Lidocaine; Prilocaine cream

What is this medicine?

LIDOCAINE; PRILOCAINE (LYE doe kane; PRIL oh kane) is a topical anesthetic that causes loss of feeling in the skin and surrounding tissues. It is used to numb the skin before procedures or injections.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): ANODYNE LPT, EMLA, IV Novice Pack, Lido-Prilo Caine, LiProZonePak, LIVIXIL Pak, LP Lite Pak, Medolor Pak with Tegaderm Dressing, Microvix LP, Port-Prep, PrepIV, Prilovix, Prilovix Lite, Prilovix Lite Plus, Prilovix Plus, Prilovix Ultralite, Prilovix Ultralite Plus, Prilovixil, Relador, Soluline, SOLUPICC

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• G6PD deficiency
• heart disease
• kidney disease
• liver disease
• skin conditions or sensitivity
• an unusual or allergic reaction to lidocaine, prilocaine, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

This medicine is for external use only on the skin. Do not take by mouth. Follow the directions on the prescription label. Wash hands before and after use. Do not use more or leave in contact with the skin longer than directed. Do not apply to eyes or open wounds. It can cause irritation and blurred or temporary loss of vision. If this medicine comes in contact with your eyes, immediately rinse the eye with water. Do not touch or rub the eye. Contact your health care provider right away.

Talk to your pediatrician regarding the use of this medicine in children. While this medicine may be prescribed for children for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This medicine is usually only applied once prior to each procedure. It must be in contact with the skin for a period of time for it to work. If you applied this medicine later than directed, tell your health care professional before starting the procedure.

What may interact with this medicine?

This medicine may interact with the following medications:

• acetaminophen
• certain antibiotics like dapsone, nitrofurantoin, aminosalicylic acid, sulfasalazine
• certain medicines for seizures like phenobarbital, phenytoin, valproic acid
• chloroquine
• cyclophosphamide
• flutamide
• hydroxyurea
• ifosfamide
• metoclopramide
• nitroglycerin
• other local anesthetics like pramoxine, tetracaine
• primaquine
• quinine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Be careful to avoid injury to the treated area while it is numb and you are not aware of pain. Avoid scratching, rubbing, or exposing the treated area to hot or cold temperatures until complete sensation has returned. The numb feeling will wear off a few hours after applying the cream.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• blurred vision
• chest pain
• difficulty breathing
• dizziness
• drowsiness
• fast or irregular heartbeat
• skin rash or itching
• swelling of your throat, lips, or face
• trembling

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• changes in ability to feel hot or cold
• redness and swelling at the application site

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep container tightly closed. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Emla – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

This combination product contains two medications: lidocaine and prilocaine. Both of these medications belong to the family of topical anesthetics. Together, they are used to reduce the pain or discomfort experienced with minor procedures on intact skin, such as vaccination with certain vaccines, having blood taken, or laser treatment skin surgeries. This medication may also be used for pain relief before removing debris around leg skin ulcers or prior to minor procedures on the genitalia.

Lidocaine – prilocaine works by numbing the surface and lower layers of skin to prevent pain messages being sent from the nerves under the skin. The numbing effect starts about 1 hour after applying the medication and will continue for at least 2 hours after removing the medication.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Cream

Each 1 gram of cream contains 25 mg of lidocaine and 25 mg of prilocaine. Nonmedicinal ingredients: carboxypolymethylene, polyoxyethylene, hydrogenated castor oil, sodium hydroxide to adjust pH to 8.7–9.7, and purified water.

Patch

Each cellulose and cotton disc in the patch contains 25 mg of lidocaine and 25 mg of prilocaine. Nonmedicinal ingredients: carboxypolymethylene, polyoxyethylene, hydrogenated castor oil, sodium hydroxide to adjust pH to 8.7–9.7, and purified water. Patch components: cellulose and cotton disc, polyethylene foam with acrylate adhesive, polyamide / aluminium / plastic and polypropylene / aluminium / plastic laminates.

How should I use this medication?

Cream

The amount of cream to be applied to the affected area, and the length of time it is left on the skin, depends on the type of procedure being done. Applying more cream or leaving it on for a longer period of time than recommended by your doctor can cause serious side effects.

Apply the cream to clean, dry skin and cover it with a dressing that does not allow the skin underneath to contact air. This allows the medications to be absorbed into the skin. The numbing effect starts about 1 hour after the cream is applied. Do not apply it near the eyes or inside the ears or mouth. After applying the cream, cover it with an air-tight dressing to allow the cream to be absorbed.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. Do not apply more cream than is recommended by your doctor and do not leave the medication on the skin for longer than advised.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Patch

The number of patches applied at one time and the length of time the patch is left on the skin depend on the size of the area being treated and the type of procedure being done. The numbing effect of the patch starts about 1 hour after the patch is applied.

Apply the patch to clean, dry skin. The round, white pad containing the medication should cover the area to be treated. Press firmly around the edges of the patch to make sure that the patch sticks well to the skin. Gently press the white pad, to make sure that the medication is in contact with the skin. Do not apply it near the eyes or inside the ears or mouth.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. Do not apply more patches than is recommended by your doctor and do not leave the medication on the skin for longer than advised, as this can cause serious side effects.

When you remove the patch or the dressing, fold it so the side with medication is on the inside. This will prevent accidental contact with the remaining medication.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

• are allergic to lidocaine, prilocaine or any ingredients of the medication
• have methemoglobinemia
• need large amounts of this medication and are not in a health-care facility
• are using other medications that are known to cause methemoglobinemia (in children less than 12 months old)
• are using this for a pre-term infant

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• burning or itching where medication is applied
• puffiness at application site
• small red dots or purple spots where medication is applied
• whitening or redness to the skin

Stop taking the medication and seek immediate medical attention if any of the following occur:

• eye irritation
• signs of a serious allergic reaction (e. g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

• signs of methemoglobinemia (reduced oxygen to the body tissues; brownish or greyish skin colour, discoloured lips and nail beds)
• signs of too much medication in the body (e.g., drowsiness, tongue feeling numb, lightheadedness, confusion, headache, hearing problems, vomiting, slow heartbeat, unusual sweating, seizures)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: It is possible to experience a severe allergic reaction to topical anesthetics. Before you use lidocaine – prilocaine, inform your doctor about any previous adverse reactions you have had to medications, especially medications used to numb the skin. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing, or swelling of the face and throat.

Eyes: Avoid applying this medication to the skin near the eyes. If it happens to come into contact with an eye, immediately rinse the eye with water or sodium chloride solution.

Liver function: Lidocaine – prilocaine is broken down by the liver. Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Methemoglobinemia: Methemoglobinemia is a condition where the blood cannot carry enough oxygen through the body because the “wrong” form of hemoglobin, called methemoglobin, is produced. Prilocaine promotes the body’s production of methemoglobin. Usually, only a small amount of prilocaine is absorbed, so the amount of methemoglobin produced is not a problem. When too much prilocaine is in the body, or you have a condition that already causes excess methemoglobin to be produced, the extra production of methemoglobin may be noticed. If you or your child develop greyish or brownish skin colour, or discoloration around the lips or nail beds, remove the medication and seek immediate medical attention.

Overdose: Lidocaine – prilocaine is absorbed into the body. As such, it is possible to receive too much medication. It is important to apply the medication only to the areas that are being treated and to leave it on only for the length of time your doctor has suggested. Applying this medication to a large area of the body may cause a dangerous amount of medication to be absorbed into the body. Contact with the medication remaining on the patch or dressing can also cause this to happen to children.

Symptoms of too much of this medication in the body include confusion, dizziness, seizures, and very slow heart rate, leading to the heart and breathing to stop. If you or your child experience any of these symptoms, seek immediate medical help.

Skin problems: If you have a skin condition, such as allergic dermatitis, you may need to use this medication for a shorter period of time to get the same numbing effect. Let your doctor know if you have any skin conditions.

The skin where you apply this medication will stay numb for several hours. Be careful to avoid accidental injury or exposure to extremely hot or cold temperatures until complete skin sensation returns.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Lidocaine passes into breast milk. If you are a breast-feeding mother and are taking lidocaine – prilocaine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: Children should be closely watched during and after use of this medications, since they are more at risk of serious side effects. The use of this medication for children older than 3 months and weighing less than 20 kg should be limited to the smallest possible amount for the shortest time that it is effective. Avoid using lidocaine – prilocaine for children less than 3 months of age.

What other drugs could interact with this medication?

