lidocaine topical

Lidocaine topical is a local anesthetic applied to numb and lubricate the mucous membranes in the nose, mouth and throat during certain medical procedures such as nasal or oral intubation, and the urinary passage (urethra) in urologic procedures such as cystoscopy or catheterization. Lidocaine topical is also used to delay premature ejaculation, and relieve pain and itching from minor skin irritations.

Lidocaine topical relieves pain by blocking the nerve ends from sending pain signals to the brain. Lidocaine stabilizes the membrane of nerve cells (neurons) and inhibits the flux of sodium ions, preventing the conduction of nerve impulses to the brain. Lidocaine topical is available on prescription and over-the-counter in many forms such as jellies, ointments, lotions, gels, creams and sprays.

Lidocaine uses include:

• Oral or nasal endotracheal intubation, in which a thin flexible tube is inserted through the mouth or nose into the airway, typically to provide oxygen
• Urologic procedures including catheter placement and cystoscopy in which a flexible tube with a lighted camera is inserted through the urethra to examine the bladder
• Temporarily reduce sensitivity of the penis to delay premature ejaculation in adults
• Relieve pain from minor skin irritations such as sunburn, insect bites, minor burns, cuts and scrapes in adults and pediatric patients

• Lidocaine topical use may cause significant systemic absorption
• Serious adverse reactions have been reported when viscous lidocaine 2% is used in young children to treat mouth pain; reactions include seizures, severe brain injury, and cardiovascular depression which may lead to cardiac arrest
• Excessive and rapid systemic absorption may occur with:
  • Sepsis, severely injured mucous membranes (mucosa), or open wounds in the area of application
  • Doses applied to large surface areas that remain on the skin for longer than 2 hours
  • Repeated doses with short dosing intervals
• Patients with severe liver disease are at greater risk for increased blood concentration of lidocaine from topical, because the drug is metabolized by the liver; use with caution
• Do not use lidocaine topical in patients with known hypersensitivity to amide type of local anesthetics, or to any of the components in lidocaine topical
• Some lidocaine topical formulations may contain sulfites; do not use on patients with sulfite allergy
• Take care to avoid getting the lidocaine topical jelly into the endotracheal tube or on the stylette; the jelly may dry and narrow or block the tube
• Cases of methemoglobinemia have been reported in association with lidocaine topical anesthetic use. Patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are at higher risk for developing methemoglobinemia; monitor closely

Side effects of lidocaine topical include:

• Allergic reactions including:
  • Skin lesions
  • Hives (urticaria)
  • Swelling (edema)
  • Anaphylaxis-like reactions
• Cardiovascular reactions (with excessive systemic absorption) including:
  • Slow heartbeat (bradycardia)
  • Low blood pressure (hypotension)
  • Cardiovascular collapse
  • Cardiac arrest
• Central nervous system excitation and/or depressant effects including:
  • Drowsiness
  • Light-headedness
  • Dizziness
  • Sensations of heat, cold or numbness
  • Nervousness
  • Euphoria
  • Anxiety
  • Confusion
  • Ringing in the ears (tinnitus)
  • Blurred or double vision
  • Vomiting
  • Twitching
  • Tremors
  • Convulsions
  • Unconsciousness
  • Respiratory depression
  • Respiratory arrest

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Topical Jelly

• 2% (Xylocaine Jelly)

Topical Gel

• 0.5% (Solarcaine Aloe Extra Burn Relief)
• 0.8% (Hawaiian Tropic Gel)
• 3% (LidoRx)
• 4% (Topicaine)

Topical Cream

• 2% (Xolido)
• 4% (AneCream, LidoStat, LMX4, Xolido)
• 5% (AneCream5)

Topical Ointment

• 5%

Topical Lotion

• 3%

Topical Spray

• 2% (Regenecare HA)
• 4% (Derma Numb, Lidocoll)
• 10mg/spray (Epic, Premjact, Promescent)

Topical Solution, Mouth/Throat

• 2%
• 4% (Xylocaine Solution)

Adult

Anesthetic lubricant for endotracheal intubation

• Jelly (2%): Apply moderate amount to external surface of endotracheal tube shortly before use
• Ointment: Apply to tube prior to intubation
• Not to exceed 600 mg/12 hour

Urethral surface anesthesia

• When using Xylocaine 2% Jelly 30 mL tubes for urologic procedures, sterilize the plastic cone for 5 minutes in boiling water, cool, and attach to the tube

