Diversifying the Pain Management Toolbox: A review of IV Lidocaine and Oral Mexiletine as Non-opioid Options
by Stephaney Cheng, 2022 PharmD Candidate, Katie M. Fermanich, 2022 PharmD Candidate, Sommer L. Gay, 2022 PharmD Candidate, Jillian M Kolasinski, 2022 PharmD Candidate
"In 2017, the US Department of Health and Human Services declared the opioid epidemic a public health emergency. The following year, approximately 10.3 million Americans misused prescription opioids, highlighting the need for safe and effective alternative pain management options. One solution to the growing epidemic is the use of intravenous (IV) lidocaine for the management of both acute and chronic pain. Lidocaine is a class 1B sodium channel blocker and produces analgesia and anti-inflammatory effects at low doses. Lidocaine is commonly used as a local injection, and increasingly used via IV to manage perioperative pain. Intravenous lidocaine has additionally been used in the management of neuropathic pain, fibromyalgia, burns and other pain conditions, and may reduce or even eliminate the need for opioids in both acute and chronic pain management.
Another pain management alternative is mexiletine, the oral analogue of lidocaine. Similar to lidocaine, mexiletine is a class 1B sodium channel blocker with analgesic properties useful in the treatment of neuropathic pain. Currently, mexiletine usage in chronic pain therapy is limited due to a perceived lack of efficacy and tolerability. One study demonstrated that a stronger response to IV lidocaine was predictive of patient acceptance of mexiletine. Additionally, mexiletine provides unique benefits as an oral therapy in comparison to lidocaine, which may not be delivered orally due to high first-pass metabolism. Although it is not commonly used as a first-line option, mexiletine can be considered as a safe alternative to opioids for chronic pain management. The purpose of this article is to raise pharmacists’ awareness of the use and benefits of two non-opioid pain management medications, IV lidocaine and oral mexiletine."
Keywords: Mexiletine, Analgesics, Opioid, Lidocaine, Pain Management, Chronic Pain, Sodium Channel Blockers, Fibromyalgia, Pharmacists, Public Health, Opioid Epidemic, Neuralgia, Analgesics, Analgesia, Burns, Prescriptions, United States Dept. of Health and Human Services, Anti-Inflammatory Agents
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2021 March/April Table of Contents
"In 2017, the US Department of Health and Human Services declared the opioid epidemic a public health emergency. The following year, approximately 10.3 million Americans misused prescription opioids, highlighting the need for safe and effective alternative pain management options. One solution to the growing epidemic is the use of intravenous (IV) lidocaine for the management of both acute and chronic pain. Lidocaine is a class 1B sodium channel blocker and produces analgesia and anti-inflammatory effects at low doses. Lidocaine is commonly used as a local injection, and increasingly used via IV to manage perioperative pain. Intravenous lidocaine has additionally been used in the management of neuropathic pain, fibromyalgia, burns and other pain conditions, and may reduce or even eliminate the need for opioids in both acute and chronic pain management.
Another pain management alternative is mexiletine, the oral analogue of lidocaine. Similar to lidocaine, mexiletine is a class 1B sodium channel blocker with analgesic properties useful in the treatment of neuropathic pain. Currently, mexiletine usage in chronic pain therapy is limited due to a perceived lack of efficacy and tolerability. One study demonstrated that a stronger response to IV lidocaine was predictive of patient acceptance of mexiletine. Additionally, mexiletine provides unique benefits as an oral therapy in comparison to lidocaine, which may not be delivered orally due to high first-pass metabolism. Although it is not commonly used as a first-line option, mexiletine can be considered as a safe alternative to opioids for chronic pain management. The purpose of this article is to raise pharmacists’ awareness of the use and benefits of two non-opioid pain management medications, IV lidocaine and oral mexiletine."
Keywords: Mexiletine, Analgesics, Opioid, Lidocaine, Pain Management, Chronic Pain, Sodium Channel Blockers, Fibromyalgia, Pharmacists, Public Health, Opioid Epidemic, Neuralgia, Analgesics, Analgesia, Burns, Prescriptions, United States Dept. of Health and Human Services, Anti-Inflammatory Agents
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2021 March/April Table of Contents