ZINGO- lidocaine hydrochloride powder
Zingo™ is indicated for use on intact skin to provide topical local analgesia prior to venipuncture or peripheral intravenous cannulation, in children 3-18 years of age.
Apply one Zingo™ (0.5 mg lidocaine hydrochloride monohydrate) to the site planned for venipuncture or intravenous cannulation, one to three minutes prior to needle insertion.
Perform the procedure within 10 minutes after Zingo™ administration.
Use Zingo™ only on intact skin.
Application of one additional Zingo™ at a new location is acceptable after a failed attempt at venous access. Multiple administrations of Zingo™ at the same location are not recommended.
When Zingo™ is used concomitantly with other products containing local anesthetic agents, the amount absorbed from all sources should be considered, as local anesthetics are thought to have at least additive toxicities.
|Prepare the Treatment Site and Device: Examine the treatment site to ensure that the skin is intact. Clean the site, according to standard practice.Visually inspect the pouch. Do not use if the pouch has been torn, or damaged or if the device has been dropped.Tear open the pouch using the notch provided (Figure 1a). Remove Zingo™ from the pouch, being careful not to touch the purple outlet (open end) to avoid contamination (Figure 1b).||Figure 1a Figure 1b|
|Position Zingo™: Grip Zingo™ and place on the application site, with one hand, as illustrated in Figure 2, or with both hands, as shown in Figure 3.||Figure 2 Figure 3|
|Ensure that the patient’s treatment site is supported to prevent movement. Seal the purple Zingo™ outlet against the patient’s skin. Hold the device perpendicular to the skin, making sure that your thumb can reach the green start button.Avoid gaps between the skin and the Zingo™ outlet, like the one illustrated in Figure 4, as gaps will impede drug delivery.||Figure 4|
|Release the Safety Interlock: Apply adequate downward pressure to release the safety interlock, while maintaining the seal between Zingo™ and the skin.Zingo™ is ready for administration when the green start button has moved into the upward position, as illustrated in Figure 5a.||Figure 5a|
|Zingo™ cannot be actuated without releasing the internal safety interlock, as illustrated in Figure 5b.|
|Administer Zingo™: While maintaining downward pressure, administer the dose by pressing the green start button, as illustrated in Figure 6. Do not move Zingo™ during administration. Actuation is accompanied by a “popping” sound, indicating that the dose has been discharged.||Figure 6|
|Remove Zingo™: Remove Zingo from the application site and dispose.|
|Begin Procedure: Start the venipuncture or intravenous cannulation procedure 1–3 minutes after Zingo™ administration.|
Zingo™ (lidocaine hydrochloride monohydrate) powder intradermal injection system contains 0.5 mg of sterile lidocaine hydrochloride monohydrate.
Zingo™ is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type.
Do not use around the eyes.
Do not use Zingo™ on body orifices, mucous membranes, or on areas with a compromised skin barrier. Only use Zingo™ on skin locations where an adequate seal can be maintained.
Patients with severe hepatic disease or pseudocholinesterase deficiency, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations of lidocaine.
Patients with bleeding tendencies or platelet disorders could have a higher risk of superficial dermal bleeding.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
The safety of Zingo™ was evaluated in five randomized, double-blind, parallel-arm, sham-placebo controlled trials in which 1761 patients, ages 3 to 18, received either Zingo™ or a sham placebo device. A total of 906 received active treatment, while 855 received placebo.
Application S ite Reaction
The application site was specifically assessed for four categories of skin site reaction (erythema, edema, pruritus, and petechiae). Erythema occurred in 53% of Zingo-treated patients, and in 27% of placebo-treated patients. Petechiae occurred in 44% of Zingo-treated patients, and in 5% of placebo-treated patients. Edema occurred in 8% of Zingo-treated patients, and in 3% of placebo-treated patients. Pruritus occurred in 1% of patients in both treatment groups.
Amongst the 906 pediatric patients receiving active treatment and 855 pediatric patients receiving sham placebo treatment, the percentage of pediatric patients with any adverse reactions was approximately 9% in each treatment group.
Most adverse reactions were application-site related (i.e., bruising, burning, pain, contusion, hemorrhage), occurring in 4% of pediatric patients in each treatment group.
The most common systemic adverse reactions were nausea (2%) and vomiting (1%).
Zingo™ was not formally evaluated for effects on reproduction. Significant systemic exposure to lidocaine is not expected under recommended conditions of use of Zingo™ as lidocaine levels were below the limit of detection in human studies. Lidocaine has been previously tested for reproductive toxicity in animal studies, however. The following ratios are based on the assumption that the applied dose is completely absorbed through the skin.
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