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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 15 - Anaesthesia 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
15.02 Local anaesthesia
15.02 Articaine
15.02 Bupivacaine
15.02 Levobupivacaine
15.02 Lidocaine

Lidocaine

RED
Formulary
0.5% & 1% Injection (10mL)
1% & 2% Injection (5mL)
1% Injection Ampoule

BNF BNFc SPC

Lidocaine 10%
(Spray)

GREEN
Formulary

10mg/dose

Use Xylonor spray whilst there is a shortage [update Jan 2025]

BNF BNFc SPC

Lidocaine 2.5% with Prilocaine 2.5% (EMLA®)
(Cream)

GREEN
Formulary
BNF BNFc SPC

Lidocaine 5% and Phenylephrine 0.5%
(Topical Spray )

RED
Formulary
BNF BNFc SPC

Lidocaine 5% Plaster

 
Restricted Drug Restricted

Current cost-effective brand in primary care is Ralvo

 

Amber SPA Restricted - Must be initiated only for the licensed indication: post herpetic neuralgia.

The evidence for the effectiveness of lidocaine medicated plasters is limited, of low quality, and the clinical effectiveness remains unclear. However, low quality individual studies indicate that it may have a role in pain relief.

Response to treatment should be evaluated after 4 weeks of treatment. Patients with an inadequate initial response after 4 weeks, (improvement after this time is unlikely) – DISCONTINUE treatment.

The therapeutic benefit should be reassessed regularly at least every three months.

 

Red Restricted - For the treatment of pain in acute rib fractures as an inpatient and for no more than 7 days post discharge. [DTC Approved Sept 2023]

 

The DTC previously approved for palliative patients for neuropathic pain where systemic treatment is not tolerated. This indication is under review.

Entry reviewed: November 2023

BNF BNFc SPC

Lidocaine with Adrenaline (1% / 1:200,000)

RED
Formulary
BNF BNFc SPC

Lidocaine2% with Chlorhexidine 0.25%
(Gel)

GREEN
Formulary

Brands include Instillagel.

Pharmacy product - not from Materials Management

BNF BNFc SPC

LMX Lidocaine

RED
Formulary
Lidocaine W/W 4% Cream
BNF BNFc SPC

LAT
(Gel)

RED
Restricted Drug Restricted
LAT Gel

Restricted - To be used prior to suturing of wounds in children only
BNF BNFc SPC
Non formulary items

Lidocaine 150mg/g & Cetrimide 1.5mg/g spray (Xylonor® Spray)

RED
Non Formulary

FOR USE ONLY WHILST THERE IS A SHORTAGE OF LIDOCAINE 10mg SPRAY 

Each actuation delivers approximately a dose of 10mg of lidocaine and 0.1mg of cetrimide.

Dose equivalence and conversion

1 metered dose of Xylonor spray is equivalent to 10mg of lidocaine.

[Update Jan 2025]

BNF BNFc
15.02 Mepivacaine
15.02 Prilocaine
15.02 Procaine
15.02 Ropivacaine
15.02 Tetracaine
15.02 Other local anaesthetics
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.