There may be an interaction between lidocaine – prilocaine and any of the following:

• amiodarone
• benzocaine
• certain beta-adrenergic blockers (e.g., propranolol, sotalol)
• chloroquine
• dapsone
• digoxin
• dofetilide
• flecainide
• mexilitine
• nitrates (e. g., isosorbide dinitrate, isosorbide mononitrate, nitroglycerin)
• nitrofurantoin
• phenobarbital
• phenytoin
• primaquine
• procainamide
• quinidine
• quinine
• sulfonamide antibiotics (“sulfas”; e.g., sulfisoxazole, sulfamethoxazole)
• verapamil

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Emla

EMLA, Oraqix (lidocaine-prilocaine) dosing, indications, interactions, adverse effects, and more

Lidocaine cream for numbing the skin before a procedure

A doctor or nurse will usually give you a prescription for the lidocaine cream or the cream itself ahead of your appointment. Always follow the instructions that come with your cream.

If you’re having a drip fitted or having blood taken, put the lidocaine cream on 1 hour beforehand.

For minor surgery, your doctor may tell you to use the cream more than 1 hour before the procedure.

If the procedure is delayed and the numbing effects of the cream have worn off, ask your doctor or nurse for advice before using any more cream.

If you’re having a cosmetic procedure and have bought lidocaine from a pharmacy to numb the area, tell the person doing the procedure before it starts. It will help them to know that the area has been numbed and you will not feel as much pain.

How much to use

The amount you use depends on the procedure you’re having and the type of lidocaine cream you’re using.

Read the instructions that come with the cream or follow the advice of your doctor or nurse.

They may tell you to use a whole tube of cream on each area of your skin, more than 1 tube, or only part of a tube.

How to put it on

1. Gently squeeze the tube so the cream goes straight onto the area of skin to be treated.
2. Do not rub it in.
3. Place a waterproof dressing over the cream to keep it in place. (The dressings come with the cream.)
4. Make a note of the time that you put the cream on.
5. As soon as you’ve finished putting the cream on, wash your hands carefully with soap and water.
6. When you’re about to have your procedure, take off the dressing and wipe off any excess cream with a tissue. You may not need to do this if the cream has soaked into your skin.

What if I forget to put it on?

If you forget to use the cream, or you put it on less than 1 hour beforehand, tell the person who is going to do the procedure. They may want to delay it.

Do not apply extra cream, as this will not make the lidocaine work any faster.

What if I apply too much?

Using more than the recommended amount can cause side effects. This can also happen if you put the cream on a large area of skin, or use it for longer than recommended.

If you’ve been prescribed lidocaine, you’re unlikely to use too much cream, as a doctor or nurse will usually give you the amount you need for a one-off procedure.

Lidocaine and Prilocaine Side Effects, Adverse Reactions

Localized Reactions: During or immediately after treatment with lidocaine and prilocaine cream, 2.5%/2.5% on intact skin, the skin at the site of treatment may develop erythema or edema or may be the locus of abnormal sensation. Rare cases of discrete purpuric or petechial reactions at the application site have been reported. Rare cases of hyperpigmentation following the use of lidocaine and prilocaine cream, 2.5%/2.5% have been reported. The relationship to lidocaine and prilocaine cream, 2.5%/2.5% or the underlying procedure has not been established. In clinical studies on intact skin involving over 1,300 lidocaine and prilocaine cream, 2.5%/2.5%-treated subjects, one or more such local reactions were noted in 56% of patients, and were generally mild and transient, resolving spontaneously within 1 or 2 hours. There were no serious reactions that were ascribed to lidocaine and prilocaine cream, 2.5%/2.5%.

Two recent reports describe blistering on the foreskin in neonates about to undergo circumcision. Both neonates received 1.0 g of lidocaine and prilocaine cream, 2.5%/2.5%.

In patients treated with lidocaine and prilocaine cream, 2.5%/2.5% on intact skin, local effects observed in the trials included: paleness (pallor or blanching) 37%, redness (erythema) 30%, alterations in temperature sensations 7%, edema 6%, itching 2% and rash, less than 1%.

In clinical studies on genital mucous membranes involving 378 lidocaine and prilocaine cream, 2.5%/2.5%-treated patients, one or more application site reactions, usually mild and transient, were noted in 41% of patients. The most common application site reactions were redness (21%), burning sensation (17%) and edema (10%).

Allergic Reactions: Allergic and anaphylactoid reactions associated with lidocaine or prilocaine can occur. They are characterized by urticaria, angioedema, bronchospasm, and shock. If they occur they should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value.

Systemic (Dose Related) Reactions: Systemic adverse reactions following appropriate use of lidocaine and prilocaine cream, 2.5%/2.5% are unlikely due to the small dose absorbed (see Pharmacokinetics subsection of CLINICAL PHARMACOLOGY ). Systemic adverse effects of lidocaine and/or prilocaine are similar in nature to those observed with other amide local anesthetic agents including CNS excitation and/or depression (light-headedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest). Excitatory CNS reactions may be brief or not occur at all, in which case the first manifestation may be drowsiness merging into unconsciousness. Cardiovascular manifestations may include bradycardia, hypotension and cardiovascular collapse leading to arrest.

Lidocaine/prilocaine (On the skin) | Drug Notes | Health Information

Lidocaine/prilocaine (On the skin)

Lidocaine (LYE-doe-kane), Prilocaine (PRIL-oh-kane)

Relieves pain. It is used on the skin or in the genital area to cause numbness or loss of feeling before certain medical procedures. This medicine is a topical anesthetic.

Brand Name(s):

AgonEaze, DermacinRx Cinlone-I CPI, DermacinRx Empricaine, DermacinRx Prizopak, EMLA, IV Infusion CPI, Lidopril, Lidopril XR, Livixil Pak, Medolor Pak, Prilolid, Relador Pak, Relador Pak Plus, Venipuncture CPI

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

You should not use this medicine if you have had an allergic reaction to lidocaine, prilocaine, or other similar anesthetics such as bupivacaine, mepivacaine, or dibucaine.

How to Use This Medicine:

Cream, Thin Sheet

• A nurse or other trained health professional will give you this medicine. The medicine is usually applied right before the medical procedure in a hospital or clinic.
• You may be taught how to apply this medicine to yourself or your child at home before the medical procedure.
• Your doctor will tell you how much medicine to use. Do not use more than directed. Do not use it for any other condition without first checking with your doctor. This medicine may cause unwanted effects if too much is used, because more of it is absorbed through the skin.
• Use this medicine only on your skin. Rinse it off right away if it gets on a cut or scrape. Do not get the medicine in your eyes, nose, or mouth.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Wash your hands with soap and water before and after you use this medicine.
• Apply a thick layer of medicine to the area where numbness is needed. Do not spread the medicine on the skin.
• Cover the medicine with a special bandage called an occlusive dressing. This will keep the medicine in place. Your doctor will give you the bandage or tell you what to use.
• Seal the edges of the bandage to keep the medicine from leaking. Do not lift the bandage or disturb it. Keeping the medicine tightly covered helps it work properly.
• For babies or young children, a second covering may be used to prevent them from touching the medicine.
• Carefully watch your baby or child while the medicine is in place. Do not let them loosen or remove the bandage, touch the medicine, or put it in the mouth, eyes, nose, or ears.
• Keep the bandage in place until you or your child arrive at the hospital or clinic.
• Your doctor will remove the bandage and wipe the medicine off the skin before the medical procedure.

How to Store and Dispose of This Medicine:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist or doctor how to dispose of the medicine container and any leftover or expired medicine.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using acetaminophen, acetanilid, aniline dyes, benzocaine (Americaine®), chloroquine (Aralen®), dapsone, or naphthalene. Tell your doctor if you are also using nitrofurantoin (Furandantin®), nitroglycerin (Nitrostat®), nitroprusside (Nitropress®), pamaquine, para-aminosalicylic acid, phenacetin, phenobarbital (Luminal®), phenytoin (Dilantin®), primaquine, quinine, or a sulfonamide antibiotic (such as trimethoprim/sulfamethoxazole, Bactrim®).
• Tell your doctor if you are also using a medicine to treat an abnormal heart rhythm such as amiodarone (Cordarone®), bretylium (Bretylol®), dofetilide (Tikosyn®), flecainide (Tambocor®), mexiletine (Mexitil®), propafenone (Rythmol®), quinidine (Cardioquin®, Quinaglute®, Quinidex®), sotalol (Betapace®), or tocainide (Tonocard®).

