lidocaine / prilocaine
Lidocaine/prilocaine is a combination medication containing lidocaine and prilocaine. It works well to treat and prevent pain on your skin or genital area, and it's typically used to numb the skin before procedures or injections. It is available as a lower-cost, generic cream.
What is Lidocaine/prilocaine?
What is Lidocaine/prilocaine used for?
- Pain on unbroken skin
- Pretreatment for local infiltration anesthesia (when a medication is injected in an area of your body to take away feeling, usually before surgery) of inner lining of genitals
- Pain from minor surgery on inner lining of genitals
How Lidocaine/prilocaine works
Lidocaine/prilocaine is a combination of two local anesthetics, lidocaine and prilocaine. Both medications are absorbed through your skin, where they work on your nerves to lower how much pain you feel. By applying lidocaine/prilocaine onto an area of your skin, it causes a loss of feeling where you apply it.
Drug facts
Side effects of Lidocaine/prilocaine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Paleness (skin turning white, 37% on unbroken skin)
- Skin redness (30% on unbroken skin, 21% on genital mucosa)
- Burning sensation (17% on genital mucosa)
- Swelling (6% on unbroken skin, 10% on genital mucosa)
- Change in temperature sensations (7% on unbroken skin)
- Itching (2% on unbroken skin)
- Rash (fewer than 1% on unbroken skin)
Less Common Side Effects
The following side effects can occur if too much lidocaine/prilocaine is absorbed into your body:
- Lightheadedness
- Nervousness
- Feeling excited
- Confusion
- Dizziness
- Drowsiness
- Ringing in the ears
- Blurred or double vision
- Vomiting
- Twitching
- Tremors
- Seizures
- Unconsciousness (not responding to sound or touch)
- Shallow or stopped breathing
Lidocaine/prilocaine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reaction: trouble breathing, swelling, low blood pressure, rash
- Methemoglobinemia: blue or gray skin color, seizures, coma, changes in heart rate or rhythm
The following Lidocaine/prilocaine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
difficulty with swallowing
large, hive-like swellings on the eyelids, face, lips, tongue, or genitals
severe dizziness or feeling faint
tightness in the chest
troubled breathing
Incidence not known
Blisters on the skin at application site
blue or blue-purple color of lips, fingernails, mouth, or skin
blurred or double vision
dark urine
dizziness or drowsiness
fainting
feeling hot, cold, or numb
headache
irregular or fast heartbeat
muscle twitching or trembling
ringing or buzzing in the ears
seizures
unusual excitement, nervousness, or restlessness
unusual tiredness or weakness
vomiting
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning, swelling, itching, or skin rash at application site
white or red skin at the application site
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Lidocaine/prilocaine
Pros
- Starts working to numb the area where you apply it within an hour
- Available in cream form
- Safe to use during pregnancy
- Available in a lower-cost generic form
Cons
- Can’t use on broken skin
- Not a good option if you have pain in many areas on your body
- Can take a few hours for numbness to wear off
- Might need to wait 1 to 2 hours until it works before a procedure
Pharmacist tips for Lidocaine/prilocaine
- Wash your hands before and after using lidocaine/prilocaine, unless you're applying it to your hands.
- Avoid touching your eyes after using lidocaine/prilocaine, since it can cause irritation. If medication gets into your eye, immediately wash out the eye with water or saline and protect it until you can feel around your eye again.
- Don’t apply lidocaine/prilocaine to areas of your skin with open cuts or wounds because this can raise your risk of side effects.
- Avoid scratching the treated areas or exposing them to hot or cold temperatures until the numbness goes away because you might not feel if you hurt yourself.
- Only apply lidocaine/prilocaine the way your provider has told you to, and use the dosing diagram provided in the instructions to measure your dose correctly. Using too much medication on large areas of your body and using it too often can cause serious side effects like seizures or trouble breathing.
- If you’re applying lidocaine/prilocaine onto your child’s skin, watch out for accidental ingestion of or eye contact with the medication. Also, if you notice that your child becomes dizzy, very sleepy, or their face or lips darkening in color after applying lidocaine/prilocaine, remove the cream from your child’s skin and contact your child’s provider right away. These can be signs of serious side effects from the medication.
- Some products (e.g., Nuvakaan II, Prizotral II, Aprizio Pak) come as kits that have extra lidocaine medication or wound care treatment. Follow your provider’s instructions on how to use any other treatments that come with lidocaine/prilocaine to make sure you’re using them correctly and safely.
Common questions about Lidocaine/Prilocaine
Lidocaine can be found in the breast milk of nursing mothers who use it. Generally, lidocaine hasn't shown side effects in breastfed infants. Currently, the use of prilocaine in nursing mothers and its effects on breastfed infants aren’t known. If you're breastfeeding, ask your provider if Lidocaine/Prilocaine is the best option for you.
No, Lidocaine/Prilocaine isn't available over the counter, so you'll need a prescription from your provider.
It typically takes 1 hour after applying Lidocaine/Prilocaine onto your skin before you notice the full effects, but it might work faster if it's applied on the genitals.