Females

• Instill 2-5 mL jelly (60-100 mg) into urethra
• Some jelly may also be deposited on a cotton swab and introduced into the urethra
• Allow several minutes following instillation prior to performing urological procedure

Males

• Slowly instill 15 mL (300 mg lidocaine) into the  urethra or until patient experiences tension
• Apply a penile clamp for several minutes at the corona
• An additional dose of not more than 15 mL (300 mg) can be instilled for adequate anesthesia
• Prior to sounding or cystoscopy, a penile clamp should be applied for 5-10 minutes to obtain adequate anesthesia
• A total dose of 30 mL (600 mg) is usually required to fill and dilate the male urethra
• Prior to catheterization, smaller volumes of 5-10 mL (100-200 mg) are usually adequate for lubrication

Premature ejaculation

• Epic, Premject, Promescent: Apply 3 or more sprays (10 mg/spray), not to exceed 10 sprays, to the head and shaft of the penis before intercourse
• Wash product off after intercourse
• Correct quantity and time of application will be determined by individual requirements; use the minimum effective quantity
• Do not exceed 24 sprays/24 hour

Skin irritation

• Apply topically to the affected area 3 or 4 times a day

Pediatric

Anesthetic lubricant for endotracheal intubation

• Jelly (2%): Apply moderate amount to external surface of endotracheal tube shortly before use
• Ointment: Apply to tube prior to intubation

Children below 10 years of age

• Not to exceed 4.5 mg/kg per 12 hours

Older children/adolescents

• Not to exceed 600 mg/12 hours

Skin irritation

Children below 2 years of age

• Safety and efficacy not established

Children 2 years of age and above

• Apply topically to affected area 3 or 4 times a day

• The patient’s vital signs should be constantly monitored after every local anesthetic administration to prevent overdose. Oxygen should be administered at the first sign of change in vital signs.
• Overdose of lidocaine can cause convulsions and cardiovascular depression and appropriate supportive treatment should be instituted.
• In case of overdose from lidocaine topical OTC use, if the patient shows signs of systemic toxicity (lethargy, shallow breathing, seizure activity), seek emergency medical attention immediately.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

Use of local anesthetics increases the risk of developing methemoglobinemia, a blood disorder, when concurrently exposed to certain drugs. Examples of drugs associated with methemoglobinemia include:

• Nitrates/nitrites such as nitric oxide, nitroglycerin, nitroprusside, nitrous oxide
• Other local anesthetics such as articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine
• Antineoplastic agents such as cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase
• Antibiotics such as dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides
• Antimalarials such as chloroquine, primaquine
• Anticonvulsants such as phenobarbital, phenytoin, sodium valproate
• Other drugs including acetaminophen, metoclopramide, quinine, sulfasalazine

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.

Check with your doctor or health care provider if you have any questions about the medication.

• Lidocaine topical may be used in pregnancy, labor and delivery.
• Lidocaine topical is excreted in breast milk and must be used with caution in nursing women.
• Seek advice from a health professional before using OTC drugs including lidocaine topical, if you are pregnant or breastfeeding.

While using OTC lidocaine topical:

• Do not let it come in contact with eyes; in case of contact, immediately wash with water or saline and protect it until sensation returns
• Apply on clean, dry, intact skin; applying on broken or inflamed skin can increase absorption and blood concentration of lidocaine
• Follow package instructions exactly on dosage and administration guidelines
• Special care for lidocaine 2% viscous solution include:
  • Accurately measure prescribed dose and do not administer more often than prescribed, and take extra care with children younger than 3 years of age
  • Use a measuring device to carefully measure correct volume
  • Use it for prescribed indications only
• If patient shows any symptom of systemic toxicity (lethargy, shallow breathing, seizure activity), seek emergency medical attention immediately
• Use of topical lidocaine increases the risk of developing methemoglobinemia, a blood disorder, when used concurrently with certain drugs. Seek medical attention immediately if the patient develops symptoms such as bluish skin, rapid heart rate, shortness of breath, lightheadedness or fatigue
• Keep the container tightly closed and store it well out of reach of children, immediately after each use. Dispose of the unused portion carefully to prevent possible exposure to children and pets
• Lidocaine topical anesthetic used in the mouth or throat can impair swallowing and has the risk of aspiration; avoid eating or drinking anything for 60 minutes after use
• Numbness of tongue or the inside of the cheeks may increase danger of biting injury; avoid food and/or chewing gum while mouth or throat area is anesthetized