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you or your child have liver disease, heart disease, heart rhythm problems, methemoglobinemia (blood disease), or glucose-6-phosphate dehydrogenase (G6PD) deficiency (blood disease).
• Do not use this medicine on a baby younger than 3 months of age unless your child’s doctor tells you to. Young babies may have more unwanted effects if too much is used and absorbed through the skin. If you use this medicine on a baby younger than 3 months of age, blood tests may be needed to check for unwanted effects.
• Do not use this medicine to treat a skin problem your doctor has not examined.
• During the time that the skin feels numb, serious injury can occur. Be especially careful to avoid injury until the numbness wears off and you or your child have normal feeling in the area. Do not scratch or rub the area, and do not allow very hot or very cold objects to touch it.
• Using too much of this medicine or using it on a large area of your skin can cause serious unwanted effects. Remove the cream and contact your doctor right away if you or your child have any of these symptoms: lightheadedness, dizziness, vision problems, an irregular or slow heartbeat, difficulty with breathing, or convulsions.
• This medicine may cause serious types of allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you or your child have a rash; itching; hoarseness; trouble with breathing; trouble with swallowing; or any swelling of the hands, face, or mouth after you receive the medicine.
• This medicine may cause a rare, but serious blood problem called methemoglobinemia. Remove the cream and call your doctor right away if you or your child develop a blue or bluish purple color on the lips, fingernails, or skin, or have headaches, dizziness, fainting, sleepiness, or trouble with breathing.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Confusion, dizziness, sleepiness, or lightheadedness.
• Loss of color in your face or lips.
• Skin turns a blue color around your mouth, fingers, or toes.
• Tremors or convulsions (seizures).

If you notice these less serious side effects, talk with your doctor:

• Mild burning, itching, or rash.
• Pale or red skin where the medicine was applied.
• Swelling of the skin where the medicine was applied.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 1/27/2017

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lidocaine and prilocaine topical | Frankel Cardiovascular Center

What is the most important information I should know about lidocaine and prilocaine?

An overdose of numbing medicine can cause fatal side effects if too much of the medicine is absorbed through your skin. Overdose symptoms may include uneven heartbeats, seizure (convulsions), coma, slowed breathing, or respiratory failure (breathing stops).

Use the smallest amount of this medicine needed to numb the skin. Do not use large amounts of lidocaine and prilocaine topical, or cover treated skin areas with a bandage or plastic wrap without medical advice.

What is lidocaine and prilocaine topical?

Lidocaine and prilocaine are local anesthetics (numbing medicines). They work by blocking nerve signals in your body.

Lidocaine and prilocaine topical (for the skin) is a combination medicine used to numb the skin or surfaces of the penis or vagina. This medicine is used to prepare you for minor surgery or medical procedures on these areas.

Lidocaine and prilocaine topical may also be used for purposes not listed in this medication guide.

What should I discuss with my health care provider before using lidocaine and prilocaine topical?

You should not use lidocaine and prilocaine topical if you are allergic to any type of numbing medicine.

Fatal overdoses have occurred when numbing medicines were used without the advice of a medical doctor (such as during a cosmetic procedure like laser hair removal). However, overdose has also occurred in women treated with a numbing medicine before having a mammography.

Be aware that many cosmetic procedures are performed without a medical doctor present.

To make sure lidocaine and prilocaine topical is safe for you, tell your doctor if you have:

• a blood cell disorder called methemoglobinemia;
• liver disease;
• a genetic enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency; or
• a family history of methemoglobinemia, or any genetic enzyme deficiency.

FDA pregnancy category B. Lidocaine and prilocaine topical is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Lidocaine and prilocaine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use lidocaine and prilocaine topical?

Follow all directions on your prescription label. Do not apply this medicine in larger amounts than recommended.

You may need to apply lidocaine and prilocaine topical at home up to 4 hours before your surgery or procedure. You will be given instructions about how much medicine to use and how long to leave it on the skin. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Use the smallest amount of medicine needed to numb the skin. Your body may absorb too much of this medicine if you use too much, if you apply it over large skin areas, or if you apply heat, bandages, or plastic wrap to treated skin areas. Skin that is cut or irritated may also absorb more topical medication than healthy skin.

You may need to cover the skin to help keep the medicine in place. Do not cover treated skin unless your doctor has told you to.

Carefully follow dosing instructions when applying this medicine to a child. Lidocaine and prilocaine topical doses are based on weight in children. Do not allow a child to use this medicine without adult supervision.

Store at room temperature away from moisture and heat. Do not allow the cream to freeze.

What happens if I miss a dose?

Call your doctor for instructions if you forget to apply lidocaine and prilocaine topical at the time needed before your surgery or medical procedure.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

An overdose of numbing medicine can cause fatal side effects if too much of the medicine is absorbed through your skin and into your blood. Symptoms may include uneven heartbeats, seizure (convulsions), slowed breathing, coma, or respiratory failure (breathing stops).

Lidocaine and prilocaine applied to the skin is not likely to cause an overdose unless you apply more than the recommended dose.

What should I avoid while using lidocaine and prilocaine topical?

Do not allow this medicine to come into contact with your eyes. If it does, rinse with water.

Do not take by mouth. Lidocaine and prilocaine topical is for use only on the skin.

Avoid accidentally injuring treated skin areas while they are numb. Avoid coming into contact with very hot or very cold surfaces.

What are the possible side effects of lidocaine and prilocaine topical?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• severe burning, stinging, or irritation where the medicine was applied;
• swelling or redness;
• sudden dizziness or drowsiness after medicine is applied;
• confusion, blurred vision, ringing in your ears;
• bruising or purple appearance of the skin; or
• unusual sensations of temperature.

Common side effects may include:

• mild burning where the medicine is applied;
• itching, rash; or
• changes in skin color where the medicine was applied.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect lidocaine and prilocaine topical?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with lidocaine and prilocaine topical, especially:

• chloroquine, dapsone, nitrofurantoin, isosorbide dinitrate, nitroglycerin, nitroprusside, quinine;
• heart rhythm medication –amiodarone, dofetilide, dronedarone, mexiletine, sotalol, tocainide, and others;
• seizure medicine –phenobarbital, phenytoin, primaquine; or
• a sulfa drug –Bactrim, Septra, SMX-TMP or SMZ-TMP, and others.

This list is not complete. Other drugs may interact with lidocaine and prilocaine topical, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

Your pharmacist can provide more information about lidocaine and prilocaine topical.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 2.06. Revision date: 9/9/2014.

Emla instructions for use: indications, contraindications, side effects – description Emla cream for local. and outdoor approx. 25 mg + 25 mg / 1 g: 5 g tubes 5 pcs. or 30 g 1 pc. (999)

Application of lidocaine / prilocaine anesthetic cream for laser procedures in dermatology and cosmetology

Laser methods for correcting age-related changes and treating various skin pathologies (vascular and pigmentary abnormalities, hypertrichosis, cicatricial deformities, etc.)) are in high demand and allow us to expand the range of services in dermatology and cosmetology. Contrary to popular belief, most laser procedures involve painful discomfort. The increasing demand for effective and painless laser procedures has spurred the search for the ideal method of anesthesia. Patients expect fast yet impressive results from the procedures. To meet these needs, dermatologists are constantly looking for anesthetics that are effective, pose the least risk to the patient, and have the least unwanted side effects.

Innervation and sensory function of the skin. Skin pain. Quick Details

Sensory receptors in the skin convert certain forms of energy into action potentials in sensory neurons. Cutaneous mechanoreceptors respond to touch and pressure. Thermoreceptors are involved in the sensation of warmth and coldness. Nociceptors are polymodal receptors and respond to stimuli such as pain (bite, pinch, cut, prick), extreme heat (burn) and cold, inflammatory mediators (Table 1).1). Table 1. Basic sensory modalities of the skin Source: Kim E. Barrett, Susan M. Barman, Heddwen L. Brooks, Jason X.-J. Yuan. Ganong`s Revew of Medical Physiology. 26th ed. McGraw-Hill Education; 2019.

Sensory axons originate in the sensory ganglia and define areas of the skin called dermatomes. They are myelinated in the dermis, but not in the epidermis. From the plexus in the deep dermis, nerve fibers rise to the surface of the skin and form a superficial nerve plexus at the junction of the reticular and papillary dermis.Nerve endings can be loose, dilated, or corpuscular. Impulses from nociceptors are transmitted through myelinated Aδ fibers (2-5 microns in diameter) at a speed of 12-35 m / s and unmyelinated C-fibers (0.4-1.2 microns in diameter), conducting the impulse at a lower speed – 0.5— 2 m / s. The activation of Aδ fibers is responsible for the primary, so-called rapid, pain, which is an immediate response to a stimulus and determines the site of action and the intensity of the painful stimulus. C-fiber activation is responsible for secondary pain (delayed or slow pain), which is characterized by vague, dull, diffuse, aching painful sensations [1].

Skin pain, mainly acute, arises from physical, chemical or thermal injuries, but it can also be chronic. Pain is not so common in skin diseases (mainly in ulcerative skin lesions, in Lyell’s syndrome), but nevertheless accompanies neurological or neurocutaneous diseases. External pain stimuli, as well as numerous chemicals such as bradykinin, histamine, serotonin, prostaglandins, interleukin-1, etc., are capable of modifying or inducing nociceptor activation.Substance P is the best known and most important mediator of pain. Other mediators of pain have also been described: CGRP, somatostatin, glutamate, etc. [2].