Your skin can be numb for anywhere between 5 minutes and a few hours, depending on the amount of Lidocaine/Prilocaine and the area of your body you're applying it to.
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Risks and warnings for Lidocaine/prilocaine
Lidocaine/prilocaine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Overdose
- Risk factors: Applying the cream to broken skin | Using the cream longer than recommended | Using the cream on large areas of your body | Severely weak or ill | Older age | History of severe liver disease
Applying lidocaine/prilocaine to larger areas of skin or for a longer period of time than recommended by your provider can cause too much medication to be absorbed into your body. In addition, people with severe liver disease might have problems getting rid of the medication and it can build up in the body. This can cause serious side effects, like seizures or trouble breathing. Older adults and people who are severely weak or ill might be more sensitive to the side effects of this medication. Make sure to use lidocaine/prilocaine only as directed by your provider.
Changes in heart rate or rhythm
- Risk factors: People taking antiarrhythmic medications, like amiodarone (Pacerone) or sotalol (Betapace)
Using lidocaine/prilocaine while taking certain heart medications (e.g., amiodarone (Pacerone), sotalol (Betapace)) can cause changes in your heart rate or rhythm, because it might add to the effects of your heart medications. Lidocaine itself can cause changes to your heart rhythm when it’s injected into the veins. Though lidocaine/prilocaine is applied onto your skin, it’s important to note that it might boost the effects of your heart medications. Tell your provider if you are taking any heart medications and check if you need to be monitored while taking lidocaine/prilocaine.
Methemoglobinemia (a blood condition)
- Risk factors: Glucose-6-phosphate dehydrogenase (G6PD) deficiency | Lung problems | Heart problems | Methemoglobinemia | Infants under 6 months of age | Taking medications known as oxidizing agents (e.g., benzocaine, dapsone (Aczone))
Some people taking lidocaine/prilocaine are at a higher risk of developing a serious blood condition called methemoglobinemia. When your body makes too much of a protein called methemoglobin, your red blood cells deliver less oxygen to different parts of your body. This can cause serious side effects like blue or gray skin color, seizures, coma, changes in heart rate or rhythm, and death. Let your provider know if you have a genetic condition called G6PD deficiency, heart or lung problems, or taking medications known as oxidizing agents like benzocaine or dapsone (Aczone) before using lidocaine/prilocaine. Get medical help as soon as possible if you experience pale, blue, or gray skin color, headache, fast heart rate, shortness of breath, or lightheadedness, as these can be early signs of this blood condition.
Not for use in ears
Animal studies have shown that applying lidocaine/prilocaine to the middle ear can cause ringing in the ears, hearing loss, or balance problems. Only apply lidocaine/prilocaine onto your skin and as directed by your provider.
Lidocaine/prilocaine dosage
Tube of cream| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30g of 2.5%/2.5% | 1 tube | $16.23 | $16.23 |
| 5g of 2.5%/2.5% | 6 tubes | $19.50 | $3.25 |
Typical dosage for Lidocaine/prilocaine
Adults
- Unbroken skin: The typical dose is to apply a thick layer of lidocaine/prilocaine to unbroken skin. Then, cover with an air- and water-tight dressing (bandaging and sealing the area to protect from injury and infections).
- Minor skin procedures: The typical dose is to apply 2.5 grams of lidocaine/prilocaine over 20 cm2 to 25 cm2 of skin and leave on for at least 1 hour.
- Major skin procedures: The typical dose is to apply 2 grams of lidocaine/prilocaine per 10 cm2 of a larger area of skin and leave on for at least 2 hours.
- Male genital skin before local anesthetic infiltration: The typical dose is to apply 1 gram of lidocaine/prilocaine per 10 cm2 of skin and leave on for 15 minutes.
- Female genital mucous membranes (e.g., area around the vagina) before local anesthetic infiltration and minor procedures: The typical dose is to apply 5 to 10 grams of lidocaine/prilocaine to the affected areas and leave on for 5 to 10 minutes.
Children: The dose and the maximum amount of time lidocaine/prilocaine should be left on your child’s skin depends on your child’s age and weight. Maximum dosages can range from 1 to 20 grams per specific body area. Talk to your child’s provider and check the package insert for dosing information.
The cream contains 2.5% lidocaine and 2.5% prilocaine.
Interactions between Lidocaine/prilocaine and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Dihydroergotamine
- Dronedarone
- Saquinavir
- Vernakalant
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Amifampridine
- Amiodarone
- Amprenavir
- Arbutamine
- Atazanavir
- Bretylium
- Bupivacaine Liposome
- Bupropion
- Cobicistat
- Dasabuvir
- Delavirdine
- Disopyramide
- Dofetilide
- Donepezil
- Dronedarone
- Encainide
- Etravirine
- Flecainide
- Fosamprenavir
- Fosphenytoin
- Hyaluronidase
- Ibutilide
- Lopinavir
- Metoprolol
- Mexiletine
- Moricizine
- Nadolol
- Phenytoin
- Procainamide
- Propafenone
- Quinidine
- Sotalol
- Succinylcholine
- Telaprevir
- Tocainide
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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