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Synera

lidocaine / tetracaine
Used for Pain, Anesthesia
Used for Pain, Anesthesia

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.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Allison Gourley, PharmD
Last reviewed on July 22, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Synera (lidocaine / tetracaine)?

What is Synera (lidocaine / tetracaine) used for?

To numb the skin before procedures, such as:

  • Accessing a vein for administering medications or drawing blood

  • Accessing a vein to place a cannula (a small plastic tube for delivering medications)

  • Removing lesions from the skin

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.

Are you looking for information on Pliaglis (lidocaine / tetracaine) cream or Aprizio Pak (lidocaine / prilocaine) instead?

Drug Facts

Common BrandsSynera
Drug ClassLocal anesthetic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the 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%)

Other Side Effects

  • Itching
  • Rash
  • Skin discoloration

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

Source: DailyMed

The following 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

cough

fainting or loss of consciousness

fast or irregular breathing

fever

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:

Rare

Headache

nausea

sleepiness or unusual drowsiness

vomiting

Incidence not known

Continuing ringing or buzzing or other unexplained noise in the ears

depression

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.

pros-and-cons

Pros and cons of Synera (lidocaine / tetracaine)

thumbs-up

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

thumbs-down

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

Pharmacist tips for Synera (lidocaine / tetracaine)

pharmacist

  • 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.

            faqs

            Frequently asked questions about Synera (lidocaine / tetracaine)

            Is Synera (lidocaine / tetracaine) still available?
            No, Synera (lidocaine / tetracaine) is no longer available. It's not clear why Synera (lidocaine / tetracaine) was discontinued and removed from the market.
            Is lidocaine the same as tetracaine?
            Lidocaine and tetracaine are both local anesthetics that share similarities, but they're two different medications. They are structurally different, which gives them different properties, like how quickly they work, how long they last, and how they're broken down.
            How long does Synera (lidocaine / tetracaine) last?
            How long the effects of Synera (lidocaine / tetracaine) last hasn't been well-studied. But this medication should last long enough to numb the skin area before injections, IV line placements, or certain skin procedures. Synera (lidocaine / tetracaine) isn't meant to be worn for longer-than-recommended or to provide long-term pain relief. Doing so raise the risk of serious side effects, such as dizziness, blurry vision, or tremors.
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            What are the 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.

            risk-warning

            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.

              risk-warning

              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.

                risk-warning

                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.

                  risk-warning

                  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.

                  risk-warning

                  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.

                  dosage

                  Synera (lidocaine / tetracaine) dosage forms

                  The average cost for 10 patches of 70mg/70mg of Synera (lidocaine / tetracaine) is $174.19 with a free GoodRx coupon. This is 14.4% off the average retail price of $203.49.
                  patch
                  Patch
                  DosageQuantityPrice as low asPrice per unit
                  70mg/70mg10 patches$174.19$17.42

                  Typical dosing 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

                  Interactions between Synera (lidocaine / tetracaine) and other drugs

                  Synera (lidocaine / tetracaine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Synera (lidocaine / tetracaine). Please note that only the generic name of each medication is listed below.

                  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.

                  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.

                  drug-cost

                  How much does Synera (lidocaine / tetracaine) cost?

                  To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
                  Synera (brand)
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                  $174.19

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                  contraindications-icon

                  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)

                  alternatives

                  What are alternatives to Synera (lidocaine / tetracaine)?

                  There are a number of medications that your doctor can prescribe in place of Synera (lidocaine / tetracaine). Compare a few possible alternatives below.
                  Synera (lidocaine / tetracaine)
                  Used for:

                  To numb the skin before procedures, such as:

                  • Accessing a vein for administering medications or drawing blood

                  • Accessing a vein to place a cannula (a small plastic tube for delivering medications)

                  • Removing lesions from the skin

                  $174.19 Lowest GoodRx priceView Prices
                  Pliaglis (lidocaine / tetracaine)
                  Used for:

                  • Dermal filler injections

                  • Laser resurfacing of the face

                  • Laser tattoo removal

                  $417.30 Lowest GoodRx priceView Prices

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                  References

                  Best studies we found

                  Galen US Incorporated. (2020). Synera- lidocaine and tetracaine patch [package insert]. DailyMed.

                  Giordano, D., et al. (2015). Topical local anesthesia: Focus on lidocaine-tetracaine combination. Local and Regional Anesthesia.

                  Ludlow, J. T., et al. (2023). Methemoglobinemia. StatPearls.

                  View All References (3)

                  MedlinePlus. (2022). Methemoglobinemia.

                  Ortega, R., et al. (2008). Peripheral intravenous cannulation. The New England Journal of Medicine.

                  Trost, J. G., et al. (2016). Common adult skin and soft tissue lesions. Seminars in Plastic Surgery.

                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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