The main “nociceptive triggers” in cosmetology are all injection techniques (mesotherapy, contour plastics, biorevitalization, PRP therapy, thread technologies, etc.), laser and IPL procedures, RF microneedle lifting, dermabrasion, chemical peels. In fact, any of the listed procedures has a pronounced stimulating effect on all types of nociceptors – chemical, mechanical and thermal [3].

High-energy laser action on the skin can cause acute pain. The somatosensory system responds instantly to the transduction of the nociceptive signal due to intense transcendental stimulation of polymodal nociceptors, primarily thermal nociceptors.

Pharmacology of local anesthetics

Local anesthetics are divided into 2 groups: containing an ester bond (for example, procaine (novocaine), tetracaine, cocaine) and those containing an amide bond (for example, lidocaine and prilocaine) (Fig.1). Rice. 1. Diagram of the structure of ether and amide anesthetics. (J. Morgan. Clinical anesthesiology. Book. 1. M., St. Petersburg: Binom; 2001).

Ether-type local anesthetics are metabolized by plasma cholinesterase and other nonspecific esterases, while amide anesthetics are mainly metabolized in the liver via microsomal enzymes. It is known that ester anesthetics can cause allergic reactions when in contact with the skin, while these are rare cases with amide group anesthetics.Para-aminobenzoic acid is a metabolite of ester hydrolysis and is associated with allergic reactions. The solubility of local anesthetics in fats correlates with their strength and duration of action (Table 2) Table 2. Structure and properties of local anesthetics ¹ Note. Adapted from Strichartz GR, et al. Fundamental properties of local anesthetics. II. Measured octanol: buffer partition coefficients and pKa values ​​of clinically used drugs. Anesth Anal. Aug 1990; 71 (2): 158-170.[4].

Mechanism of action of local anesthetics

Local anesthetics reversibly block nerve conduction near the injection site by acting on free nerve endings in the dermis or mucous membrane, resulting in temporary loss of sensation in a limited area. Nerve impulse conduction is blocked by a decrease in the permeability of nerve cell membranes to sodium ions, possibly due to competition with calcium-binding sites that control sodium ion permeability (Fig.2). Rice. 2. Mechanism of action of local anesthetics (adapted from K. Whalen, C. Feild, R. Radhakrishnan. Lippincott Illustrated Reviews: Pharmacology. 7th ed. Wolters Kluwer; 2019).

Rice. 3. Recommendations for the use of topical anesthesia in laser ablation procedures.

Rice. 4. Recommendations for the use of topical anesthesia in laser non-ablative procedures without compromising the integrity of the skin.

Complete inhibition of conduction is achieved by increasing the concentration of the anesthetic.

Clinical and pharmacological properties of a combined local anesthetic cream containing 2.5% lidocaine and 2.5% prilocaine (eutectic mixture)

Eutectic Blends are compounds that melt at lower temperatures than any of their constituents, allowing higher concentrations of anesthetic agents to be used. It is a 5% oil-in-water emulsion with a melting point of 18 ° C, consisting of 25 mg / ml lidocaine, 25 mg / ml prilocaine, thickener, emulsifier and distilled water adjusted to pH 9.4.Since the eutectic mixture is a liquid, the anesthetics do not need to be dissolved in oil before they are introduced into the aqueous phase of the formulation; this increases the concentration of the active substance in the emulsion droplets and allows more anesthetic to penetrate the nerve endings in the deeper layers of the skin. Lidocaine / prilocaine cream is applied in a thick layer (1-2 g per 10 cm ² , the maximum dose is 60 g per 600 cm ² ) on intact skin under the occlusive film (cling film can be used) to facilitate the penetration of local anesthetics through the stratum corneum layer.The depth of anesthesia depends on the time of contact with the cream. It has been shown that the anesthetic effect reaches a depth of 3 mm after 60 min, 4 mm – after 90 min, and 5 mm – after 120 min of use [5]. Skin analgesia intensifies within 3 hours with an occlusive dressing and persists for 1-2 hours after removing the cream. After applying lidocaine / prilocaine cream to the skin, a two-phase response occurs with initial vasoconstriction and skin blanching (with a peak after 90 minutes of application). After 2-3 hours of application, vasodilation occurs, which leads to erythema of the skin.It should not be confused with other adverse skin reactions such as hives or allergic contact dermatitis. The amount of systemic absorption of a cream is directly related to the duration and area of ​​application. The blood flow and thickness of the skin, the presence of a particular skin pathology affect the absorption, onset of action, the effectiveness and duration of action of the lidocaine / prilocaine cream.

The stratum corneum of the epidermis is the main barrier for the delivery of local anesthetic into the skin. There are 3 ways of penetration through the stratum corneum: intercellular (through the intercellular spaces of keratinous keratinocytes), para- or transcellular (through keratinous cells), through the infundibulum (follicular part) of the hair follicle and the ducts of the sweat glands.Local anesthetics penetrate more easily through the mucous membrane of the oral cavity, genitals and conjunctiva due to the absence of the stratum corneum [6].

Factors affecting the delivery of local anesthetics to the skin:

1) dosage form – free bases are lipophilic and can independently penetrate into the stratum corneum, while for salt forms this requires special delivery systems;

2) melting point and eutectic mixtures – the lower the melting point, the better the penetration.Eutectic mixtures have a lower melting point, thus better penetration than a single component;

3) the concentration of the drug in the vehicle – the higher it is, the faster the penetration rate.

Despite the low risk of systemic toxicity, physicians should be wary of potential side effects. The use of lidocaine / prilocaine cream on damaged or inflamed skin or over a large area (more than 600 cm ² ) may increase the risk of systemic side effects.Prilocaine as part of a combination cream can cause methemoglobinemia due to its ability to oxidize iron in red blood cells to a trivalent state that interferes with oxygen transport. Lidocaine / prilocaine cream should not be used in patients with congenital or idiopathic methemoglobinemia or in children under 12 months of age who are taking medications that cause methemoglobinemia such as sulfonamides, dapsone, acetaminophen, nitrates, nitrites, and phenobarbital.

Lidocaine / prilocaine cream is Category B for pregnant women, but caution should be exercised when using it in nursing mothers, as lidocaine and probably prilocaine are excreted in breast milk in small quantities.The risk of side effects in infants is considered minimal.

Dangers of using essential and highly concentrated anesthetics

The US Food and Drug Administration (FDA) has issued a recommendation regarding the risk of dangerous side effects associated with the use of local anesthetics for cosmetic procedures. It states that local anesthetics are sometimes used in unapproved ways and in doses that can pose a serious risk to the patient’s health and life.2 deaths have been reported related to the application of topical anesthetics to the legs for pain relief during laser hair removal. Patients, at the direction of specialists, wrapped their legs in cellophane to increase anesthesia. Both patients developed convulsions, coma with subsequent death due to the toxic effects of anesthetics. As it turned out, in these cases, creams with a high concentration and an excess of lidocaine and tetracaine were used (10% lidocaine gel + 10% prilocaine in the first case and 6% lidocaine gel + 6% tetracaine in the other) [7].

In this regard, in 2006 the FDA issued an official warning about the potential danger of side effects caused by drugs containing a mixture of ether and amide local anesthetics. The active ingredients of products not recommended by the FDA as a topical anesthetic are: Benzocaine 20% + Tetracaine 4% + Lidocaine 6%; lidocaine 10% + tetracaine 10%; lidocaine 30% + prilocaine 2% + tetracaine 4%; lidocaine 15% + prilocaine 5%; lidocaine + prilocaine + tetracaine.

Application of lidocaine / prilocaine cream in laser procedures in dermatology

The use of lidocaine / prilocaine cream significantly expands the possibilities of outpatient dermatological procedures.Topical anesthesia significantly reduces pain discomfort during skin biopsy (razor and punch biopsy), curettage, laser and electrosurgical removal of molluscum contagiosum and warts, laser treatment of port wine stains and removal of blood vessels on the legs, laser sanitation of trophic ulcers, etc. [7-11 ]. Topical anesthesia is also used on the genital mucosa in adults for painless removal of local lesions, such as genital warts [12].

The main indications for laser procedures in dermatology and the time of application of lidocaine / prilocaine cream are shown in table.3. Table 3. Indications and time of application of lidocaine / prilocaine cream for common laser procedures in dermatology

Application of lidocaine / prilocaine cream in laser aesthetic procedures

All types of laser interventions in dermatology can be conditionally subdivided into 2 types:

1) procedures during which ablation (layer-by-layer removal) of the affected skin area is performed;

2) procedures aimed at selective removal of pathological structures without violating the integrity of the skin (the principle of selective photothermolysis).

