Xylogard infusion indication?
Reading File
Finding Sources
Searching the Web
Xylogard infusion lidocaine indication
Searching PubMed
"lidocaine"[MeSH Terms] AND "ventricular tachycardia"[MeSH Terms]
I couldn't find a product called "Xylogard". It is probably a regional brand of IV lidocaine (lignocaine) for arrhythmias, like Xylocard, but please check the label or ampoule to confirm the active ingredient. If it is lidocaine, the indication is below.
Indication (IV lidocaine infusion)
- Acute treatment of ventricular arrhythmias. The Xylocard product monograph lists ventricular tachycardia during cardiac manipulation (surgery, catheterization). It also lists VT during acute MI, digitalis toxicity, or other cardiac disease.
- The infusion is for patients whose arrhythmia tends to recur after a bolus and who can't take oral antiarrhythmics. The monograph gives 1-2 mg/min, about 15-30 µg/kg/min in a 70 kg adult, after a loading bolus.
- The FDA lidocaine/dextrose label gives the same indication.
Why an infusion follows the bolus
- A single bolus only suppresses the arrhythmia briefly. It redistributes out of the central compartment quickly, so concentrations fall. - Goodman & Gilman's The Pharmacological Basis of Therapeutics, Clinical Pharmacokinetics
- Lidocaine blocks sodium channels mainly in ventricular tissue, not atrial tissue. It is used for acute control and prevention of ventricular arrhythmias after MI. - Henry's Clinical Diagnosis and Management by Laboratory Methods, Lidocaine
Current role
- It is a second-line option for stable VT and for refractory VF or pulseless VT. Amiodarone is preferred, and lidocaine is used if amiodarone is unavailable. - Tintinalli's Emergency Medicine, Lidocaine (Lignocaine)
Safety points
- Give it under continuous ECG and blood pressure monitoring.
- Stop it once the rhythm is stable or at the first signs of toxicity.
- Reduce the infusion rate in hepatic impairment, severe renal impairment (eGFR below 30), heart failure and low cardiac output. Clearance is lower in these patients and the drug can accumulate over prolonged (24 hour) infusions.
- Lidocaine is incompatible with some drugs, including phenytoin and cephazolin.
Don't confuse it with the analgesic use. IV lidocaine is also used off-label as a perioperative analgesic infusion. That use is contraindicated in patients with arrhythmia or heart failure. - Barash, Cullen, and Stoelting's Clinical Anesthesia, 9e, Table 55-17
The recent PubMed meta-analyses I found covered only the perioperative analgesic use. None of them changes the antiarrhythmic indication above.
If you tell me the country and the active ingredient on the label, I can confirm the exact product and dosing.
Difference between xylocard and cordararone
Finding Sources
Finding Sources
Searching PubMed
"amiodarone"[MeSH Terms] AND "lidocaine"[MeSH Terms]
Xylocard is lidocaine and Cordarone is amiodarone. Both are IV antiarrhythmics for ventricular arrhythmias, but they are different drugs. Cordarone also comes as an oral tablet.
| Xylocard (lidocaine) | Cordarone (amiodarone) | |
|---|---|---|
| Class | Class Ib (sodium channel blocker) | Class III (potassium channel blocker). It also has class I, II and IV actions. |
| Main target | Ventricular tissue, not atrial. Most active in ischemic, depolarized myocardium. | Atrial and ventricular arrhythmias |
| Indications | Acute ventricular arrhythmias: VT during cardiac manipulation, acute MI or digitalis toxicity (per the Xylocard monograph) | VT and VF, and also AF, flutter and SVT (rhythm control) |
| Cardiac arrest (VF/pulseless VT) | Alternative if amiodarone is unavailable | Preferred option |
| Typical IV dosing | Bolus, then 1-2 mg/min infusion | 300 mg bolus in arrest. In stable tachyarrhythmia, 150 mg over 10 min, then 1 mg/min for 6 h. - Tintinalli's Emergency Medicine |
| Onset and duration | Fast, short-lived. A bolus redistributes quickly, so an infusion is needed. - Goodman & Gilman's | Slower onset. Very long half-life because of tissue storage. |
| Long-term use | None. Infusion for hours only. | Oral maintenance is possible, with organ toxicity |
| Key adverse effects | CNS (perioral numbness, tinnitus, confusion, seizures) and bradycardia or hypotension at high levels. It accumulates in hepatic failure, heart failure or low output. | Hypotension and bradycardia (IV); thyroid dysfunction (hypo or hyper); pulmonary fibrosis; liver injury; corneal deposits; skin discoloration. It needs regular liver, lung, thyroid and eye monitoring. - Tintinalli's Emergency Medicine, Table 19-15 |
| QT effect | Minimal | Prolongs QT, but torsades is uncommon |
| Interactions | Few that matter acutely | Many. It inhibits CYP and P-gp, so it raises warfarin, digoxin and DOAC levels. |
Key points
- Cardiac arrest: The 2020 AHA ACLS guidelines say amiodarone may be considered for VF/pulseless VT unresponsive to CPR, defibrillation and a vasopressor. Lidocaine is an alternative. - Miller's Anesthesia, 10e, Antiarrhythmia Medications
- Survival evidence: A large 2016 trial found no survival benefit for either drug over placebo in shock-refractory VF or pulseless VT. - Tintinalli's Emergency Medicine
- Choosing between them: Lidocaine suits short-term suppression of ventricular ectopy or VT, particularly in ischemia. Amiodarone suits broader or longer-term rhythm control, including AF, but only if the patient can accept its toxicity.
A 2025 meta-analysis found an increased bleeding risk when amiodarone is combined with DOACs. This is relevant if the patient is anticoagulated. I found no recent evidence that changes the comparison above.
This is a shared conversation. Sign in to Orris to start your own chat.