Information for Physicians and Patients Information for Physicians

Safe Lidocaine Dosing:

The recommended maximum dose for lidocaine is 3 mg/kg(1). For a 40kg 10-year-old, the oldest patient we recommend treating, a maximum dose would be 120mg. Four sprays with the tonsil fire extinguisher filled with 4% lidocaine (our recommended dose) delivers 20mg, one-sixth of the recommended safe dosage. The half-life of the drug in the body is 90 min, so a maximum every 2 hour dosing should be safe. There is a published study which documents efficacy of topical lidocaine postoperatively (2), in which 10% lidocaine spray was used. There have been studies using repeated dosing aerosolized lidocaine in the treatment for chronic cough and for asthma (3), (4), (5). There were no incidences of lidocaine toxicity or serious aspiration in these studies. Nevertheless, there are no pharmaokinetic studies showing the clearance of lidocaine after repeated aerosol spraying on a raw wound. It is therefore very important to keep the dosage low and infrequent.

Total amount of 4% lidocaine in the filled spray bottle is 17ml x 40mg/ml, or 680 mg. This would be a toxic dose if swallowed all at once. The Tonsil Fire Extinguisher comes in a childproof container, where it should be kept when not in use.

Patients Should Be Made Aware of the Signs of Lidocaine Toxicity:

Early signs: Nervousness, lightheadedness, dizziness, anxiety or confusion, tinnitus, blurred or double vision, a sensation of heat, cold, or numbness, twitching, tremor or vomiting

More severe toxicity: Tachypnea, tachycardia, fever, tonic-clonic seizures, cardiovascular collapse

Other Concerns:

In over 250 patients treated in out practice, we have had

  • No lidocaine toxicity,
  • No aspiration,
  • No increase in post tonsillectomy bleeding.

We don’t use this on small children under 10 years old. We are avoiding lidocaine toxicity and find it is more trouble to get them to accept the spray intervention. They get better quicker in any case.

Practical Tips:

  • Have some devices in the exam room. Introduce the device at the pre-op visit. It brings a smile to your patient to see it, and this is a good way to start a tough week. Make sure they can get the tongue low enough to get the sprayer where it needs to go. Click on Sample and we’ll send you some.
  • Have your Hospital or Surgery Center order the device, so you can have it in the OR filled with Lidocaine.
    2 sprays on each side once the hemostasis is achieved eases the emergence form anesthesia. Send the Tonsil Fire Extinguisher with the patient to the Recovery Room. The nurses love having this option for managing the post-op pain.
  • At home, we recommend the Tonsil Fire Extinguisher for breakthrough pain. We still recommend you offer you routine medications such as acetaminophen and/or ibuprophen as you have in the past for basic pain control. Our recommended dose for the Lidocaine is 2 sprays on each side every 2 hours, as needed. It is especially useful before drinking or eating, or when waking from sleep. Most patient will need only one filled 15ml device with 30 doses for the entire post-op period.
  • The Tonsil Fire Extinguisher will help most, but not all patients (about 70% find it useful). Gag reflexes, inability to tolerate the taste of lidocaine, and large tongues can affect a patient’s ability to benefit from our device.


Physicians, Pharmacists, Hospitals, or Surgery centers may order the devices from this website to be filled by the physician and or pharmacist. The patient receives the filled devices from the hospital, the compounding pharmacist, or directly from those physicians who chose to fill the devices and dispense directly to the patient.


The Tonsil Fire Extinguisher is a Class 1 medical device according to the FDA, and requires no premarket approval as such. It is manufactured in complete compliance with Quality Control guidelines for such devices.


  1. S Derbyshire M J Donald, Lignocaine toxicity: a complication of local anaesthesia administered in the community Emerg Med J 2004:21:249-250
  2. Kaygusuz I, Susaman N. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillec-tomy. International Journal of Pediatric Otorhinolaryngology 2003;67(7):737-42
  3. Long-term Safety of Nebulized Lidocaine for Adults With Difficult-to-Control Chronic Cough    CHEST 2013; 143(4):1060–1065
  4. Treatment of asthma with nebulized lidocaine: a randomized, placebo-controlled study. J Allergy Clin Immunol. 2004 May;113(5):853-9.
  5. Nebulized lidocaine in the treatment of severe asthma in children: a pilot study. Ann Allergy Asthma Immunol. 1999 Jan;82(1):29-32

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