Synera
Synera is patch that contains a combination of two local anesthetics, lidocaine and tetracaine. It's applied to the skin for 20 to 30 minutes before intravenous (IV) line placements or skin procedures to ease pain. This patch can be used by adults and children ages 3 years and older. Some common side effects of Synera (lidocaine / tetracaine) include redness, skin discoloration, and swelling.
Please note: Synera (lidocaine / tetracaine) has been discontinued and is no longer available in the United States. Your care team might use an alternative medication, such as Pliaglis (lidocaine / tetracaine) cream.
What is Synera (lidocaine / tetracaine)?
What is Synera (lidocaine / tetracaine) used for?
How Synera (lidocaine / tetracaine) works
Synera (lidocaine / tetracaine) is a combination of two local anesthetics, lidocaine and tetracaine. Both medications work by blocking sodium channels in the skin, which stops your nerves from sending pain signals to your brain.
Synera patch also has a heating component that activates once the patch is removed from the pouch and exposed to air. The warming helps the skin absorb more medication.
Drug facts
| Common Brands | Synera |
|---|---|
| Drug Class | Local anesthetic |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Synera (lidocaine / tetracaine)
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
- Skin redness (71%)
- Whitish or pale coloring of skin (12%)
- Swelling (12%)
Less Common Side Effects
- Itching
- Rash
- Skin discoloration
Synera (lidocaine / tetracaine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe blood problem (methemoglobinemia): seizures, loss of consciousness, fast heart beat, trouble breathing, feeling dizzy or faint, feeling tired, skin color turning blue or pale
- Serious allergic reactions: swelling of the face, difficulty breathing, trouble speaking, throat tightening up, red and itchy rash, lightheadedness, clammy skin
The following Synera (lidocaine / tetracaine) 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 or nurse immediately if any of the following side effects occur:
More common
Flushing or redness of the skin
swelling
unusually warm skin
Less common
Blistering, burning, crusting, dryness, or flaking of the skin
change in the color of treated skin
itching, scaling, severe redness, soreness, or swelling of the skin
rash
Rare
Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chills
fainting or loss of consciousness
fast or irregular breathing
hives or welts
hoarseness
lower back or side pain
painful or difficult urination
swelling of the eyes or eyelids
tightness in the chest
trouble with breathing
Incidence not known
Blurred vision
chest pain or discomfort
cold, clammy, or pale skin
confusion
difficulty with breathing
difficulty with swallowing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, slow, or irregular heartbeat
feelings of coldness, heat, or numbness
irregular, fast or slow, or shallow breathing
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
no breathing
noisy breathing
pale or blue lips, fingernails, or skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
seizures
shakiness in the legs, arms, hands, or feet
slow heart rate
sweating
trembling or shaking of the hands or feet
twitching
unusual tiredness or weakness
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Change in consciousness
fast, pounding, or irregular heartbeat or pulse
no blood pressure or pulse
stopping of the heart
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:
Incidence not known
Continuing ringing or buzzing or other unexplained noise in the ears
double vision
drowsiness
false or unusual sense of well-being
fear
hearing loss
nervousness
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 Synera (lidocaine / tetracaine)
Pros
- Can help lessen pain related to certain medical procedures on the skin
- Combination of two local anesthetics in one patch
- The patch is applied directly to the skin
- Can be used in children as young as 3 years old
Cons
- Can't be used on broken skin
- Can cause severe eye irritation if it makes contact with the eyes
- Higher risk of methemoglobinemia if taken with some other medications, such as acetaminophen (Tylenol) and nitrofurantoin (Macrobid)
Pharmacist tips for Synera (lidocaine / tetracaine)
- Only take Synera (lidocaine / tetracaine) out of the pouch when you're ready to use it. Once it's removed and exposed to air, the the patch will start to heat up. Never cut or remove the top cover of the pouch because this can lead to burns.
- Synera (lidocaine / tetracaine) is applied for 20 to 30 minutes and then taken off. Don't apply this patch for longer than recommended. Also don't apply more than one patch at a time or multiple patches one after another. Doing so can lead to serious side effects, including dizziness, blurry vision, or tremors.
- You can expect some mild warmth, swelling, and blanching of the skin (skin turning more pale or white in color) after putting on Synera (lidocaine / tetracaine). These should go away once you remove the patch after you're done with treatment. But if your skin hurts or burns after Synera (lidocaine / tetracaine) is applied, remove the patch to prevent further irritation.
