lidocaine/prilocaine

Contraindicated in:

Hypersensitivity to lidocaine, prilocaine, or any other amide-type local anesthetic;
Hypersensitivity to any other product in the formulation;
Should not be applied to middle ear, mucous membranes, or broken/inflamed skin;
Pedi: Infants <1 mo if gestational age is <37 weeks;
Pedi: Infants <12 mo receiving methemoglobin-inducing agents.

Use Cautiously in:

Repeated use or use on large areas of skin (more likely to result in systemic absorption);
Acutely ill, or debilitated patients (↑ risk of absorption and systemic effects);
Severe liver disease;
Glucose–6–phosphate dehydrogenase deficiency, history of methemoglobinemia, cardiac or pulmonary disease, or concurrent exposure to oxidizing agents (or metabolites of these agents) (↑ risk of methemoglobinemia);
Pedi: Infants <6 mo (↑ risk of methemoglobinemia); area/duration of treatment should be limited in neonates and children <20 kg or 37 wk gestation (↑ susceptibility to methemoglobinemia);
Geri: Older adults may have ↑ absorption and risk of systemic effects.

Adv. Reactions/Side Effects ⬆ ⬇

Hemat: methemoglobinemia

Local: blanching, redness, alteration in temperature sensation, edema, hyperpigmentation, itching, rash

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with class I antiarrhythmics including mexiletine may result in adverse cardiovascular effects.
Concurrent use with other local anesthetics may result in ↑ toxicity.
Concurrent use of acetaminophen, benzocaine, bupivacaine, chloroquine, cyclophosphamide, dapsone, flutamide, hydroxyurea, ifosfamide, metoclopramide, nitrofurantoin, nitroglycerin, nitroprusside, nitrous oxide, phenobarbital, phenytoin, prilocaine, primaquine, procaine, quinine, rasburicase, ropivacaine, sulfonamides, tetracaine, and valproate may ↑ risk of methemoglobinemia; monitor closely; avoid concurrent use in children <12 mo.

Availability ⬆ ⬇

(Generic available)

Cream: 2.5% lidocaine with 2.5% prilocaine
Periodontal gel: 2.5% lidocaine with 2.5% prilocaine; 1.7 g/dental cartridge

Route/Dosage ⬆ ⬇

Topical Cream

(Adults and Children ): Minor dermal procedures including venipuncture and IV cannulation: 2.5 g (½ of the 5-g tube) applied to 20–25 cm² (2 in. by 2 in.) area of skin, covered with an occlusive dressing applied for at least 1 hr. Major dermal procedures including split-thickness skin graft harvesting: 2 g/10 cm² area of skin, covered with an occlusive dressing for at least 2 hr. Adult male genital skin: as an adjunct prior to local anesthetic infiltration, apply a thick layer (1 g/10 cm²) to skin surface for 15 min; local infiltration anesthesia should be performed immediately after removal of cream. Adult female genital mucous membranes: apply a thick layer (5–10 g) for 5–10 min.
(Children 7–12 yr and >20 kg): Dose should not exceed 20 g over more than 200 cm² for more than 4 hr.
(Children 1–6 yr and >10 kg): Dose should not exceed 10 g over more than 100 cm² for more than 4 hr.
(Children 3 mo–12 mo and >5 kg): Dose should not exceed 2 g over more than 20 cm² for more than 4 hr.
(Children 0–3 mo or <5 kg): Dose should not exceed 1 g over more than 10 cm² for more than 1 hr.

Periodontal Gel

(Adults ): Apply on gingival margin around the selected teeth using the blunt-tipped applicator included in package; wait 30 seconds, then fill the periodontal pockets with gel using the blunt-tipped applicator until the gel becomes visible at the gingival margin; wait another 30 seconds before starting treatment; maximum recommended dose at one treatment session is 5 cartridges (8.5 g).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses. Combination of two anesthetics is applied as a system consisting of a cream under an occlusive dressing. Active drug is released into the dermal and epidermal skin layers, resulting in accumulation of local anesthetic in the regions of dermal pain receptors and nerve endings.

Therapeutic effects:

Anesthetic action localized to the area of the application.

Classifications ⬆ ⬇

Therapeutic Classification: anesthetics (topical/local)

Pharmacokinetics ⬆ ⬇

Absorption: Small amounts are systemically absorbed.

Distribution: Small amounts absorbed are widely distributed and cross the placenta and blood-brain barrier.

Metabolism/Excretion: Lidocaine: mostly metabolized by the liver. Prilocaine: metabolized by the liver and kidneys.

Half-Life: Lidocaine: 90–120 min (topical cream); 2–6 hr (periodontal gel): Prilocaine: 10–50 min (topical cream); 2–6 hr (periodontal gel).

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(local anesthesia)

ROUTE	ONSET	PEAK	DURATION
Topical	1 hr (cream); 30 sec (periodontal gel)	3 hr (cream)	1–2 hr (cream)‡ 20 min (periodontal gel)

‡Following removal of occlusive dressing.

Patient/Family Teaching ⬆ ⬇

Explain the purpose of cream and occlusive dressing to patient and parents. Inform the patient that lidocaine/prilocaine cream may block all sensations in the treated skin. Caution patient to avoid trauma to the area from scratching, rubbing, or exposure to extreme heat or cold temperatures until all sensation has returned.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Home Care Issues: Instruct patient or parent in proper application. Provide a diagram of location for application.