In the first case, lasers operating in the middle and far infrared spectrum, Er: YAG (2940 nm) and CO2 (10 600 nm), are used for ablation. The chromophore is water. Various modes of action on the skin are used – incision and excision, continuous and fractional ablation. The level of pain during ablation procedures depends on the energy parameters of the impact that determine the depth of the impact, the percentage of coverage (the greater the distance between the microthermal ablation sites, the more comfortable the procedure), the treatment area (the most sensitive: periorbital area, nasolabial triangle, centrofacial area).Before the advent of topical anesthetics, ablative laser procedures required the use of intravenous sedation. With the introduction of more superficial single-pass and fractional techniques, it is possible to provide adequate anesthesia with the use of topical anesthetics [13]. The market leader for topical anesthesia is the eutectic mixture of lidocaine and prilocaine. For almost all ablative procedures, the recommended minimum application time for lidocaine / prilocaine cream is 60 minutes. This time is sufficient to treat the skin to the level of the basement membrane, when it is necessary to carry out continuous or fractional superficial ablation without removing the laser-induced scab.In the case when it is required to remove the scab with subsequent repeated passage in this area, it is necessary to increase the anesthesia time to 90-120 minutes, and also provide for the possibility of conduction anesthesia.

A prerequisite before starting the procedure is to completely remove the cream and dry the skin for unhindered interaction of laser light with tissues.

To carry out deep laser multipass resurfacing, additional methods of anesthesia are required – intravenous sedation, conduction anesthesia, anesthesia.While there are many local anesthetic options for laser resurfacing, unfortunately there is no standardized guideline for optimal safety in the use of local anesthetics. Several factors need to be considered when deciding which one to use: the anatomical region, the amount of anesthetic applied, the duration required for the desired depth of anesthesia, the safety profile of the individual local anesthetic, and how it interacts with the patient’s comorbid conditions [14].

Type 2 laser procedures do not violate the integrity of the epidermis, but at the same time they can also be accompanied by significant discomfort associated with painful sensations.

Laser fractional photothermolysis is used for non-ablative rejuvenation in case of mild to moderate photodamage of the skin, wrinkles and dyspigmentation. The popularity of this procedure is due to its high clinical efficacy and moderate side effects – transient erythema and edema. However, the deep penetration of laser light in the near infrared spectrum creates the effect of volumetric thermal heating in the deep layers of the skin, providing a pronounced pain effect due to the high density of polymodal nociceptors and thermoreceptors in the dermis.To increase the comfort of the procedure, a combination of topical anesthesia with lidocaine / prilocaine cream (application 45–60 min) and cooling of the treatment area with a forced jet of cold air is recommended [15–17].

Laser hair removal is the most common procedure that uses topical anesthetics, especially in sensitive areas such as the upper lip and groin. For effective anesthesia in these places, the time of application of the lidocaine / prilocaine cream under the occlusive film should be at least 30 minutes if the skin is prepared for epilation (hair shaving) immediately before the procedure.Due to the deep penetration of laser light (up to 4 mm for epilation with a neodymium laser), the application time of the cream on the skin prepared in advance for the procedure (shaving the hair in 1 day) should be 45-60 minutes. To prevent delayed side effects after laser hair removal (thermal injury, paradoxical hypertrichosis), it is recommended to apply a cooling bag to the laser-treated skin area for 30 s during the procedure [18, 19].

Treatment of vascular skin pathology in most cases does not require anesthesia.Especially when it comes to the removal of single telangiectasias or small vascular malformations (cherry and arachnoid angioma, pyogenic granuloma, venous lake, etc.). However, with laser removal of port wine stains in the facial area, especially in children and adolescents, severe painful sensations are observed that require adequate anesthesia. Lidocaine / prilocaine cream with an exposure time of 20–40 min is effective as an anesthetic, depending on the area of ​​the port wine stain and its location – the closer to the center of the face, the more painful the procedure [10].Despite the discoloration of the skin due to the vasoconstrictor effect of the local anesthetic in the cream, treatments using a pulsed dye laser or IPL device provide a satisfactory treatment for port wine stains. Restoration of blood flow in pale areas can be achieved by rubbing or blowing a stream of warm air over the skin surface (hair dryer). In this case, the effectiveness of anesthesia is not reduced. Additionally, to improve the comfort of the procedure, it is recommended to apply cooling bags to the treated area.

Anesthesia for laser treatment of pigmented skin pathology and tattoo removal is carried out according to the same scheme.

Before the laser procedure, it is strongly recommended to thoroughly remove the cream with a water-based antiseptic solution and dry the skin in every case of application of local anesthesia. This will facilitate the smooth interaction of the laser light with the skin surface. It should be remembered that the anesthetic cream is an oil-in-water emulsion containing excipients that practically do not penetrate the skin – polyethylene glycol-54, hydrogenated castor oil.As a result, after absorption of anesthetics, a film can remain on the skin surface, which, when interacting with laser light, absorbs a certain part of the energy, thereby provoking a burn on the epidermis and / or reducing the effectiveness of laser exposure.

Choosing an effective local anesthetic for minimally invasive dermatological and cosmetic procedures is not an easy task for practitioners. What type of anesthesia to use depends on a number of factors, including patient characteristics, age, pregnancy, health status, allergic history, current medication intake, comorbidities, type of procedure and its duration, patient preference (fear of a needle), experience doctor, etc.A feature of medical services in cosmetology is the patient’s unwillingness and unwillingness to experience tangible pain discomfort during procedures. But the realities of modern cosmetology are such that more and more its arsenal is replenished with technologies that not only provide convincing clinical effects, but are also capable of provoking a negative psychoemotional state in a patient who is undergoing certain painful procedures. Laser treatment methods are precisely the type of painful effects on the skin.Almost any type of laser skin interaction (ablative, non-ablative) requires adequate anesthesia. Taking into account the variety of indications for laser procedures (hair removal, removal of blood vessels, tattoos, photorejuvenation, etc.), as well as the area and area of ​​influence, it is logical to assume that the most appropriate type of pain relief in this situation would be cream-based anesthesia with an effective combination of local anesthetics. The application of such a tool will provide a local anesthetic and analgesic level, at which the laser procedure will be carried out in a comfortable environment not only for the patient, but also for the doctor – a specialist will be able to select adequate parameters for laser treatment without compromising its effectiveness due to patient complaints of pain.An additional and important advantage of effective application anesthesia is the low risk of systemic toxic effects (cardio- and neurotoxic). All of these factors work in the context of a professional attitude towards the assigned tasks and the implementation of clinical guidelines.

The author declares no conflicts of interest.

The author declares no conflict of interest.

Credits

Shepty O.B. – https://orcid.org/0000-0002-5967-3002

Corresponding author: Sheptiy O.V. –
e-mail: [email protected]

Arpimed

Special instructions

It is not recommended to use Lidocaine, 5% ointment in dentistry in the presence of inflammatory processes or sepsis.

Despite the low risk of systemic absorption, it should be taken with caution in case of anemia, congenital or acquired methemoglobinemia, deficiency of glucose-6-phosphate dehydrogenase.If the patient has an allergic reaction, the drug should be discontinued immediately and symptomatic treatment should be carried out.

Lidocaine should not be administered to patients with hypovolemia, heart block, or other conduction disorders. Use caution for congestive heart failure, bradycardia, or respiratory depression.

When using the recommended doses, the risk of side effects from the central nervous system is low.

Hypersensitivity: Lidocaine is used with caution in patients with hypersensitivity to it.In patients allergic to para-aminobenzoic acid derivatives (procaine, tetracaine, benzocaine, etc.), cross-sensitivity to lidocaine is not observed.

Pregnancy: Appropriate studies have not been conducted. However, the drug should be taken with caution early in pregnancy.

Breastfeeding: Lidocaine is excreted in breast milk in small amounts, which may not pose a risk to the infant.

In renal failure the pharmacokinetics of Lidocaine 5% ointment does not change.

In case of liver failure is used with extreme caution, since lidocaine is metabolized mainly by the liver.

Avoid contact with eyes.

Overdose

Systemic toxicity with local anesthetics is mainly associated with high plasma concentrations and includes mainly CNS and cardiovascular side effects.

Symptoms

From the side of the central nervous system : paresthesia, numbness of the tongue, dizziness and distraction, ringing in the ears, drowsiness, feeling of heat, cold or numbness, tinnitus, trembling, unusual anxiety, agitation, nervousness or anxiety, diplopia, confusion , convulsions.Possibly unconsciousness or minor convulsions that can last from a few seconds to several minutes.

From the cardiovascular system : acute hypotension, bradycardia, arrhythmias, and cardiovascular collapse.

Treatment: Symptomatic – Ensure free airway, oxygen utilization, carbon dioxide removal, oxygen administration and / or artificial respiration.To relieve seizures, it is necessary to administer succinylcholine at a dose of 50-100 mg and / or diazepam at a dose of 5-15 mg. It is also possible to use short-acting barbiturates (sodium thiopental). In the acute phase of lidocaine overdose, dialysis is ineffective.

