Kido Kazuhiko
Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA.
Clin Cardiol. 2025 Apr;48(4):e70126. doi: 10.1002/clc.70126.
Lidocaine is an antiarrhythmic with narrow therapeutic window indicated for refractory ventricular arrhythmia. Limited guidance is available regarding the initial infusion rate ranging from 1 to 4 mg/min in patients with heart failure (HF).
The primary objective was to assess the optimal initial dosing of lidocaine therapy in patients with HF and ventricular arrhythmia.
The retrospective cohort study was performed to include patients aged 18 years or older with past medical history of HF or new onset HF who developed ventricular arrythmia requiring lidocaine therapy in cardiovascular intensive care units. The primary outcome was lidocaine levels within the therapeutic ranges (defined as 1.5 to 5.0 μg/L). The study also described the predictive performance of lidocaine one compartment PK model using correlation efficient between the population PK model-predicted levels and observed levels.
A total of 56 patients with HF and ventricular arrhythmia was included. The mean lidocaine maintenance dose was 1.1 ± 0.5 mg/min. The median (IQR) lidocaine level was 3.1 (2.3, 4.1) μg/L. The probabilities within therapeutic, supratherapeutic, and subtherapeutic ranges were 66.1%, 19.6%, and 14.3%, respectively in the whole cohort. Predicted lidocaine levels with one compartment PK model were not correlated with observed lidocaine levels (R = 0.34). The simulation investigation showed that 1 mg/min rate achieved the highest probability within therapeutic range compared to 0.5, 1.5, and 2.0 mg/min rates (78.6 vs. 53.6, 53.6, and 28.6%, respectively).
Lidocaine initial infusion rate should be up to 1 mg/min in patients with HF and ventricular arrhythmia.
利多卡因是一种治疗窗狭窄的抗心律失常药物，用于难治性室性心律失常。对于心力衰竭（HF）患者，关于初始输注速率为1至4毫克/分钟的指导有限。
主要目的是评估HF合并室性心律失常患者利多卡因治疗的最佳初始剂量。
进行回顾性队列研究，纳入年龄在18岁及以上、有HF病史或新发HF且在心血管重症监护病房发生需要利多卡因治疗的室性心律失常的患者。主要结局是利多卡因水平在治疗范围内（定义为1.5至5.0微克/升）。该研究还使用群体药代动力学模型预测水平与观察水平之间的相关系数描述了利多卡因一室药代动力学模型的预测性能。
共纳入56例HF合并室性心律失常患者。利多卡因的平均维持剂量为1.1±0.5毫克/分钟。利多卡因水平的中位数（四分位间距）为3.1（2.3，4.1）微克/升。在整个队列中，治疗范围内、治疗范围以上和治疗范围以下的概率分别为66.1%、19.6%和14.3%。一室药代动力学模型预测的利多卡因水平与观察到的利多卡因水平不相关（R = 0.34）。模拟研究表明，与0.5、1.5和2.0毫克/分钟的速率相比，1毫克/分钟的速率在治疗范围内达到的概率最高（分别为78.6%对53.6%、53.6%和28.6%）。
HF合并室性心律失常患者利多卡因的初始输注速率应高达1毫克/分钟。
