Cathejell® [Lidocaine, chlorhexidine]

Pharmacological properties

Cathejell with lidocaine - a sterile antiseptic gel with a local anesthetic effect. by local, surface anesthesia, a cathejel with lidocaine provides anesthesia of the mucous membrane, which leads to a rapid symptomatic reduction in pain. anesthesia occurs within 5–10 minutes after application of the drug and lasts 20–30 minutes. in addition to the analgesic effect, a cathejel with lidocaine significantly prevents urinary tract infections after catheterization.

Lidocaine is a clinically tested anesthetic of the amide group for topical application. Lidocaine reversibly and locally inhibits the conductivity of sensory nerve fibers. Sensitivity decreases consecutively: cold / heat, touch and pressure. With local anesthesia, the effect of the drug occurs in 3-5 minutes. In inflammatory tissues, its effect decreases due to the acidic pH that dominates. In addition to the anesthetic effect, lidocaine also has an antiarrhythmic effect. Unlike most other local anesthetics, lidocaine does not have a vasodilating effect.

Chlorhexidine is an antimicrobial drug that is active against most gram-positive and gram-negative bacteria, as well as against a number of fungi and viruses. As part of the drug, chlorhexidine acts as a prophylactic to prevent iatrogenic infections with topical application.

Indications

For local anesthesia of the mucous membrane and as a lubricant for urethral catheterization, probing, endoscopic examinations, endotracheal intubation.

Application

The use of the drug with the introduction of a catheter, endoscope or other medical instruments into the urethra.

The corrugated syringe tube contains 12.5 g of gel, of which approximately 10 g enter the urethra during instillation.

Recommended doses for adult men: 12.5 g of the drug is used to adequately fill the urethra. The contents of one corrugated syringe tube are enough to fill the urethra. For one manipulation, it is not recommended to use more than one tube. The drug begins to act in 5-10 minutes.

Women, children (aged 2-12 years) and adolescents (aged 12 years): there are no special recommendations regarding dosing in this category of patients. Do not use more than 4 doses for 24 hours.

Mode of application:

1. Clean and disinfect the external opening of the urethra.

2. Remove the paper that covers the transparent blister to the tapered end.

3. Break off the tip of the tube; if possible, leaving the tube in a blister.

4. Remove the tube tip completely to prevent it from accidentally getting into the urethra.

5. Squeeze out a drop of gel to facilitate insertion of the tip.

6. Gently pushing the tube, slowly introduce the gel into the urethra.

The remains of the drug should be discarded with a syringe tube.

Anesthesia for general and tracheal intubation

Adults and children over 15 years of age: Evenly distribute approximately 5 ml of gel across the lower third of the tube. To avoid drying, the gel is applied to the instrument immediately before use. The gel should not fall deep into the lumen of the tube. For adults with an average body weight, the maximum dose of Cathejell with lidocaine is 16 g.

Doses for children aged 2-15 years: for children under 15 years of age, the dose of the drug should not exceed 6 mg of lidocaine (= 0.3 ml of gel / kg of body weight). Do not use more than 4 doses for 24 hours.

Dosage recommendations for patients at risk

For elderly people, weakened and seriously ill patients, as well as in case of impaired liver function or severe renal failure, the dose of the drug should be selected individually.

The maximum single dose is calculated in mg of lidocaine hydrochloride per 1 kg of body weight (2.9 mg of lidocaine hydrochloride / kg of body weight).

Contraindications

Hypersensitivity to one of the components of the drug, as well as hypersensitivity to other local amide type anesthetics; bulbocavernous (urethrocavernous) reflux; severe heart failure (iv functional class according to nyha classification); severe bradycardia (33 bpm); severe av blockade (grade III); cardiogenic shock; hypovolemic shock.

Side effects

Adverse reactions after the use of the drug Cathejell with lidocaine are rare (1/10 000), if the drug is used according to the dosage recommendations and route of administration.

Cases of local and / or systemic hypersensitivity reactions to lidocaine and / or chlorhexidine can rarely be observed.

special instructions

Avoid contact with lidocaine cathejel in the eyes. the drug should be used with caution in patients with severe hepatic impairment (stage III and iv), impaired renal function (creatinine clearance 30 ml / min), and severe cardiac or respiratory function impairment (stage III – iv).

Use during pregnancy and lactation. During pregnancy, Cathejell with lidocaine can be used only after a thorough analysis by the doctor of the benefit / risk ratio and after establishing an individual dose. Repeated use of the drug during pregnancy is not recommended. During lactation, Cathejell with lidocaine should be used only if necessary; doses should be selected individually. The interval between instillation of Cathejell with lidocaine and the next breastfeeding should be 12 hours. Repeated use of the drug during breastfeeding is not recommended.

Children. Do not prescribe Cathejell with lidocaine for children under 2 years of age.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. Cathejell with lidocaine practically does not affect the ability to drive vehicles or work with other mechanisms, but its influence cannot be completely excluded in cases of increased individual sensitivity.

Interactions

Cathejell with lidocaine should not be used in combination with preparations containing lidocaine hydrochloride, or with other local amide type anesthetics, as this can lead to unpredictable mutual influence of the drugs.

Due to the possible additive effect on the heart muscle, lidocaine should be used carefully in patients who are simultaneously receiving antiarrhythmic drugs, such as mexiletine and tocainide, β-adrenergic blockers (e.g. propranolol) or calcium channel antagonists (e.g. diltiazem, verapamil).

Propranolol, diltiazem and verapamil lead to a significant increase in T_½ due to a decrease in clearance of lidocaine. Drugs that reduce lidocaine clearance can lead to potentially toxic plasma concentrations if lidocaine is reused in high doses for a long time. Therefore, with the short-term use of Cathejell with lidocaine in recommended doses, such interactions do not have clinical significance.

Special studies of the interaction of lidocaine and class III antiarrhythmic drugs (e.g. amiodarone) have not been carried out, but caution is advised when used together.

Caution must be exercised in the combined use of Cathejell with lidocaine and cimetidine, an antagonist of H₂receptors. The concentration of lidocaine in blood plasma may increase due to a decrease in hepatic perfusion and inhibition of microsomal enzymes.

Overdose

With the correct use of a cathejel with lidocaine in the blood plasma, a toxic concentration of the drug is not reached (5 μg / ml). however, combined use with other local anesthetics can cause an additive effect, which, in turn, can lead to an overdose of the drug with the subsequent development of systemic toxic reactions.

Storage conditions

In the dark place.