Interaction with other drugs

Antiarrhythmic drugs: There is evidence of paralysis or cardiac arrest in patients who received lidocaine with amiodarone or tocainide. Disturbance of consciousness has been observed when used with procainamide.

Antiepileptic drugs: Phenytoin and barbiturates can reduce the concentration of lidocaine in the blood. IV phenytoin enhances the cardiodepressant effect of Lidocainase.

Beta-blockers: When used simultaneously with propranolol, the concentration of lidocaine in plasma is significantly increased. A detailed interaction is observed with nadolol.

H ₂ – antagonists: Cimetidine increases the hepatic metabolism of lidocaine, leading to an increased risk of lidocaine toxicity.

Hypokalemia caused by acetazolamide, loop and thiazide diuretics, counteracts the effect of lidocaine.

Side effects are observed with simultaneous use with vasoconstrictors.

Form of issue and packaging

5% ointment in 15 g aluminum tubes together with a leaflet in a cardboard box.

Storage conditions

Keep out of the reach of children, in a dry, dark place at a temperature not exceeding 15˚C.

Expiry date

3 years. Do not use after the expiration date.

Vacation conditions

Prescribed by a doctor.

Lidocaine + Prilocaine [LifeBio.wiki]

Local anesthetics of the amide series. Their mechanism of action includes blocking sodium channels, which leads to a rapid inhibition of the flow of sodium ions and prevents depolarization of the neuron under the action of impulses. In the preparation in the form of an oil-in-water emulsion, both substances are a eutectic mixture (concentration 2.5%), at room temperature the preparation is in liquid form, which facilitates its penetration into the deep layers of the skin and absorption into the systemic circulation.After application to intact skin for at least 1 hour, it is absorbed into the skin under an occlusive dressing, providing anesthesia to a depth of 2-3 mm and remaining for 1-2 hours after removing the dressing. Initially, vasoconstriction occurs, and then vasodilation. Absorption into the systemic circulation depends on the time, type (blood supply), as well as the size of the surface on which the drug was applied, however, with proper use, the concentration of both substances in the blood is always significantly less than toxic concentrations (after applying 60 g of cream [that is 1.5 g of each active substance] on a surface of 400 cm2 [thigh] after 24 hours, the maximum concentrations were 1/20 and 1/36 of the toxic concentration, respectively, for lidocaine and prilocaine).When applied to mucous membranes for 5-10 minutes, it provides anesthesia for the use of an argon laser for 15-20 minutes. Lidocaine binds to plasma proteins in 70%, prilocaine in 55%, both substances penetrate the blood-brain barrier and into the placenta. Metabolism of lidocaine occurs in the liver, prilocaine in the liver and kidneys, and one of its metabolites is o-toluidine. It is excreted from the body mainly in the urine. In children, the pharmacokinetics of both substances are the same as in adults.

Lidocaine + Prilocaine: Instructions for Use

Local anesthesia of the skin before puncture or catheterization, blood sampling for examination before surgery.Local anesthesia of the genital mucosa before surgery or infiltration anesthesia.

Contraindications

Hypersensitivity to amide local anesthetics, congenital or idiopathic methemoglobinemia. Observe caution in patients with glucose-6-phosphate dehydrogenase deficiency and in patients with atopic dermatitis (duration of use 15-30 minutes). Use with caution in the eye area. Not recommended for children under 3 months of age, as well as for children 3-12 months old who are taking other drugs that cause the formation of methemoglobin.Not recommended for children on mucous membranes. Do not apply on damaged eardrums or in other situations in which the cream can penetrate into the middle ear. Do not use on open wounds. Be careful when using the drug before injecting the vaccine subcutaneously. Monitoring of the immune response is recommended after administration of live vaccines. In patients receiving class III antiarrhythmics, an ECG is recommended.

Interaction with other drugs

The parallel use of drugs that cause the formation of methemoglobin increases the risk of methemoglobinemia.Use with caution in combination with other local anesthetics of similar structure due to the risk of accumulation of side effects. Exercise caution when used concurrently with class III antiarrhythmic drugs.

Lidocaine + prilocaine: side effects

Often: swelling, pallor, or redness at the injection site. Sometimes: burning or itching. Rarely: methemoglobinemia in children, allergic reactions (rarely anaphylactic reactions), small atrophic changes at the injection site.

Pregnancy and lactation

Category B. Use caution in pregnant women. Both substances pass into breast milk; the risk of side effects in newborns after the appropriate use of the drug by the mother is small.

Lidocaine + prilocaine: dosage

Adults. In the case of minor surgical procedures, apply a thick layer of 2 g of cream to intact skin and cover with an occlusive dressing; the duration of use is 1–5 hours; in case of serious surgical procedures on the skin, apply 1.5–2 g / 10 cm2 and cover with an occlusive dressing; the duration of use is 2–5 hours.In the surgical treatment of localized changes in the mucous membranes, 5-10 g of the cream is applied in a thick layer; do not apply an occlusive dressing; the duration of use is 5-10 minutes. children 3–12 months 2 g of cream on the surface of the skin with a maximum of 16 cm2 under an occlusive dressing; duration of use 1–2 hours for children from one to 6 years up to 10 g of cream on the skin surface maximum 100 cm2 under an occlusive dressing; duration of use 1–5 hours. For children from 6 to 12 years old, up to 20 g of cream on the surface of the skin with a maximum of 200 cm2 under an occlusive dressing; duration of use 1-5 hours.In children with atopic dermatitis, the maximum duration of use is 30 minutes.

Preparations on the market containing lidocaine + prilocaine

Lidocaine + prilocaine buy

lidocaine_prilocaine.txt · Last modified: 2021/05/28 14:32 – dr.cookie

6.2.2 Lidocaine, prilocaine, emla

(1) Preparations,
readings

Lidocaine
MA of the amide group, used for
local infiltration anesthesia and
regional nerve blockade.Characterized
rapid onset of action, anesthesia
develops within a few minutes;
has a short-term effect.
Additional use
vasoconstrictors reduce absorption
into the systemic circulation, and also causes
faster onset of action and longer
the effect. Effective surface lidocaine
anesthetic that can quickly
absorbed at the site of application
(mucous membranes) and cause systemic
effects. Hyaluronidase is able to enhance
absorption of lidocaine. Lidocaine is added
in some injections, for example, with
administering corticosteroids for
preventing pain and itching caused by
local inflammation.

Prilokain MA
amide group in terms of strength of action is similar to
lidocaine. Be that as it may, he has
slower onset of action, less
vasodilating ability, slightly
long duration of the effect. He also
less toxic. Used for
infiltration, regional anesthesia
the following solutions: 0.5%, 1%, 2%. 1% and 2% solutions
used for epidural analgesia,
for intravenous local administration
suitable 0.5%. In dentistry, 3% solution
with the addition of vasoconstrictors
(felypressin) or 4% without them.In some
countries use a 4% solution with
adding epinephrine (diluted
1: 200,000) in dentistry. Soda solutions
prilocaine is also used for
epidural anesthesia and shoulder block
plexus. Prilocaine with lidocaine
added to the eutectic mixture
local anesthetics – EMLA.

(2) Dosages,
side effects and toxicity

Dose
lidocaine depends on the injection site and
planned procedure, but in general
the maximum dose should not exceed
3 mg / kg (up to 200 mg) in combination with
vasoconstrictors.Lidocaine solution
hydrochloride containing epinephrine
(1: 200,000) is used for infiltration
anesthesia and regional anesthesia,
higher doses of epinephrine are used
quite rarely, the exception is
dentistry, where it is usually used
dilution 1:80 000. Maximum dose
epinephrine should be 5 mcg / kg
and lidocaine 5 mg / kg. Adrenaline – containing
solutions are not used on distal
parts of the extremities (operations on
fingers), as well as, for example, with penile
block. Lidocaine can be used
for various indications for superficial
anesthesia.Applying lidocaine to
skin, mucous membranes causes them
anesthesia. For local anesthesia
urinary tract and aphthous ulcers
gels are applied. Also possible local
analgesia of the mucous membranes of the mouth,
throat, upper gastrointestinal tract 2% solution
or 10% spray. Eye drops containing
lidocaine hydrochloride 4% with fluorescene
used when measuring intraocular
pressure. Other methods of transdermal
the introduction of anesthetic is the application
5% lidocaine on the skin to treat pain,
associated with postherpetic neuralgia,
and iontophoresis of drugs with the introduction of lidocaine
with epinephrine.

