lidocaine and prilocaine (EMLA)

Lidocaine and prilocaine is a topical anesthetic cream. Lidocaine and prilocaine enter through the skin and block pain receptors in nerve endings. Lidocaine and prilocaine reduce conduction of nerve impulses by interrupting the transfer of sodium ions across the membranes of nerve cells. This results in a local anesthetic action. The FDA approved lidocaine/prilocaine in December 1992.

Lidocaine and prilocaine cream is commonly used as a local anesthetic on normal intact skin and genital mucous areas, before minor procedures.

What brand names are available for lidocaine w/prilocaine cream?

DermacinRx, Prizopak, EMLA, Leva Set, Lidopril, Livixil Pak, LP Lite Pak, Oraqix, Relador Pak, Venipuncture CPI

Is lidocaine w/prilocaine cream available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for lidocaine w/prilocaine cream?

Yes

Common side effects of lidocaine and prilocaine are:

• application site redness,
• pain,
• burning,
• paleness,
• edema, and
• altered temperature sensation.

Other rare side effects include:

• shock,
• central nervous system depression,
• hypersensitivity reactions, and
• hypotension (low blood pressure).

Adults

• Minor skin procedures: Apply 2.5 grams of cream over 20 to 25 cm2of skin surface for at least 1 hour.
• Major skin procedures: Apply 2 grams of cream per 10 cm2of skin and allow to remain in contact with the skin for at least 2 hours.
• Genital mucous membrane (female): Apply a thick layer (5 to 10 grams) of cream for 5 to 10 minutes.
• Male genital skin: Apply a thick layer of cream (1 g/10 cm2) to the skin surface for 15 minutes. Local anesthetic infiltration should be performed immediately after removal of cream.

Children

• Birth to 3 month or weight less than 5 kg: Maximum of 1 gram of cream to be applied to the maximum area of 10 cm2 for the maximum application time of 1 hour.
• Three to 12 months or weight more than 5 kg: Maximum of 2 gram of cream to be applied to the maximum area of 20 cm2 for the maximum application time of 4 hour.
• One to 6 years or weight more than 10 kg: Maximum of 10 gram of cream to be applied to the maximum area of 100 cm2 for the maximum application time of 4 hour.
• Seven to 12 years or weight more than 20 kg: Maximum of 20 gram of cream to be applied to the maximum area of 200 cm2 for the maximum application time of 4 hour.

Lidocaine and prilocaine cream is not recommended in neonates with a gestational less than 37 weeks or infants younger than 12 months who are receiving treatment with methemoglobin-inducing agents.

Lidocaine and prilocaine should not be used together with anti-arrhythmic drugs such as tocainide (Tonocard) and mexiletine (Mexitil), due to additive effects on heart rate and rhythm.

Prilocaine may contribute to formation of methemoglobin in patients treated with other drugs known to cause methemoglobinemia.

Lidocaine and prilocaine should be used with caution with anti-arrhythmic drugs like amiodarone (Cordarone), sotalol (Betapace), bretylium, and dofetilide (Tikosyn) because of increased risk developing abnormal heart rate and rhythm.

There are no adequate studies of lidocaine and prilocaine to determine safe and effective use in pregnant women.

Lidocaine and prilocaine may be excreted in breast milk; therefore, caution should be exercised before using them in nursing mothers.

What preparations of lidocaine w/prilocaine cream are available?

Lidocaine and prilocaine is a combination cream, containing 2.5% of each component. Lidocaine and prilocaine is available in 5 gram and 30 gram tubes.

How should I keep lidocaine w/prilocaine cream stored?

Cream should be stored at room temperature 20 C to 25 C (68 F to 77 F). The tube must be closed tightly at all times when not in use.