lidocaine and prilocaine topical

Generic Name: lidocaine and prilocaine topical (LYE doe kane and PRIL oe kane TOP ik al)
Brand Name: Emla, Emla Anesthetic Disc

What is lidocaine and prilocaine topical?

Lidocaine and prilocaine are local anesthetics (numbing medicines). They work by blocking nerve signals in your body.

Lidocaine and prilocaine topical (for the skin) is a combination medicine used to numb the skin or surfaces of the penis or vagina. This medicine is used to prepare you for minor surgery or medical procedures on these areas.

Lidocaine and prilocaine topical may also be used for purposes not listed in this medication guide.

What is the most important information I should know about lidocaine and prilocaine?

An overdose of numbing medicine can cause fatal side effects if too much of the medicine is absorbed through your skin. Overdose symptoms may include uneven heartbeats, seizure (convulsions), coma, slowed breathing, or respiratory failure (breathing stops).

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Use the smallest amount of this medicine needed to numb the skin. Do not use large amounts of lidocaine and prilocaine topical, or cover treated skin areas with a bandage or plastic wrap without medical advice.

What should I discuss with my health care provider before using lidocaine and prilocaine topical?

You should not use lidocaine and prilocaine topical if you are allergic to any type of numbing medicine.

Fatal overdoses have occurred when numbing medicines were used without the advice of a medical doctor (such as during a cosmetic procedure like laser hair removal). However, overdose has also occurred in women treated with a numbing medicine before having a mammography.

Be aware that many cosmetic procedures are performed without a medical doctor present.

To make sure lidocaine and prilocaine topical is safe for you, tell your doctor if you have:

  • a blood cell disorder called methemoglobinemia;

  • liver disease;

  • a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency; or

  • a family history of methemoglobinemia, or any genetic enzyme deficiency.

FDA pregnancy category B. Lidocaine and prilocaine topical is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Lidocaine and prilocaine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use lidocaine and prilocaine topical?

Follow all directions on your prescription label. Do not apply this medicine in larger amounts than recommended.

You may need to apply lidocaine and prilocaine topical at home up to 4 hours before your surgery or procedure. You will be given instructions about how much medicine to use and how long to leave it on the skin. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Use the smallest amount of medicine needed to numb the skin. Your body may absorb too much of this medicine if you use too much, if you apply it over large skin areas, or if you apply heat, bandages, or plastic wrap to treated skin areas. Skin that is cut or irritated may also absorb more topical medication than healthy skin.

You may need to cover the skin to help keep the medicine in place. Do not cover treated skin unless your doctor has told you to.

Carefully follow dosing instructions when applying this medicine to a child. Lidocaine and prilocaine topical doses are based on weight in children. Do not allow a child to use this medicine without adult supervision.

Store at room temperature away from moisture and heat. Do not allow the cream to freeze.

What happens if I miss a dose?

Call your doctor for instructions if you forget to apply lidocaine and prilocaine topical at the time needed before your surgery or medical procedure.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of numbing medicine can cause fatal side effects if too much of the medicine is absorbed through your skin and into your blood. Symptoms may include uneven heartbeats, seizure (convulsions), slowed breathing, coma, or respiratory failure (breathing stops).

Lidocaine and prilocaine applied to the skin is not likely to cause an overdose unless you apply more than the recommended dose.

What should I avoid while using lidocaine and prilocaine topical?

Do not allow this medicine to come into contact with your eyes. If it does, rinse with water.

Do not take by mouth. Lidocaine and prilocaine topical is for use only on the skin.

Avoid accidentally injuring treated skin areas while they are numb. Avoid coming into contact with very hot or very cold surfaces.

Lidocaine and prilocaine topical side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe burning, stinging, or irritation where the medicine was applied;

  • swelling or redness;

  • sudden dizziness or drowsiness after medicine is applied;

  • confusion, blurred vision, ringing in your ears;

  • bruising or purple appearance of the skin; or

  • unusual sensations of temperature.

