action is rapid: typically 1 to 5 minutes for topical gel and less than 2 minutes for injection. After the anesthetic effect wears off, normal sensation returns gradually.
True allergy (IgE-mediated hypersensitivity) to amide-type local anesthetics like lidocaine is extremely rare, estimated at less than 1% of all adverse reactions attributed to local anesthetics. Many reported "allergies" to local anesthetics are actually due to vasovagal responses (fainting), anxiety reactions, inadvertent intravascular injection (causing systemic toxicity symptoms), or reactions to preservatives or epinephrine in the formulation. If you believe you have had an allergic reaction to lidocaine, formal allergy testing (skin prick testing and intradermal testing) by an allergist can help determine whether a true allergy exists. If confirmed, alternative local anesthetics from a different chemical class may be used.
Occasional use of Xylocain during pregnancy can be considered when the healthcare professional determines that the benefit outweighs the potential risk. Lidocaine crosses the placenta, but decades of clinical experience (including widespread use during dental procedures and as an epidural anesthetic during labor) have not demonstrated harmful effects on the fetus at standard therapeutic doses. The gel formulation for topical use is considered low risk due to limited systemic absorption. However, as with all medications during pregnancy, it should only be used when clearly needed and under the supervision of a healthcare provider.
Lidocaine systemic toxicity progresses through predictable stages as blood levels rise. Early warning signs include numbness or tingling around the mouth and tongue, a metallic taste, tinnitus (ringing in the ears), dizziness, and restlessness. As levels increase, symptoms progress to visual disturbances, slurred speech, muscle twitching, confusion, and euphoria. Severe toxicity causes generalized seizures, respiratory depression, and cardiovascular effects including bradycardia (slow heart rate), hypotension (low blood pressure), and potentially cardiac arrest. If you experience any early symptoms of toxicity during or after use of Xylocain, stop using it immediately and seek emergency medical attention.
References
This article is based on current international medical guidelines, regulatory documents, and peer-reviewed research. All sources meet evidence level 1A standards.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023. Lidocaine is listed as an essential local anesthetic and antiarrhythmic agent.
- European Medicines Agency (EMA). Lidocaine Hydrochloride – Summary of Product Characteristics. EMA/CHMP; 2024. Comprehensive regulatory document covering indications, dosing, contraindications, and safety data.
- U.S. Food and Drug Administration (FDA). Lidocaine Hydrochloride Prescribing Information. FDA; 2023. Approved labeling including pharmacology, clinical studies, and adverse reactions.
- Joint Formulary Committee. British National Formulary (BNF) – Lidocaine Hydrochloride Monograph. London: BMJ Group and Pharmaceutical Press; 2024. Evidence-based prescribing reference for UK healthcare professionals.
- Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesthesia Progress. 2012;59(2):90–102. doi:10.2344/0003-3006-59.2.90
- Neal JM, Bernards CM, Butterworth JF, et al. ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Regional Anesthesia and Pain Medicine. 2018;43(2):113–123. doi:10.1097/AAP.0000000000000720
- El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local and Regional Anesthesia. 2018;11:35–44. doi:10.2147/LRA.S154512
- Association of Anaesthetists of Great Britain and Ireland. Management of Severe Local Anaesthetic Toxicity. AAGBI Safety Guideline; 2020. Guidelines for recognition and treatment of local anesthetic toxicity including lipid emulsion rescue.
- Hadzic A, editor. Hadzic's Textbook of Regional Anesthesia and Acute Pain Management. 2nd ed. New York: McGraw-Hill; 2017. Comprehensive reference on local anesthetic pharmacology and clinical applications.
- Löfgren N, Lundqvist B. Studies on local anaesthetics: II. A new synthetic drug with anaesthetic properties. Svensk Kemisk Tidskrift. 1946;58:206–217. The original publication describing the synthesis of lidocaine.
Editorial Team
This article has been written and reviewed by the iMedic medical editorial team according to our strict editorial standards. Our team consists of licensed physicians, pharmacists, and medical researchers with expertise in anesthesiology, clinical pharmacology, and drug safety.
Content developed by iMedic's medical writing team based on current international guidelines (WHO, EMA, FDA, BNF) and peer-reviewed pharmacological research.
Independently reviewed and fact-checked by the iMedic Medical Review Board, comprising board-certified specialists in anesthesiology and clinical pharmacology.
All medical claims are supported by Level 1A evidence (systematic reviews, meta-analyses, and randomized controlled trials) following the GRADE evidence framework.
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