Drug General Information (ID: DDIV5W6F4B)
Drug Name			Lidocaine		Drug Info		Tocainide		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anesthetics				Antiarrhythmic Agents
Structure

Mechanism of Lidocaine-Tocainide Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Lidocaine				Tocainide
Mechanism		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Lidocaine and Tocainide

Recommended Action
Management		Management consists of cautiously starting patients on tocainide six hours before stopping lidocaine infusions, then starting the next maintenance dose of tocainide six hours after the lidocaine drip has ended. The patient's heart rhythm and clinical response should be monitored during this time.

References
1	Product Information. Tonocard (tocainide). Merck & Co, Inc, West Point, PA.
2	Forrence E, Covinsky JO, Mullen C "A seizure induced by concurrent lidocaine-tocainide therapy: is it just a case of additive toxicity?" Drug Intell Clin Pharm 20 (1986): 56-9. [PMID: 3080299]