A Hypothesis for the Rapid Attainment and Maintenance of Lidocaine Plasma Levels

¹ Department of Pharmaceutics, School of Pharmacy, State University of New York at Buffalo, Buffalo, N.Y. 14214.

The frequent occurrence of life-threatening arrhythmias in the early phase of acute myocardial infarction requires that therapeutic blood levels of an effective antiarrhythmic agent such as lidocaine be established as early as possible. The usual practice of administering an intravenous bolus injection followed by constant-rate infusion of lidocaine can easily lead to either toxic or subtherapeutic blood levels depending on the size of the bolus dose. Based on clinical data and theoretical considerations, it is shown that an essentially constant effective blood level of the drug may be achieved in less than 5 minutes if an appropriate loading dose is given as an intramuscular injection concomitant with a constant-rate intravenous infusion.

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