Generic Name: Lidocaine + Prilocaine Brand Name(s): Generics only. No brands available.

Uses

What is Lidocaine + Prilocaine used for?

This medication contains 2 amide-type local anesthetics, lidocaine and prilocaine. It is used on normal, unbroken skin or on the outer genital area to prevent pain before certain procedures such as inserting a needle, skin grafts, or skin laser surgery. It works by temporarily numbing the skin and surrounding area. Do not use this product in the ears.

If this product alone cannot completely numb the area being treated, it may be used to numb the area before a lidocaine injection is given to provide enough pain relief for certain procedures (e.g., removal of genital warts).

How should I take Lidocaine + Prilocaine?

Use this medication only on normal skin and the genital area. Do not apply to broken/irritated skin or open wounds unless directed by your doctor. Wash your hands before using this product.

Apply this product to the area at the proper time as directed. The length of time for the medication to stay on the skin depends on the type of procedure you are having. It is usually applied at least 1 hour before needle sticks and 2 hours before minor skin procedures. It may be applied by a health care professional before certain genital procedures. In this case, it is recommended that you remain lying down so the medication will stay in place.

To apply, squeeze out the prescribed amount of cream directly onto the skin. You can also squeeze it onto a measuring guide to make sure you get the right dose and then apply it to the area. Do not rub in. Cover with an airtight dressing/bandage as directed by your doctor. Allow the cream to remain in place, usually in a thick layer, as directed by your doctor. Remove the dressing and cream and clean the area thoroughly, usually shortly before the procedure or as directed by your doctor.

Dosage and length of application time are based on your age and medical condition and the procedure you are having. In children, dosage may also be based on weight. Do not use larger amounts than prescribed. Do not use on large areas of skin, apply heat, or leave it in place longer than directed or serious side effects may occur.

If you are applying this product on a child, make sure the medication stays in place and that your child does not put the medication or dressing/bandage in his/her mouth. You may want to use a second covering to prevent the child from touching the cream.

Wash hands immediately after use unless you are treating an area on the hands. Avoid getting the product in your eyes, nose, ears, or mouth. If this medication gets in the eyes, rinse the affected eye immediately and completely with water or saline. Numbness in the eye can lead to injury because you cannot feel particles in the eye or other dangers. Therefore, protect the eye until feeling returns.

The area may be numb for several hours after the procedure. Protect the area from injury. Be careful not to bump, rub, or scratch the area or expose it to heat/cold until feeling returns.

How do I store Lidocaine + Prilocaine?

Lidocaine + Prilocaine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Lidocaine + Prilocaine in the bathroom or the freezer. There may be different brands of Lidocaine + Prilocaine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Lidocaine + Prilocaine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Lidocaine + Prilocaine?

Before using this product, tell your doctor or pharmacist if you are allergic to lidocaine or prilocaine; or to any other amide anesthetics (e.g., bupivacaine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain blood disorder (methemoglobinemia).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain blood disorder (G6PD deficiency, especially in children), heart disease (e.g., irregular heartbeat), kidney disease, liver disease.

Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug, especially the dizziness effect.

Caution is advised when using this drug in children, especially if your child is younger than 3 months or small for their age. These children are at greater risk for a certain rare blood problem (methemoglobinemia). Contact the doctor right away in the unlikely event your child has symptoms such as pale/bluish skin around the mouth/lips or fast heartbeat. The risk for serious side effects (including methemoglobinemia) is increased if this medication is applied over too large an area at one time in young children.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Lidocaine passes into breast milk. It is unknown if prilocaine passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Lidocaine + Prilocaine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Lidocaine + Prilocaine. Lidocaine + Prilocaine is pregnancy risk category B according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Lidocaine + Prilocaine?

Redness, swelling, tingling/burning, or lightening of the skin may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Notify your doctor right away if you develop blistering of the skin where the medication is applied.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Lidocaine + Prilocaine?

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs that may rarely cause a certain blood disorder called methemoglobinemia (e.g., acetaminophen, benzocaine, phenobarbital, antimalarials such as chloroquine/primaquine/quinine, nitrates such as nitroglycerin, certain antibiotics such as sulfonamides/nitrofurantoin/dapsone), heart rhythm medications (e.g., amiodarone, bretylium, mexiletine, phenytoin, sotalol).

Lidocaine + Prilocaine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Lidocaine + Prilocaine?

Lidocaine + Prilocaine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Lidocaine + Prilocaine?

Lidocaine + Prilocaine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Lidocaine + Prilocaine.

What is the dose of Lidocaine + Prilocaine for an adult?

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.

Liver Dose Adjustments

Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations.

What is the dose of Lidocaine + Prilocaine for a child?

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

Dose Adjustments

In pediatric patients older than 3 months who do not meet the minimum weight requirement, the maximum total dose should be restricted to that which corresponds to the patient’s weight.

Precautions

Lidocaine-prilocaine topical cream should not be used in neonates with a gestational age less than 37 weeks nor in infants younger than 12 months who are receiving treatment with methemoglobin-inducing agents.

Caution should be exercised when applying this cream over large areas or leaving it on for longer than 2 hours. The incidence of adverse effects can be expected to be directly proportional to the area and time of exposure.

Lidocaine-prilocaine is contraindicated in patients with a known history of sensitivity to amide-type local anesthetics.

Patients with congenital or idiopathic methemoglobinemia should not use lidocaine-prilocaine topical cream. Also, patients with glucose-6-phosphate dehydrogenase deficiencies and those taking drugs associated with drug-induced methemoglobinemia are at a greater risk of developing methemoglobinemia.

Neonates and infants up to 3 months should be monitored for methemoglobinemia levels before, during, and after the application of lidocaine-prilocaine topical cream.

Lidocaine-prilocaine topical cream should not be used in any clinical situation in which its penetration or migration beyond the tympanic membrane into the middle ear is possible. Studies in laboratory animals (guinea pigs) have shown an ototoxic effect when instilled into the middle ear. The animals exposed to the topical in the external auditory canal only, showed no abnormality.

Use cream with caution in patients who may be more sensitive to the systemic effects of lidocaine or prilocaine as a result of acute illness, debilitated, or the elderly.

Do not allow the cream to come into contact with the eye because animal studies have demonstrated severe eye irritation. Also, the loss of protective reflexes can permit corneal irritation and potential abrasion. If contact with the eye occurs, wash out the eye immediately with water or saline and protect the eye until sensation returns.

Patients with severe hepatic diseases are at a greater risk of developing toxic plasma concentrations of lidocaine and prilocaine.

Patients should be advised that a block of all sensations to the treated skin may occur and to avoid inadvertent trauma to the treated area.

Lidocaine-prilocaine topical cream should be used with caution in patients receiving Class I antiarrhythmic drugs since the toxic effects are additive and potentially synergistic.

For application to intact skin only.

How is Lidocaine + Prilocaine available?

Lidocaine + Prilocaine is available in the following dosage forms and strengths:

  • Topical cream,
  • Topical kit,
  • Topical film

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Lidocaine + Prilocaine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: March 17, 2018 | Last Modified: March 17, 2018

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