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lidocaine/prilocaine topical (EMLA)

lidocaine 2.5% & prilocaine 2.5% Indications: 1) topical anesthetic for use on intact skin for use with IV cannulation or venipuncture 2) topical anesthetic for painful procedures such as lumbar puncture & skin graft harvesting Contraindications: - NOT for ophthalmic use Caution: 1) severe hepatic disease 2) G6PD deficiency 3) concurrent use of drugs associated with methemoglobinemia pregnancy-category ? safety in lactation ? Dosage: (topical anesthesia) 1) apply cream to region at least 1 hour prior to procedure 2) apply 2.5 g/site 3) for painful procedure apply 2 g/10 cm2 & leave on for 2 hours prior to procedure 4) maximum area of application for infants & children a) < 10 kg, < 100 cm2 b) 10-20 kg, < 600 cm2 c) > 20 kg, < 2000 cm2 Cream: 1:1 eutectic mixture containing lidocaine 2.5% & prilocaine 2.5% (5 g, 30 g) Pharmacokinetics: 1) onset of action: 1 hour for sufficient dermal analgesia 2) peak effect: 2-3 hours 3) duration of action: 1-2 hours after removal of cream 4) absorption is related to duration of applicaton & area applied a) 3 hour application: - 3.6% of lidocaine & 6.1% of prilocaine absorbed b) 24 hour application: - 16% of lidocaine & 34% of prilocaine absorbed 5) both agents cross blood brain barrier 6) 1/2life a) lidocaine: 65-150 minutes, prolonged with hepatic or cardiac dysfunction b) prilocaine: 10-150 minutes, prolonged with hepatic or renal dysfunction Adverse effects: 1) not common (1-10%) - contact dermatitis, burning, stinging, angioedema 2) uncommon (< 1%) - methemoglobinemia in infants, tenderness, urticaria, edema, urethritis

Interactions

drug interactions

Specific

topical agent ELA Max

General

lidocaine/prilocaine topical anesthetic

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. Prescriber's Letter 9(8):48 2002

Components

lidocaine (Xylocaine) Lidocaine Topical prilocaine; o-Methyl-2-propylaminopropionanilide (Propitocaine, Citanest)