Prilocaine and Lidocaine|
Dental: Amide-type topical anesthetic for use on normal intact skin to
provide local analgesia for minor procedures such as I.V. cannulation or
Medical: Topical anesthetic for use on normal intact skin to provide local
analgesia for minor procedures such as I.V. cannulation or venipuncture; has
also been used for painful procedures such as lumbar puncture and skin graft
harvesting; for superficial minor surgery of genital mucous membranes and as an
adjunct for local infiltration anesthesia in genital mucous membranes.
Children <1 month of age
Administration on mucous membranes
Administration on broken or inflamed skin
Children with congenital or idiopathic methemoglobinemia, or in children who
are receiving medications associated with drug-induced methemoglobinemia [ie,
acetaminophen (overdosage), benzocaine, chloroquine, dapsone, nitrofurantoin,
nitroglycerin, nitroprusside, phenazopyridine, phenelzine, phenobarbital,
phenytoin, quinine, sulfonamides]
Patients with a documented hypersensitivity to amide type anesthetic agents
[ie, lidocaine, prilocaine, dibucaine, mepivacaine, bupivacaine, etidocaine]
Patients with a documented hypersensitivity to any components of
EMLA® cream or
Use with caution in patients receiving class I antiarrhythmic drugs, since
systemic absorption occurs and synergistic toxicity is
1% to 10%:
Dermatologic: Angioedema, contact dermatitis
Local: Burning, stinging
<1%: Bradycardia, hypotension, shock, edema, nervousness, euphoria,
confusion, dizziness, drowsiness, convulsions, CNS excitation, erythema,
itching, rash, urticaria, methemoglobinemia in infants, blanching, alteration in
temperature sensation, tenderness, tremors, blurred vision, tinnitus,
respiratory depression, bronchospasm
Drugs known to induce methemoglobinemia
Store at room temperature
Local anesthetic action occurs by stabilization of neuronal membranes and
inhibiting the ionic fluxes required for the initiation and conduction of
Onset of action: 1 hour for sufficient dermal analgesia
Peak effect: 2-3 hours
Duration: 1-2 hours after removal of the cream
Absorption: Related to the duration of application and to the area over which
it is applied
3-hour application: 3.6% lidocaine and 6.1% prilocaine were absorbed
24-hour application: 16.2% lidocaine and 33.5% prilocaine were absorbed
Distribution: Both cross the blood-brain barrier
Lidocaine: 1.1-2.1 L/kg
Prilocaine: 0.7-4.4 L/kg
Lidocaine: Metabolized by the liver to inactive and active metabolites
Prilocaine: Metabolized in both the liver and kidneys
Lidocaine: 65-150 minutes, prolonged with cardiac or hepatic dysfunction
Prilocaine: 10-150 minutes, prolonged in hepatic or renal dysfunction
Although the incidence of systemic adverse effects with
EMLA® is very low, caution should be exercised,
particularly when applying over large areas and leaving on for >2 hours
Dosing is based on child's age and weight:
Age 0-3 months or <5 kg: Apply a maximum of 1 g over no more than 10
cm2 of skin and leave on for no longer than 1 hour.
Age 3 months to 12 months and >5 kg: Apply no more than a maximum 2 g
total over no more than 20 cm2 of skin and leave on for no longer
than 4 hours.
Age 1-6 years and >10 kg: Apply no more than a maximum of 10 g total over
no more than 100 cm2 of skin and leave on for no longer than 4 hours.
Age 7-12 years and >20 kg: Apply no more than a maximum 20 g total over no
more than 200 cm2 of skin and leave on for no longer than 4 hours.
Note: If a patient greater than 3 months old does not meet the
minimum weight requirement, the maximum total dose should be restricted to the
corresponding maximum based on patient weight.
Adults (intact skin):
EMLA® cream and EMLA® anesthetic
disc: A thick layer of EMLA® cream is applied to intact
skin and covered with an occlusive dressing, or alternatively, an
EMLA® anesthetic disc is applied to intact skin
Minor dermal procedures (eg, I.V. cannulation or venipuncture): apply 2.5 g
of cream (1/2 of the 5 g tube) over 20-25 cm of skin surface area, or 1
anesthetic disc (1 g over 10 cm2) for at least 1 hour. Note:
In clinical trials, 2 sites were usually prepared in case there was a technical
problem with cannulation or venipuncture at the first site.
EMLA® cream: A thick layer of cream is applied to
intact skin and covered with an occlusive dressing
Major dermal procedures (eg, more painful dermatological procedures involving
a larger skin area such as split thickness skin graft harvesting): Apply 2 g of
cream per 10 cm2 of skin and allow to remain in contact with the skin
for at least 2 hours.
Adult male genital skin (eg, pretreatment prior to local anesthetic
infiltration): Apply a thick layer of cream (1 g/10 cm2) to the skin
surface for 15 minutes. Local anesthetic infiltration should be performed
immediately after removal of EMLA® cream.
Note: Dermal analgesia can be expected to increase for up to 3 hours
under occlusive dressing and persist for 1-2 hours after removal of the cream
Adult females: Genital mucous membranes: Minor procedures (eg, removal of
condylomata acuminata, pretreatment for local anesthetic infiltration): Apply
5-10 g (thick layer) of cream for 5-10 minutes
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
No effects or complications reported
This drug will block sensation to the applied area. Report irritation, pain,
burning at application site.
In small infants and children, an occlusive bandage should be placed over the
EMLA® cream to prevent the child from placing the cream in
Cream: Lidocaine 2.5% and prilocaine 2.5% [2 Tegaderm®
dressings] (5 g, 30 g)
Disc, anesthetic: 1 g
Broadman LM, Soliman IE, Hannallah RS, et al,
"Analgesic Efficacy of Eutectic Mixture of Local Anesthetics (EMLA®)
vs Intradermal Infiltration Prior to Venous Cannulation in Children," Am J
Anaesth, 1987, 34:S56.
Halperin DL, Koren G, Attias D, et al,
"Topical Skin Anesthesia for Venous Subcutaneous Drug Reservoir and Lumbar Puncture in Children,"
Pediatrics, 1989, 84(2):281-4.
Robieux I, Kumar R, Radhakrishnan S, et al,
"Assessing Pain and Analgesia With a Lidocaine-Prilocaine Emulsion in Infants and Toddlers During Venipuncture,"
J Pediatr, 1991, 118(6):971-3.
Taddio A, Shennan AT, Stevens B, et al,
"Safety of Lidocaine-Prilocaine Cream in the Treatment of Preterm Neonates,"
J Pediatr, 1995, 127(6):1002-5.
Vickers ER, Mazbani N, Gerzina TM, et al,
"Pharmacokinetics of EMLA Cream 5% Application to Oral Mucosa," Anesth
Prog, 1997, 44:32-7.
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