Lidocaine therapy with an exponentially declining infusion. Clinical evaluation of an optimized dosing technique.

A novel technique to achieve rapidly and continually maintain therapeutic lidocaine concentrations was designed according to known pharmacokinetic properties of the drug and was tested in 12 patients who required immediate lidocaine prophylaxis because of suspected acute myocardial infarction. The serum lidocaine concentrations achieved by this method remained within the therapeutic range (1.2 to 5.0 mg/L) in 83 of 84 determinations and showed little fluctuation over time for individual patients. Unlike previously recommended dose regimens for lidocaine, this technique uses an exponentially declining infusion and has the advantages of greater simplicity, less chance of medication error, and avoidance of rapid changes of lidocaine concentrations. Furthermore, similar methods can be applied when rapid attainment of stable plasma drug concentrations is needed for clinical or experimental pharmacologic studies.