Lidocaine
binds to plasma proteins, including
acidic alpha – 1 – glycoprotein
(orosomucoid, AAG),
by 66%. It depends on the concentration of that
and the other in blood plasma. Any change
concentration of acidic alpha – 1-
glycoprotein affects concentration
lidocaine in plasma. Plasma
concentration decreases rapidly immediately
after intravenous administration, with
initial half-life less than 30
min, half-life is
1 – 2 hours, however it can be extended,
if the infusion lasts more than 24 hours, or
decreased hepatic blood flow.Lidocaine
almost completely metabolized
in the liver, therefore any violation of it
function or decreased hepatic
blood flow leads to significant
changes in pharmacokinetics and requires
dose adjustments. First pass effect
is 35% after enteral administration.
As a result of hepatic metabolism
about 90% of the administered dose is exposed
dealkylation, transforming into
monoethylglycinexylidide and glycinexylidide.
Both of these metabolites cause therapeutic
and the toxic effects of lidocaine, so
how its metabolites have a longer
half-life than lidocaine itself,
it causes cumulation mainly
glycinexylidide as a result of prolonged
infusion.As a result of further
transformations are formed by the final
metabolites, as well as less than 10% lidocaine,
which are excreted by the kidneys. Decrease
clearance of lidocaine is observed in
patients with heart failure,
severe liver damage. Preparations,
altering hepatic blood flow or
activating enzyme systems of the liver,
may also affect ground clearance
lidocaine. However, despite this
accumulation of active metabolites is possible.
Lidocaine crosses the placenta and
blood-brain barrier, enters
into breast milk.Lidocaine is considered
unsafe drug for patients
with porphyria, since it has been proven that
it can cause porphyria in animals.

Clearance
lidocaine can reduce propranolol and
cimetidine. Cardiodepressant effect
lidocaine increases in the presence
beta blockers and other antiarrhythmics.
Additional effects on the cardio –
vascular system lidocaine has
with joint intravenous administration
phenytoin, mexiletine or amiodarone,
one way or another as a result of prolonged
use of phenytoin and others
enzyme activators such as
barbiturates, it is necessary to increase
dose of lidocaine.Hypokalemia induced
aceazolamide, loop diuretics
and thiazides reduces the effects of lidocaine.

Dose
prilocaine in children after 6 months
reaches 5 μg / kg. For local
dental infiltration anesthesia
nerves, a 4% solution is often used
epinephrine at a dilution of 1: 200,000. Children up to
10 years usually require a dose of about 40 mg (1
ml). Prilocaine hydrochloride dose c
felipressin 0.03 IU / ml requires a 3% solution
about 30 – 60 mg (1 – 2 ml) for children under 10
years.

Prilokain
has a relatively low toxicity
relative to other anesthetics amide
groups.55% binds to plasma proteins,
rapidly metabolized in the liver and
kidneys and excreted in the urine. One
of the key metabolites is o-
toluidine, which can cause
methemoglobinemia in high doses. He
crosses the placenta and as a result
prolonged epidural anesthesia
can cause methemoglobinemia in
fetus. Also passes into breast milk.
Maximum plasma concentration
toxic to the central nervous system is 20 mg / ml.
Symptoms usually appear when the dose
prilocaine hydrochloride reaches 8
mg / kg, however, the younger the age, the
the organism is more sensitive.Methemoglobinemia was observed in
newborns whose mothers,
received prilocaine for a short time,
and also methemoglobin is described in
children after prolonged local
using eutectic mixture
prilocaine / lidocaine. With methemoglobinemia
oxygen therapy is used, with
if necessary, methylthionine is used
chloride.

Prilokain
should be used with caution in
patients with anemia, congenital and
acquired methemoglobinemia,
with heart and respiratory failure,
hypoxia.Using prilocain
associated with the development of acute attacks
porphyria, so be careful
used in patients with this
pathology. Methemoglobinemia can
manifest at lower doses of prilocaine
in patients receiving drugs,
causing this condition (such as,
sulfonamides, for example sulfamethoxazole,
co-trimoxazole).

(3) EMLA

Lidocaine
in a mixture with prilocaine forms a mixture,
whose melting point is lower
than all the components of this mixture in
separately.Eutectic mixture,
containing 2.5% lidocaine and 2.5% prilocaine,
induces local anesthesia upon application
as a cream on intact
skin. It is widely used in venipuncture,
when staging venous and arterial
catheters, lumbar puncture, small
dermatological procedures and the like. (
see section 4.0). Eutectic ointment
applied under a pressure bandage
for at least 60 minutes to 5 hours. This period
may be accompanied by pallor,
redness, swelling of the skin.

Eutectic
mixtures of lidocaine and prilocaine are used
in newborns and are safe at one time
dosage.There is an opinion that
additional suction (especially
prilokain) can lead to
methemoglobinemia in asthma after
numerous applications. For this
reason, the maximum number of doses
per day should be strictly limited
in neonatal practice. In some
countries EMLA is licensed to use
in children from 37 weeks of gestation, and the level
methemoglobin is estimated in them up to 3
months of life. As a result, the systemic
absorption from intact skin
lidocaine and prilocaine from eutectic
mixture is minimal even with prolonged
or additional use.So
or else EMLA should not be used in
children under 1 year of age receiving drugs –
methemoglobin – educators; shouldn’t
apply on damaged skin or
mucous membranes, as well as with atopic
dermatitis. EMLA should not overlap
on the eyes and nearby tissues due to
risk of corneal irritation. Not introduced
into the middle ear. Used with care
in patients with anemia or congenital
acquired methemoglobinemia.

3. Tetracaine
   (ametocaine)

(1) Preparations,
readings

Tetracaine
powerful para-aminobenzoic acidic MA
ether group used for
surface anesthesia and spinal
anesthesia.Has a high degree
lipophilicity and penetrates well through
skin. Its use in local
reduced anesthesia due to systemic
toxicity.

For
anesthesia in ophthalmology are used
0.5% – 1.0% tetracaine hydrochloride solutions
and ointments with 0.5% tetracaine content.
Instillation of 0.5% tetracaine solution
cause anesthesia for 25 seconds and
act for 15 minutes or more,
such anesthesia is most suitable for
small interventions.

4% gel (Ametop)
used as a local skin
anesthetic.It renders faster
and a lasting effect than EMLA, and
also significantly better pain relief
for laser treatment of wine stains,
venipuncture and catheterization. Effective
in used plasters containing
lidocaine and tetracaine. Tetracaine also
added to polymer films that
adhered to the mucous membrane for pain relief
wounds after radiation therapy of tumor
neoplasms. Included in liposomes
tetracaine is also used for
full surface anesthesia.

LAT
(LET)
4% lidocaine, 0.1% epinephrine, 0.5% tetracaine
mixed, converted to gel and
applied to the skin as an anesthetic on
damage to the skin, especially on
face and head. This is less
painful alternative to local
infiltration before suturing
for damage.

(2) Doses, side
action toxicity of drugs

Tetracaine:
on hit
in the eyes causes a burning sensation. Suction
tetracaine mucous membranes occurs
fast enough and adverse reactions
may appear suddenly without seizures
and other prodromal phenomena, systemic
toxicity is higher, mortality from side
reactions are also high.He shouldn’t
apply on inflamed,
traumatized or severely
vascularized skin should not
used for broncho anesthesia
– or cystoscopy, as there are more
safe options such as lidocaine.

Tetracaine –
the gel is applied in the center of the area to
pain relief and covered with pressing
bandage. The gel and dressing are removed after
30 minutes for venipuncture and after 45 minutes for
cannulation. One-time overlay provides
anesthesia for 4 – 6 hours. Bioavailability
tetrakina is 15% after application
4% gel on intact skin, period
elimination half-life is about 75 minutes.The gel is rapidly metabolized by esterases
on the skin, in plasma and in erythrocytes. On
site of application is often observed
slight redness, slight swelling, or
itching occurs less often, it is also possible
blistering. Carefully
applied in III
trimester of pregnancy (after 28 weeks
gestation).

LAT:
1 – 3 ml of solution is applied directly
on the wound with a cotton applicator
for 15 – 30 minutes. Solution and gel are used
in children from 1 year old. Although
there is no information about the toxicity of the drug,
tetracaine is not recommended
on well-vascularized tissues,
mucous membranes and wounds more than 6 cm.When using lidocaine after
LAT applications
its maximum should not be exceeded
dosage (lidocaine 5 mg / kg).

Preparations and medicines with active ingredient Lidocaine + Prilocaine

Roster

100 g cream contains active ingredients:

• lidocaine – 2.5 g,
• prilocaine – 2.5 g

Form of issue

Cream for local and external use, 30 g in an aluminum tube.

Pharmacological action

Acriol Pro is a combined preparation containing lidocaine and prilocaine, local anesthetics of the amide type.

Skin anesthesia is caused by the penetration of lidocaine and prilocaine into the layers of the epidermis and dermis. The degree of anesthesia depends on the dose of the drug and the duration of the application.

• Intact Skin:

After applying the drug to intact skin for 1-2 hours, the duration of anesthesia after removing the occlusive dressing is 2 hours.There were no differences in efficacy (including the time to achieve an analgesic effect) and safety when using the drug on intact skin in elderly (65-96 years old) and younger patients.

