April 4, 1977

Pharmacokinetics of Lidocaine-Reply

JAMA. 1977;237(14):1434. doi:10.1001/jama.1977.03270410033007

In Reply.—  We appreciate the opportunity to consider the comments of Dr Lawyer and of Drs Wheeler et al.The major point of our article was that judicious application of pharmacokinetic principles can enhance the likelihood of safe and effective pharmacotherapy with a drug such as lidocaine, for which there is reasonably good data suggesting a relation between blood concentration and clinical efficacy and toxicity. We chose representative data from a previous publication1 to illustrate this point. Dr Lawyer raises an interesting issue regarding these data, but it is not really pertinent to our conceptual objective.Other more complicated pharmacokinetic schemes, such as those suggested by Drs Wheeler et al and by Jelliffe et al,2 may come closer to "optimizing" lidocaine therapy than the one suggested by us. However, one must consider not only the potential benefits of more complex schemes, but also the possible disadvantages. These include