lidocaine and prilocaine (EMLA)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is lidocaine w/prilocaine cream, and how does it work (mechanism of action)?

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.

What are the uses for lidocaine w/prilocaine cream?

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

What are the side effects of lidocaine w/prilocaine cream?

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).

What is the dosage for lidocaine w/prilocaine cream?

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.

Which drugs or supplements interact with lidocaine w/prilocaine cream?

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.

Is lidocaine w/prilocaine cream safe to take if I'm pregnant or breastfeeding?

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 else should I know about lidocaine w/prilocaine cream?

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.

Summary

Lidocaine and prilocaine (DermacinRx, Prizopak, EMLA, Leva Set, Lidopril, Livixil Pak, LP Lite Pak, Oraqix, Relador Pak, Venipuncture CPI) is a local topical anesthetic cream used on normal intact skin and genital mucous areas prior to minor medical procedures. Side effects, drug interactions, dosage, storage, and pregnancy safety should be reviewed prior to using this medication.

Treatment & Diagnosis

Medications & Supplements

Health Solutions From Our Sponsors

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Medically Reviewed on 3/18/2019
References
Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine

REFERENCE:

FDA Prescribing Information.
CONTINUE SCROLLING FOR RELATED SLIDESHOW