Lidocaine with epinephrine comes in 0.5% to 2% strengths with epinephrine 1:100,000 or 1:200,000. It comes as multiple-dose vials with a preservative or as preservative-free single-dose vials. Every version contains a sulfite. Here's how to buy the right one.
· 4 min read
Written and clinically reviewed by Jacob Fuchs, PharmD
Reviewed on
Lidocaine with epinephrine comes in 0.5%, 1%, 1.5%, and 2% lidocaine, with epinephrine at 1:100,000 or 1:200,000. It comes in two kinds of vial. Multiple-dose vials contain a preservative (methylparaben). Preservative-free single-dose vials (labeled "MPF") are the only ones the label allows for epidural or caudal use. Every epinephrine-containing version also contains a sulfite.
Those three facts decide what you should order. Here's each one, using Fresenius Kabi's Xylocaine label as the example (FDA label, rev. 10/2024). Other manufacturers' products are similar but not identical, so check the label on the NDC you actually buy.
From the Xylocaine with epinephrine label (FDA label):
| Product | Lidocaine | Epinephrine | Vial type | Sizes |
|---|---|---|---|---|
| Xylocaine with Epinephrine | 1% | 1:100,000 | Multiple-dose | 10, 20, 50 mL |
| Xylocaine with Epinephrine | 2% | 1:100,000 | Multiple-dose | 20, 50 mL |
| Xylocaine with Epinephrine | 0.5% | 1:200,000 | Multiple-dose | 50 mL |
| Xylocaine-MPF with Epinephrine | 1% | 1:200,000 | Single-dose, preservative-free | 10, 30 mL |
| Xylocaine-MPF with Epinephrine | 1.5% | 1:200,000 | Single-dose, preservative-free | 10, 30 mL |
| Xylocaine-MPF with Epinephrine | 2% | 1:200,000 | Single-dose, preservative-free | 10, 20 mL |
Your clinicians pick the strength. Purchasing's job is to make sure the box that shows up matches what they picked: strength, epinephrine ratio, vial type, and size.
Because the ratio rule has an exception. In 2016, USP labeling standards dropped ratio strengths like "1:1,000" from single-ingredient injectables. Local anesthetics combined with epinephrine kept them, so you'll still see "1:100,000" on lidocaine with epinephrine (APSF).
If someone on your team wants it in milligrams: 1:100,000 means 1 gram in 100,000 mL, which is 0.01 mg/mL (10 mcg/mL). 1:200,000 is 0.005 mg/mL (5 mcg/mL). That's just converting units. It isn't a dose.
The label's rule is short: "Use only the single-dose vials for caudal or epidural anesthesia" (FDA label).
If your practice does any procedure where the clinician wants preservative-free, stock MPF separately and label the bin. The two look a lot alike on a shelf.
The epinephrine in these solutions is protected by an antioxidant. The label lists 0.5 mg sodium metabisulfite per mL, "a sulfite that may cause allergic-type reactions including anaphylactic symptoms" in susceptible people (FDA label). Plain lidocaine without epinephrine doesn't need it.
That's a clinical screening question, not a purchasing one. But it's a reason to always stock some plain lidocaine alongside the epinephrine version.
A vial that sits on a sunny counter is going to fail that last check sooner or later.
Premier Pharma supplies licensed physician offices, clinics, surgery centers, and pharmacies. Want to order lidocaine with epinephrine? Contact our team for current availability and pricing. We do carry plain lidocaine 1% in several vial sizes. See our lidocaine injection guide. The full Anesthesia & Surgery category shows everything we carry right now. For the bigger picture on stocking a procedure area, see our anesthesia supplies purchasing guide. Open a free account. Credential review typically takes 1–2 business days.
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