Lidocaine (cream)

Lidocaine (cream)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adeel Jamil, M.D. [2]

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Overview

Lidocaine (cream) is a amino amide, local, anesthetic and antiarrhythmic agent that is FDA approved for the treatment of pruritus, pruritic eczemas, abrasions, minor burns, insect bites, pain, soreness and discomfort due to pruritus ani, pruritus vulvae, hemorrhoids and anal fissures. Common adverse reactions include edema, erythema, petechiae, pruritus and headache.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

• Anesthetic for relief of pruritus, pruritic eczemas, abrasions, minor burns, insect bites, pain, soreness and discomfort due to pruritus ani, pruritus vulvae, hemorrhoids, anal fissures, and similar conditions of the skin and mucous membranes.

Dosing Informaion

• Apply a thin film to the affected area two or three times daily or as directed by a physician.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Lidocaine (cream) in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Lidocaine (cream) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Lidocaine (cream) FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Lidocaine (cream) in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Lidocaine (cream) in pediatric patients.

Contraindications

• Traumatized mucosa, secondary bacterial infection of the area of proposed application and known hypersensitivity to any of the components. Lidocaine is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type.

Warnings

• For external use only. Not for ophthalmic use.

PRECAUTIONS:

• If irritation or sensitivity occurs or infection appears, discontinue use and institute appropriate therapy. Lidocaine 3% Cream should be used with caution in ill, elderly, debilitated patients and children who may be more sensitive to the systemic effects of lidocaine.

Adverse Reactions

Clinical Trials Experience

• During or immediately after treatment, the skin at the site of treatment may develop erythema or edema or may be the locus of abnormal sensation.

Postmarketing Experience

There is limited information regarding Lidocaine (cream) Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Lidocaine (cream) Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): B

• Reproduction studies have been performed for lidocaine in rats at doses up to 6.6 times the human dose and have revealed no evidence of harm to the fetus caused by lidocaine. There are, however, no adequate and well-controlled studies in pregnant women. Animal reproduction studies are not always predictive of human response. General consideration should be given to this fact before administering lidocaine to women of childbearing potential, especially during early pregnancy when maximum organogenesis takes place.

Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Lidocaine (cream) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Lidocaine (cream) during labor and delivery.

Nursing Mothers

• Lidocaine is excreted in human milk. The clinical significance of this observation is unknown. Caution should be exercised when lidocaine is administered to a nursing woman.

Pediatric Use

• Dosage in pediatric patients should be reduced commensurate with age, body weight and physical condition.

Geriatic Use

There is no FDA guidance on the use of Lidocaine (cream) in geriatric settings.

Gender

There is no FDA guidance on the use of Lidocaine (cream) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Lidocaine (cream) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Lidocaine (cream) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Lidocaine (cream) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Lidocaine (cream) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Lidocaine (cream) in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Lidocaine (cream) Administration in the drug label.

Monitoring

There is limited information regarding Lidocaine (cream) Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Lidocaine (cream) and IV administrations.

Overdosage

There is limited information regarding Lidocaine (cream) overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Lidocaine (cream) Pharmacology in the drug label.

Mechanism of Action

• Lidocaine 3% Cream releases lidocaine from a mild acidic vehicle to stabilize the neuronal membrane by inhibiting the ionic fluxes required for initiation and conduction of impulses, thereby effecting local anesthetic action. A mild acidic vehicle lowers pH to increase protection against alkaline irritations and to provide a favorable environment for healing.

Structure

• Lidocaine is chemically designated as acetamide, 2- (diethylamino)-N-(2,6-dimethylphenyl), and has the following structure.

This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Lidocaine (cream) Pharmacodynamics in the drug label.

Pharmacokinetics

• Lidocaine may be absorbed following topical administration to mucous membranes, its rate and extent of absorption depending upon the specific site of application, duration of exposure, concentration and total dosage. In general, the rate of absorption of local anesthetic agents following topical application occurs most rapidly after intratracheal administration. Lidocaine is also well-absorbed from the gastrointestinal tract, but little intact drug appears in the circulation because of biotransformation in the liver.

• Lidocaine is metabolized rapidly by the liver and metabolites and unchanged drug are excreted by the kidneys. Biotransformation includes oxidative N-dealkylation, ring hydroxylation, cleavage of the amide linkage and conjugation. N-dealkylation, a major pathway of biotransformation, yields the metabolites monoethylglycinexylidide and glycinexylidide. The pharmacological/toxicological actions of these metabolites are similar to, but less potent than, those of lidocaine. Approximately 90% of lidocaine administered is excreted in the form of various metabolites and less than 10% is excreted unchanged. The primary metabolite in urine is a conjugate of 4-hydroxy-2, 6-dimethylaniline. The plasma binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 g of free base per mL, 60 to 80 percent of lidocaine is protein bound. Binding is also dependent on the plasma concentration of the alpha-1-acid glycoprotein. Lidocaine crosses the blood-brain and placental barriers, presumably by passive diffusion. Studies of lidocaine metabolism following intravenous bolus injections have shown that the elimination half-life of this agent is typically 1.5 to 2 hours. Because of the rapid rate at which lidocaine is metabolized, any condition that affects liver function may alter lidocaine kinetics. The half-life may be prolonged two-fold or more in patients with liver dysfunction. Renal dysfunction does not affect lidocaine kinetics, but may increase the accumulation of metabolites. Factors such as acidosis and the use of CNS stimulants and depressants affect the CNS levels of lidocaine required to produce overt systemic effects. Objective adverse manifestations become increasingly apparent with increasing venous plasma levels above 6 g free base per mL. In the rhesus monkey, arterial blood levels of 18-21 g/mL have been shown to be threshold for convulsive activity.

Nonclinical Toxicology

• Studies of lidocaine in animals to evaluate the carcinogenic and mutagenic potential of the effect on fertility have not been conducted.

Clinical Studies

There is limited information regarding Lidocaine (cream) Clinical Studies in the drug label.

How Supplied

Lidocaine 3% Cream is supplied as a white cream in: 1 oz. (28.35 g) tubes, NDC 13925-159-01 3 oz. (85 g) tubes, NDC 13925-159-03.

Storage

• Store at 25ºC (77ºF); excursions permitted to 15º-30ºC (59º-86º F).

• Protect from freezing.

Images

Drug Images

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Package and Label Display Panel

Rx Only NDC-13925-159-01 Net Wt. 1 oz. (28.35 g)

Lidocaine 3% Cream Topical Anesthetic

FOR EXTERNAL USE ONLY. NOT FOR OPHTHALMIC USE.

SETON PHARMACEUTICALS

This image is provided by the National Library of Medicine.

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Patient Counseling Information

• KEEP THIS AND ALL MEDICATIONS OUT OF REACH OF CHILDREN.
• All prescriptions using this product shall be pursuant to state statutes as applicable. This is not an Orange Book product. This product may be administered only under a physician’s supervision. There are no implied or explicit claims on the therapeutic equivalence.

Manufactured for: Seton Pharmaceuticals Manasquan, NJ 08736 1-800-510-3401

Iss. 5/11

Rx Only

Seton Pharmaceuticals

Precautions with Alcohol

Alcohol-Lidocaine (cream) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Lidocaine (cream) Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Lidocaine (cream) Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.