LidoSite and Norepinephrine Bitartrate

• Generic Name: epinephrine / lidocaine
• Dosage Forms: Topical Iontophoretic Patch and Controller
• Other Brand Names: D-Care 100X, Lignospan Forte, Lignospan Standard, Xylocaine MPF With Epinephrine, Xylocaine With Epinephrine

LidoSite uses an active transdermal delivery technology known as iontophoresis, which administers medications through the skin via a mild electric current. The LidoSite system administers lidocaine and epinepherine using a patented electrotransport technology that enables the controlled delivery of medication over a predetermined period of time, from minutes to days. Topical anesthetic creams and patches can take up to an hour to numb the skin, while LidoSite works in 10 minutes. LidoSite has successfully completed clinical trials and has been found to significantly decrease pain from needle injections and similar procedures in both adults and children. Lidosite is intended to also address a strong need in adult applications. Its major impact is expected to be in the pediatric population, where pain associated with needlesticks, blood-draw procedures and immunizations is a major issue for the clinician, child and parent.

• Generic Name: norepinephrine
• Dosage Forms: n.a.
• Other Brand Names: Levophed, Levophed Bitartrate

Used as adjunctive therapy to produce vasoconstriction and maintain BP in the management of certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, MI, septicemia, blood transfusion, drug reactions).

Pressor therapy is not a substitute for replacement of blood, plasma, fluids, and/or electrolytes. Correct blood volume depletion as fully as possible before administration.

The Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock recommend norepinephrine as the vasopressor of choice in adults with septic shock; if adequate BP not achieved, vasopressin or epinephrine may be added. Vasopressin also may be given in conjunction with norepinephrine to reduce dosage requirements of norepinephrine.

Also used to provide vasopressor support in other types of shock (e.g., cardiogenic, hemorrhagic), generally as a temporary measure until underlying cause can be treated.

In patients who are hypotensive from blood volume deficits, manufacturer states to use norepinephrine only as an emergency measure to maintain coronary and cerebral artery perfusion until blood volume replacement therapy can be completed.

Early revascularization is standard of care in patients with cardiogenic shock; individualize use of vasopressors in this setting.

Has been used to treat hypotension during spinal anesthesia; however, other vasopressors with a longer duration (e.g., phenylephrine) more commonly used.

Used adjunctively in the management of cardiac arrest to restore and maintain adequate BP after an effective heartbeat and ventilation have been established by other means.

High-quality CPR and defibrillation are the only proven interventions to increase survival to hospital discharge in ACLS. Other resuscitative efforts, including drug therapy, are considered secondary and should be performed without compromising the quality and timely delivery of chest compressions and defibrillation.

Principal goal of pharmacologic therapy during cardiac arrest is to facilitate the return of spontaneous circulation (ROSC), and epinephrine is the drug of choice for this use. Vasoactive drugs such as norepinephrine may be used for hemodynamic support following resuscitation.