Common side effects may include:

  • mild burning where the medicine is applied;

  • itching, rash; or

  • changes in skin color where the medicine was applied.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Lidocaine and prilocaine topical dosing information

Usual Adult Dose for Anesthesia:

Venipuncture and intravenous cannulation: 2.5 g (one-half of 5 g tube) over 20 to 25 cm2 of skin surface for at least 1 hour.

Painful dermatologic procedure on a large skin area such as split thickness skin graft harvesting: 2 g per 10 cm2 of skin surface for at least 2 hours.

Genital skin (male): adjunct prior to local anesthetic infiltration, 1 g per 10 cm2 of skin surface for 15 minutes. Local anesthetic infiltration should be performed immediately after the removal of the cream. Dermal analgesia can be expected to increase for up to 3 hours under occlusive dressing and persist for 1 to 2 hours after removal of the cream.

Genital mucous membranes (female): 5 to 10 g for 5 to 10 minutes. Occlusion is not necessary for absorption. The procedure or the local anesthetic infiltration should be performed immediately after the removal of the cream.

Applied directly into periodontal pockets to provide localized anesthesia: Apply lidocaine-prilocaine liquid on the gingival margin around the selected teeth using the blunt tipped applicator included in the package. Wait 30 seconds, then fill the periodontal pockets with lidocaine-prilocaine liquid using the blunt tipped applicator until the gel becomes visible at the gingival margin. Wait another 30 seconds before starting treatment. A longer waiting time does not enhance the anesthesia. Anesthetic effect, as assessed by probing of pocket depths, has a duration of approximately 20 minutes. If the anesthesia starts to wear off, lidocaine-prilocaine liquid may be reapplied if needed. The maximum recommended dose of lidocaine-prilocaine liquid at one treatment session is 5 cartridges.

Usual Pediatric Dose for Anesthesia:

Neonatal:
Topical:
Gestational Age (GA): Less than 37 weeks: 0.5 g/dose has been most frequently reported. One study of 30 preterm neonates (GA: greater than or equal to 30 weeks) showed application to the heel for 1 hour resulted in no measurable changes in methemoglobin levels; others have reported similar findings
GA: greater than or equal to 37 weeks:
Painful procedures (i.e.,, intramuscular injections): Apply 1 g/site for at least 60 minutes
Circumcision: Apply 1 to 2 g to prepuce and occlude for 60 to 90 minutes prior to procedure
Manufacturer recommended maximum dose and application area (based on application to intact skin): Weight less than 5 kg:
Maximum total dose of 1 g
Maximum application area: 10 cm2
Maximum application time: 1 hour

Dosage based on age, weight, application area, and application times - maximum recommended:
Less than or equal to 3 months (or less than 5 kg): 1 g, 10 cm2, 1 hour
Greater than 3 to less than or equal to 12 months: (and greater than 5 kg): 2 g, 20 cm2, 4 hours
1 to 6 years (and greater than 10 kg): 10 g, 100 cm2, 4 hours
7 to 12 years (and greater than 20 kg): 20 g, 200 cm2, 4 hours

What other drugs will affect lidocaine and prilocaine topical?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with lidocaine and prilocaine topical, especially:

  • chloroquine, dapsone, nitrofurantoin, isosorbide dinitrate, nitroglycerin, nitroprusside, quinine;

  • heart rhythm medication--amiodarone, dofetilide, dronedarone, mexiletine, sotalol, tocainide, and others;

  • seizure medicine--phenobarbital, phenytoin, primaquine; or

  • a sulfa drug--Bactrim, Septra, SMX-TMP or SMZ-TMP, and others.

This list is not complete. Other drugs may interact with lidocaine and prilocaine topical, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about lidocaine and prilocaine topical.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 2.06. Revision Date: 2014-09-09, 3:29:35 PM.

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