Due to the action of the drug on the superficial vessels, temporary blanching or redness of the skin is possible. Similar reactions in patients with widespread neurodermatitis (atopic dermatitis) may occur more quickly, within 30-60 minutes after application of the drug, which indicates a faster penetration of the cream through the skin.

With a puncture biopsy (4 mm in diameter), the use of Acriol Pro provides adequate anesthesia for intact skin in 90% of patients 60 minutes after application of the drug with a needle inserted to a depth of 2 mm and after 120 minutes with a needle inserted to a depth of 3 mm. The effectiveness of the drug does not depend on the color or pigmentation of the skin (skin types I-IV).

When using combination vaccines against infections such as measles, rubella, mumps, or intramuscular combination vaccines against diphtheria, pertussis, tetanus, poliomyelitis and infection caused by Haemophilius influenzae type b, as well as with vaccination against hepatitis B, the use of the drug did not affect the average titer of antibodies, the rate of appearance or disappearance of specific antibodies in the blood serum, or the number of patients who have achieved a protective or positive antibody titer after immunization.

• Genital mucosa:

Anesthesia of the genital mucosa is achieved faster than anesthesia of intact skin due to faster absorption of the drug. In women, 5-10 minutes after applying the drug to the mucous membrane of the genital organs, anesthesia is achieved sufficient to relieve pain caused by the use of an argon laser; the duration of anesthesia is 15-20 minutes (taking into account individual characteristics from 5 to 45 minutes).

• Trophic ulcers of the lower extremities:

After application of the drug in the treatment of trophic ulcers of the lower extremities, the duration of anesthesia is up to 4 hours. There was no negative effect of the drug on the healing process of ulcers or in relation to the bacterial flora.

Indication for use

Adults:

• surface anesthesia of the skin during injections (including vaccination), punctures and catheterization of blood vessels and superficial surgical interventions, including minor cosmetic procedures and epilation;
• Superficial anesthesia of trophic ulcers of the lower extremities during surgical treatment (mechanical cleaning), for example, to remove fibrin, pus and necrotic tissue;
• Surface anesthesia of the genital mucosa before painful manipulations and for anesthesia before injections of local anesthetics.

For children:

• surface anesthesia of the skin during injections (including during vaccination), punctures and catheterization of blood vessels and superficial surgical interventions (including when removing molluscum contagiosum).

Methods of administration and dosage

Topically, on the skin or mucous membrane.

Pierce the protective membrane of the aluminum tube using the screw cap, squeeze out a sufficient amount of cream from the tube and apply to the site of the intended procedure.

For skin anesthesia, it is possible to use occlusive stickers. For anesthesia of trophic ulcers of the lower extremities, use a PVC occlusive dressing. Cover the applied cream with a bandage so that the layer of cream under it is thick and does not squeeze out from under the bandage. Smooth the edges of the dressing gently to prevent the cream from dripping.

After the recommended time has elapsed, remove the bandage and cream residues from the surface.

The amount of the drug and the duration of exposure are set individually, depending on the age of the patient and the area of ​​the body to be applied.

Contraindications

• Hypersensitivity to local anesthetics of the amide type or any other component of the drug.
• Premature infants born before 37 weeks of gestation.
• Newborns weighing less than 3 kg.

Special instructions

Patients with glucose-6-phosphate dehydrogenase deficiency or hereditary or idiopathic methemoglobinemia are more prone to drug-dependent methemoglobinemia.

The effectiveness of using the drug in newborns during the procedure for taking blood samples from the heel has not been established.

Caution should be exercised when applying Acriol Pro around the eyes, as it irritates the eyes. Eliminating protective reflexes can irritate or damage the cornea. In case of contact with eyes, immediately flush eyes with water or 0.9% sodium chloride solution, and protect eyes until protective reflexes are restored.

Care must be taken when applying the drug to the skin with atopic dermatitis; application time should be reduced (15-30 minutes).

In children under 3 months of age, the safety and efficacy of the drug was determined after a single dose was applied. In these children, after application of the drug, a temporary increase in blood methemoglobin levels was often observed, lasting up to 13 hours. However, the observed increase in the content of methemoglobin in the blood is probably not of clinical significance.

Patients taking class III antiarrhythmic drugs (e.g. amiodarone) should be monitored and ECG monitored continuously, i.e.it is possible to influence cardiac activity.

Do not apply the drug to a damaged tympanic membrane or in other cases of possible drug penetration into the middle ear.

Do not apply Acriol Pro to open wounds.

Due to the lack of data on the absorption of the drug, it is not recommended to apply the drug to the mucous membrane of the genital organs in children.

Lidocaine and prilocaine in concentrations above 0.5-2% have bactericidal and antiviral properties.In this regard, it is recommended to take special care when using the drug before the subcutaneous administration of a live vaccine (for example, BCG).

Due to the lack of data, the combined use of Acriol Pro and drugs that cause methemoglobinemia in children aged 0 to 12 months is not recommended.

Storage conditions

At a temperature not higher than 30 ^about C. Do not freeze. Keep out of the reach of children.

Allergy to anesthetics ✔️ symptoms and manifestations ⭐️ Filler-Shop

Before using local anesthetics, the doctor is obliged to inform the client about a possible allergic reaction and associated side effects, about how allergy to anesthetics manifests itself, and also clarify before the procedure if such problems have been observed before. Lidocaine is currently considered the most common and frequently used pain reliever, allergies to which are extremely rare, but can be life-threatening.

The main symptoms of lidocaine allergy

The term “allergy” is commonly used to describe an increased reaction of the body to contact with a certain substance, known as an allergen, which, if used continuously, leads to tissue or organ damage. After the initial acquaintance with such an irritant , the immune system develops sensitization to it, and it begins to perceive it as a dangerous element.Repeated intake of an allergen can provoke an overreaction that has a wide variety of manifestations, while even the smallest dose of the drug can cause a strong immune response. On subsequent contact with the allergen, special cells begin to produce antibodies, often without any external reaction. Allergy symptoms usually appear on the skin, mucous membranes, nasopharynx, conjunctiva, bronchi and lungs. Once the antibodies recognize the allergens that have entered the body, active compounds known as neurotransmitters are released that trigger the body’s response to stimuli.

Among the most common symptoms of allergy to anesthetics (in particular, to lidocaine) , the following can be noted:

• various dermatitis in the form of itchy redness and peeling, sometimes weeping tissues;
• urticaria, which is manifested by the presence of large blisters that merge into one large edema;
• Allergic rhinoconjunctivitis with characteristic clear nasal discharge, sneezing and lacrimation;
• bronchospasm preceding an attack of bronchial asthma;
• Quincke’s edema, as a manifestation of the most serious urticaria with large-scale edema of the larynx, lungs and other parts of the body;
• anaphylactic shock.

Similar symptoms appear immediately with the ingestion of the allergen-anesthetic into the body, and can have a delayed course and develop after a certain time.

Allergy or intolerance reaction?

It is believed that local anesthetics of the amide type, which include lidocaine, rarely cause true allergies. Often these can be manifestations of adverse reactions from the procedure itself (overdose of the drug, idiosyncrasy, psychogenic factors, when the patient pre-sets himself up for a negative result).Symptoms similar to allergies do not arise from a negative immune response, but from the effects of the drug itself. If we talk about lidocaine in the majority of modern fillers, then it can cause cardiotoxic and neurotoxic reactions : changes in the tone of peripheral vessels, local skin manifestations, heart rhythm disturbances, confusion, collapse and seizures. The formation of edema, inflammation and even tissue necrosis is possible directly at the puncture sites of soft tissues , which is one example of side effects on invasive procedures.

It is very simple and extremely necessary to identify a real allergy if the patient has a history of any reactions to drugs, including lidocaine. This is necessary to avoid the harmful and dangerous effects of the anesthetic in the event of a negative immune response. The doctor conducts a special test for lidocaine by subcutaneous injection of 0.1 ml of lidocaine on the inner side of the forearm, or several scratches are made on the forearm, where the anesthetic is dripped.The appearance in 20-30 minutes of any local skin or general reactions of the body indicates the presence of allergies and requires a more careful approach to the issue of pain relief. The most reliable diagnostic option is a blood test for ELISA to lidocaine, which will immediately show the exact degree of the body’s reaction to the administration of drugs with anesthetics.

Of course, any negative manifestations and unwanted symptoms require immediate discontinuation of the drug and the provision of necessary medical care.The main task is to stop the flow of the allergen into the bloodstream, the use of antihistamines in order to stop the attack, normalize the vascular tone and blood pressure.

According to the WHO, allergy is one of the common causes of the development of a fatal disease, therefore the use of anesthetics with obvious signs of an allergic reaction is extremely undesirable and dangerous.