Lidocaine/PrilocaineLidocaine and Prilocaine

About Lidocaine/Prilocaine

The cream blocks nerve signals in the skin it covers. It is labeled for normal intact skin and genital mucous membranes, and it is not used where it could pass through the eardrum into the middle ear. For needle sticks and IV lines, adults apply 2.5 g over 20 to 25 square centimeters under an occlusive dressing for at least an hour; skin graft harvesting uses 2 g per 10 square centimeters for at least two hours. Adult male genital skin takes 1 g per 10 square centimeters for 15 minutes before an anesthetic injection, and adult female external genitalia 5 to 10 g for 5 to 10 minutes. Numbness deepens for up to three hours under the dressing and lasts one to two hours after the cream is removed.

Children’s maximum doses depend on age and weight: 1 g over 10 square centimeters for up to one hour from birth to 3 months or under 5 kg; 2 g over 20 square centimeters for up to four hours from 3 to 12 months and over 5 kg; 10 g over 100 square centimeters for up to four hours from 1 to 6 years and over 10 kg; and 20 g over 200 square centimeters for up to four hours from 7 to 12 years and over 20 kg. A child older than 3 months who is under the weight shown is dosed by weight. Methemoglobinemia can turn the skin pale, gray or blue and cause headache, a fast heartbeat, breathlessness, lightheadedness or tiredness, sometimes hours later; infants under 6 months and people with G6PD deficiency, congenital methemoglobinemia or heart or lung disease are at higher risk, and the cream is not used in babies born before 37 weeks or in infants under 12 months taking other drugs that can cause it. Blanching, redness, swelling and itching are the common skin effects, and anyone allergic to amide-type local anesthetics must not use it.

It is not put on open wounds or in the eyes; broken or inflamed skin absorbs more, and use over larger areas or for longer than recommended can cause serious effects. Numb skin is protected from scratching, rubbing and extreme heat or cold until feeling returns, and caregivers watch a child closely so the cream is not swallowed. Studies in children under 7 showed less benefit than in older children and adults, and it has not been shown to work for heel sticks in newborns. In pregnancy it is used only if clearly needed. EMLA cream and the EMLA anesthetic disc are discontinued. Oraqix, a lidocaine and prilocaine gel placed in adults’ gum pockets during scaling and root planing, is a separate dental product.

Taking Lidocaine/Prilocaine

How to take it

Squeeze out the amount prescribed (a strip about 1.5 inches long and 0.2 inch wide is about 1 g) as a thick layer on intact skin, without spreading it out, and wash your hands. Cover it with an occlusive dressing only if told to; before the procedure the dressing is removed and the cream wiped off.

If you miss a dose

It is used before a procedure, not on a schedule. If it went on late, never add more cream, cover a larger area or leave it on longer than prescribed to make up for it; ask the clinician what to do.

Storage

At room temperature in the tightly closed tube, away from heat and moisture and out of reach of children. Use a take-back program rather than flushing.

Interactions to know about

Tell the prescriber about heart rhythm medicines, other numbing medicines and drugs that can cause methemoglobinemia, such as nitrates, some antibiotics, antimalarials, anticonvulsants, acetaminophen and metoclopramide, and about G6PD deficiency, heart, lung or liver disease, or breastfeeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Lidocaine/Prilocaine differs from pharmacy to pharmacy

Generic creams from several makers are rated equivalent to one another, so a prescription can be filled with whichever one the pharmacy carries, and quotes differ mainly in each pharmacy’s dispensing fee and markup. Tubes come in 5 g and 30 g sizes, and some makers pack the 5 g tubes five to a carton, so the size and number of tubes written change the total.

Ways to pay less for Lidocaine/Prilocaine without insurance

• Ask for the generic; EMLA is discontinued, so a prescription that names it is filled with a generic rated equivalent where substitution is allowed.
• Ask the prescriber to write the quantity the planned procedures need, and ask whether the pharmacy dispenses single 5 g tubes or only cartons of five.
• Ask the clinic whether it applies the cream itself, as a healthcare provider often does, before filling a prescription for home use.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Lidocaine/Prilocaine

1. 1.How much cream do I put on, over how large an area, and how long before my appointment?
2. 2.Should I cover it with a dressing, and who removes it?
3. 3.What is the most I can use on my child for their age and weight?
4. 4.Could any of my medicines raise the risk of methemoglobinemia?

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