Pronunciation ⬆ ⬇

LYE-doe-kane/PRI-loe-kane

Code ⬆

NDC Code

0121- PAI Holdings, LLC dba PAI Pharma
- 0121-1002- Lidocaine and Prilocaine
  - 0121-1002-30- 1 TUBE in 1 CARTON (0121-1002-30) / 30 g in 1 TUBE

0168- E. Fougera & Co. a division of Fougera Pharmaceuticals Inc.
- 0168-0357- Lidocaine and Prilocaine
  - 0168-0357-30- 1 TUBE in 1 CARTON (0168-0357-30) / 30 g in 1 TUBE

0168- E. Fougera & Co. a division of Fougera Pharmaceuticals Inc.
- 0168-0357- Lidocaine and Prilocaine
  - 0168-0357-55- 1 TUBE in 1 CARTON (0168-0357-55) / 5 g in 1 TUBE (0168-0357-05)

0168- E. Fougera & Co. a division of Fougera Pharmaceuticals Inc.
- 0168-0357- Lidocaine and Prilocaine
  - 0168-0357-56- 1 TUBE in 1 CARTON (0168-0357-56) / 5 g in 1 TUBE (0168-0357-05)

0574- Padagis US LLC
- 0574-2042- LIDOCAINE AND PRILOCAINE
  - 0574-2042-30- 1 TUBE in 1 CARTON (0574-2042-30) / 30 g in 1 TUBE

21922- Encube Ethicals, Inc.
- 21922-076- LIDOCAINE AND PRILOCAINE LIDOCAINE AND PRILOCAINE
  - 21922-076-05- 1 TUBE in 1 CARTON (21922-076-05) / 30 g in 1 TUBE

46708- Alembic Pharmaceuticals Limited
- 46708-582- Lidocaine and Prilocaine
  - 46708-582-04- 1 TUBE in 1 CARTON (46708-582-04) / 5 g in 1 TUBE

46708- Alembic Pharmaceuticals Limited
- 46708-582- Lidocaine and Prilocaine
  - 46708-582-31- 1 TUBE in 1 CARTON (46708-582-31) / 30 g in 1 TUBE

50090- A-S Medication Solutions
- 50090-6589- LIDOCAINE AND PRILOCAINE
  - 50090-6589-0- 1 TUBE in 1 CARTON (50090-6589-0) / 30 g in 1 TUBE

62332- Alembic Pharmaceuticals Inc.
- 62332-582- Lidocaine and Prilocaine
  - 62332-582-04- 1 TUBE in 1 CARTON (62332-582-04) / 5 g in 1 TUBE

62332- Alembic Pharmaceuticals Inc.
- 62332-582- Lidocaine and Prilocaine
  - 62332-582-31- 1 TUBE in 1 CARTON (62332-582-31) / 30 g in 1 TUBE

63629- Bryant Ranch Prepack
- 63629-9604- LIDOCAINE AND PRILOCAINE
  - 63629-9604-1- 1 TUBE in 1 CARTON (63629-9604-1) / 30 g in 1 TUBE

66312- Dentsply Pharmaceutical
- 66312-110- Oraqix
  - 66312-110-20- 20 APPLICATOR in 1 CARTON (66312-110-20) / 1 CARTRIDGE in 1 APPLICATOR / 1.7 g in 1 CARTRIDGE

68071- NuCare Pharamceuticals,Inc.
- 68071-1625- Lidocaine and Prilocaine
  - 68071-1625-3- 30 g in 1 BOX (68071-1625-3)

68071- NuCare Pharmaceuticals, Inc.
- 68071-3856- LIDOCAINE AND PRILOCAINE
  - 68071-3856-3- 1 TUBE in 1 CARTON (68071-3856-3) / 30 g in 1 TUBE

68788- Preferred Pharmaceuticals Inc.
- 68788-8150- Lidocaine and Prilocaine
  - 68788-8150-3- 1 TUBE in 1 CARTON (68788-8150-3) / 30 g in 1 TUBE

70771- Zydus Lifesciences Limited
- 70771-1872- Lidocaine and prilocaine
  - 70771-1872-2- 1 TUBE in 1 CARTON (70771-1872-2) / 30 g in 1 TUBE

70771- Zydus Lifesciences Limited
- 70771-1872- Lidocaine and prilocaine
  - 70771-1872-8- 5 TUBE in 1 CARTON (70771-1872-8) / 5 g in 1 TUBE (70771-1872-5)

71335- Bryant Ranch Prepack
- 71335-2716- LIDOCAINE AND PRILOCAINE
  - 71335-2716-1- 1 TUBE in 1 CARTON (71335-2716-1) / 30 g in 1 TUBE

72162- Bryant Ranch Prepack
- 72162-1125- LIDOCAINE AND PRILOCAINE
  - 72162-1125-3- 1 TUBE in 1 CARTON (72162-1125-3) / 30 g in 1 TUBE

72578- Viona Pharmaceuticals Inc
- 72578-165- Lidocaine and prilocaine
  - 72578-165-06- 1 TUBE in 1 CARTON (72578-165-06) / 30 g in 1 TUBE

72578- Viona Pharmaceuticals Inc
- 72578-165- Lidocaine and prilocaine
  - 72578-165-96- 5 TUBE in 1 CARTON (72578-165-96) / 5 g in 1 TUBE (72578-165-05)

81033- Kesin Pharma Corporation
- 81033-025- LIDOCAINE AND PRILOCAINE
  - 81033-025-50- 50 TUBE in 1 CARTON (81033-025-50) / 1 g in 1 TUBE (81033-025-01)

81033- Kesin Pharma Corporation
- 81033-025- LIDOCAINE AND PRILOCAINE
  - 81033-025-51- 5 TUBE in 1 CARTON (81033-025-51) / 5 g in 1 TUBE (81033-025-05)

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Indications ⬇

Contraind./Precautions ⬆ ⬇