- Though rare, Synera (lidocaine / tetracaine) can cause a serious side effect called methemoglobinemia. Get medical help right away if you experience symptoms like trouble catching your breath, tiredness, light-headedness, and blue-gray skin color.
- Let your care know if you're breastfeeding because Synera (lidocaine / tetracaine) shouldn't be applied directly to the nipple or immediate surrounding area. Otherwise, your baby might be exposed to the medication.
- Tell your care team about all of the medication you take before they put on Synera (lidocaine / tetracaine). Even though Synera (lidocaine / tetracaine) is a patch, it can interact with many medications, such as mexiletine, nitroglycerin (Nitrostat), nitrofurantoin (Macrobid), and acetaminophen (Tylenol).
Risks and warnings for Synera (lidocaine / tetracaine)
Synera (lidocaine / tetracaine) 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.
Blood problem (methemoglobinemia)
- Risk factors: Glucose-6-phosphate dehydrogenase (G6PD) deficiency | Heart or lung problems | Previous history of methemoglobinemia | Infants under 6 months old
Synera (lidocaine / tetracaine) can cause a serious reaction known as methemoglobinemia. This is a condition where the blood doesn't deliver oxygen to the body very well. It can occur right away or take several hours to develop. The signs of this reaction are a bluish coloring of the skin (due to lack of oxygen), trouble breathing, tiredness, seizures, coma, or even death. If your skin turns blue or you have trouble breathing after using Synera (lidocaine / tetracaine), get medical help right away.
Overdose
- Risk factors: Leaving patch on the skin for longer than recommended | Using multiple patches continuously | Applying to broken or damaged skin
You might be at risk for serious side effects from Synera (lidocaine / tetracaine) if you get too much of the medication in your system. High doses of Synera (lidocaine / tetracaine) can cause breathing and heart problems, coma, or even your heart to suddenly stop beating. Only use this medication as directed by your provider because using it for a longer period of time or more often than instructed could raise your risk for these complications. Don't use more than one Synera (lidocaine / tetracaine) patch at a time.
Risks of exposure to children and pets
- Risk factors: Keeping medication in a place accessible to children or pets | Placing used patches with the medication side exposed in the household trash
Synera (lidocaine / tetracaine) can cause serious harm if children or pets chew or ingest (swallow) the used patches. Keep Synera (lidocaine / tetracaine) in a place that's out of reach of children and pets. Follow the instructions that come with the medication for throwing away the used patches.
Eye irritation if medication gets into the eyes
Synera (lidocaine / tetracaine) can cause severe eye irritation if it makes contact with the eyes. Be sure to wash your hands after handling this medication. If you get Synera (lidocaine / tetracaine) in your eyes, rinse them right away with water or saline. You might lose sensation in your eye, so make sure to protect the eye until the sensation returns. If the irritation doesn't go away after rinsing your eyes, contact your provider.
Severe allergic reactions
Synera (lidocaine / tetracaine) can cause a severe allergic reaction in some people. Get medical help right away if you develop hives, swelling, or trouble breathing. These could be signs of a serious allergic reaction.
Synera (lidocaine / tetracaine) dosage
Patch| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 70mg/70mg | 10 patches | $179.91 | $17.99 |
Typical dosage for Synera (lidocaine / tetracaine)
Each Synera patch contains 70 mg of lidocaine and 70 mg of tetracaine.
Adults and children ages 3 years and older:
- Accessing a vein: Apply 1 patch for 20 to 30 minutes on skin where vein access is needed.
- Removing skin lesions: Apply 1 patch for 30 minutes on skin where the procedure is going to be performed.
Interactions between Synera (lidocaine / tetracaine) 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.
- Amifampridine
- Amiodarone
- Amprenavir
- Arbutamine
- Atazanavir
- Bupivacaine Liposome
- Bupropion
- Cobicistat
- Dasabuvir
- Delavirdine
- Disopyramide
- Donepezil
- Encainide
- Etravirine
- Flecainide
- Fosamprenavir
- Fosphenytoin
- Hyaluronidase
- 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.
How much does Synera (lidocaine / tetracaine) cost?
$179.91
Synera (lidocaine / tetracaine) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Synera (lidocaine / tetracaine) will not be safe for you to take.
- Allergies to lidocaine, tetracaine, or other local anesthetics
- Allergy to para-aminobenzoic acid (PABA)
What are alternatives to Synera (lidocaine / tetracaine)?
To numb the skin before procedures, such as:
