Adult Dosing
For dermal local analgesia
Minor dermal procedures
- Apply 2.5 gm of cream over 20-25 cm2 for at least 1 hr before intravenous cannulation and venipuncture
Major dermal procedures
- Apply cream 2 gm/10 cm2 on skin; allow to remain in contact for at least 2 hrs
Male genital Skin
- Apply cream 1 gm/10 cm2 to the skin surface for 15 minutes before local anesthetic infiltration
Female genital mucous membranes
- Apply 5-10 gm cream for 5-10 min before removal of condylomata acuminata, pretreatment for anesthetic infiltration
Notes- Consider smallest effective dose and shortest effective treatment duration
- Restrict application on open wounds
Dental local anesthesia
- Apply gel to gingival margin around the selected tooth using the blunt-tipped applicator. Wait for 30 sec then fill peridontal pockets using the blunt-tipped applicator; allow gel to become visible at the gingival margin; wait for 30 sec before initiating treatment
- Max: 5 cartridges (8.5 g)/treatment session
Notes- While administering Oraqix it should be in a liquid form. If it has formed a gel; place it in a refrigerator, do not freeze until it becomes a liquid again. In the liquid state, the air bubble visible in the cartridge will move if the cartridge is tilted
- Wait 30 sec before scaling and root planning
- Anesthetic effect has a duration of about 20min
- 1 cartridge = 1.7 g lidocaine/prilocaine gel
Pediatric Dosing
- Safety and efficacy in pediatric patients for use of gels has not been established
Dermal local analgesia
0-3 months or <5 kg
- Apply 1 gm cream over 10 cm2 for not more than 1 hr before procedure of analgesia
3-12 months and >5 kg
- Apply 2 gm cream over 20 cm2 for not more than 4 hrs before procedure of analgesia
1-6 yrs and >10 kg
- Apply 10 gm cream over 100 cm2 for not more than 4 hrs before procedure of analgesia
7-12 yrs and > 20 kg
- Apply 20 gm cream over 200 cm2 for not more than 4 hrs before procedure of analgesia
Notes:- For patients >3 months not meeting the minimum weight requirement, restrict the maximum total dose of cream to that which corresponds to the patient’s weight
- Consider smallest effective dose and shortest effective treatment duration
- Restrict application on open wounds
[Outline]
See Supplemental Patient Information
- Serious adverse effects have occurred on the application of cream/gel to larger areas or for prolonged duration than those recommended due to sufficient absorption
- Development of dose related methemoglobinemia has occurred; provide appropriate therapy by slow IV infusion of methylene blue at a dosage of 1-2 mg/kg given over a 5 minute period
- Consider methemoglobinemia if central cyanosis unresponsive to oxygen therapy occurs
- Avoid using cream/gel in any clinical manifestation where its penetration or migration beyond the tympanic membrane into the middle ear is possible
- Avoid using cream/gel in patients with congenital or idiopathic methemoglobinemia and in infants <12 months who are receiving treatment with methemoglobin-inducers
- Avoid using gel with standard dental syringes; use only with dispenser
- Conventionally manage allergic and anaphylactic reactions
- Monitor neonates and infants up to 3 months of age for Met-Hb levels before, during, and after the application of cream, provided the test results are obtained quickly
- Closely monitor and perform ECG in patients treated with class III anti-arrhythmic drugs
- Lidocaine and prilocaine have been shown to inhibit viral and bacterial growth. The effect of the cream on intradermal injections of live vaccines has not been determined
Cautions: Use cautiously in
- Renal impairment
- Severe hepatic disease
- Heart block
- Sepsis
- Severe shock
- Rash
- Increased skin temperature
- Patients with glucose-6-phosphate dehydrogenase deficiencies
- Concomitant use with methemoglobinemia inducers
- Age <3 months
- Patients sensitive to the systemic effects
- Very young patients
- Acutely ill patients
- Debilitated patients
- Geriatrics
Supplemental Patient Information
- Educate parents/caregivers about the need of careful application of creams to ensure that the recommended doses and areas of application are not exceeded and to limit the period of application to the minimum required to achieve the desired anesthesia
- Advise patients to avoid contact with eyes; if eye contact occurs instruct patients to immediately wash out the eye with water or saline and protect the eye until sensation returns. If necessary advise them to consult ophthalmologist
- Make it aware to the patients that production of dermal analgesia may be accompanied by the block of all sensations in the treated skin; instruct patients to avoid scratching, rubbing, or exposing themselves to extreme hot or cold temperatures until complete sensation has returned
- Advise to avoid application on open wounds/near the eyes
Pregnancy Category:B
Breastfeeding: Lidocaine concentrations excreted in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and it is poorly absorbed by the infant.No special precautions are required as it is unexpected to cause any adverse effects in breastfed infants. Literature unavailable on the use of prilocaine during breastfeeding says that a single dose of prilocaine injected during breastfeeding is unlikely to adversely affect the breastfed infant. Prefer an alternate drug especially while nursing a newborn or preterm infant. Topical use of prilocaine is unlikely to affect her breastfed infant. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 December 2010). According to manufacturer’s data, caution is advised as lidocaine/prilocaine is excreted in human milk.
US Trade Name(s)
US Availability
lidocaine/prilocaine (generic)
Emla (lidocaine/prilocaine)
Oraqix (lidocaine/prilocaine)
Canadian Trade Name(s)
Canadian Availability
Emla (lidocaine/prilocaine)
- CRE: 2.5%/2.5%
- PATCH: 2.5%/2.5%
UK Trade Name(s)
UK Availability
Emla (lidocaine/prilocaine)
Australian Trade Name(s)
Australian Availability
Emla (lidocaine/prilocaine)
- CRE: 2.5%/2.5%
- PATCH: 2.5%/2.5%
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Lidocaine-Prilocaine 2.5-2.5 % CREA [Tube] (FOUGERA)
30 % = $37.99
90 % = $95.97 - EMLA 2.5-2.5 % CREA [Tube] (APP PHARMACEUTICAL)
30 % = $55.99
90 % = $159.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.