If amiodarone is not available, which lidocaine dosing regimen is recommended?

• A. 0.5 mg/kg IV/IO initial dose, max 2 mg/kg
• B. 2 mg/kg IV/IO initial dose
• C. 1 to 1.5 mg/kg IV/IO initial dose, followed by 0.5 to 0.75 mg/kg IV/IO every 5-10 minutes, up to 3 mg/kg
• D. 0.3 mg/kg IV/IO initial dose, max 2 mg/kg

Answer: (C)

When amiodarone isn’t available, lidocaine is used as the alternative antiarrhythmic for shockable ventricular arrhythmias in ACLS. The best dosing approach is to give an initial bolus of 1 to 1.5 mg/kg IV/IO. If arrhythmias persist, repeat with 0.5 to 0.75 mg/kg IV/IO every 5–10 minutes, up to a total cumulative dose of 3 mg/kg. This titrated bolus strategy quickly achieves effective plasma levels while keeping the total amount limited to reduce toxicity. If ongoing suppression is needed after the boluses, an infusion of lidocaine (e.g., 1–4 mg/min) can be considered. Monitor for signs of toxicity, especially in patients with liver impairment or possible conduction disturbances.