Lidocaine-Prilocaine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: May 22, 2024

Warnings

Lidocaine Prilocaine Risks, Warnings, and Complications

Lidocaine prilocaine can cause serious health complications in some people. Talk to your doctor or pharmacist about other treatment options for dermal analgesia if you are at increased risk of complications from using this combination of local anesthetics. Some of the risks of using lidocaine prilocaine include:

OVERDOSE: Application of lidocaine prilocaine to large skin areas or leaving it on the treated area for a long duration can result in systemic absorption and severe adverse effects due to systemic toxicity.
This topical cream should be used with caution in elderly patients and those who are debilitated or acutely ill as these individuals may be more sensitive to the systemic effects of the drug.
CARDIAC EFFECTS: People taking antiarrhythmic medications for an irregular heartbeat (for example, sotalol, amiodarone, bretylium, dofetilide) need to be monitored closely and may require ECG monitoring to detect any cardiac effects from the local anesthetics, lidocaine, and prilocaine.
NOT FOR USE IN EYES AND EARS: Lidocaine prilocaine cream may be ototoxic if it is instilled into the middle ear, although application to the external auditory canal appears to be safe. Avoid using it anywhere near the ear to prevent accidental migration into the middle ear.
This medication can cause severe eye irritation if it comes in contact with the eyes. If this occurs, wash the eye immediately with water and protect it until sensation returns.
Use a second covering over the occlusive dressing in small children to prevent them from touching the area and putting the medication into their eyes, nose, ears, or mouth.
METHEMOGLOBINEMIA: Lidocaine prilocaine can increase the risk of developing methemoglobinemia, a serious blood problem where red blood cells are unable to carry sufficient oxygen. This drug should not be used in people who have methemoglobinemia and in infants under 6 months of age who are being treated with medications that can cause drug-induced methemoglobinemia. Babies under 3 months of age and people with an enzyme deficiency called G6PD deficiency are at a higher risk of this complication. The risk is also higher with the use of large doses of lidocaine prilocaine, application on large skin areas, and concomitant administration of other methemoglobin-inducing agents.
Most people recover spontaneously after the use of lidocaine prilocaine cream is stopped. Treatment with IV methylene blue may be required in some cases.
Tell your health care professional without delay if you develop unusual tiredness, a blue-gray discoloration of the skin, dizziness, shortness of breath, chest tightness, heart rhythm problems, seizures, or loss of consciousness after using lidocaine prilocaine.

Precautions Before Starting Lidocaine Prilocaine

Tell your doctor if you are allergic to lidocaine, prilocaine, other local anesthetics, or any other medications. Your pharmacy can give you a list of the inactive and active ingredients in lidocaine prilocaine cream.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Lidocaine prilocaine may not be safe for people with certain medical conditions such as G6PD deficiency, methemoglobinemia, or liver disease.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Lidocaine Prilocaine

Do not apply large amounts of the cream, apply the cream on a large skin area, or leave it on longer than recommended.

Serious injury can occur when your skin is numb. Avoid rubbing, scratching, or exposing your skin to cold temperatures to avoid injury.

Lidocaine Prilocaine Drug Interactions

Certain other drugs can affect how lidocaine and prilocaine work. Possible interactions between lidocaine prilocaine, and your other medicines can increase the risk of severe adverse effects. Some of the medications that can have drug interactions with lidocaine prilocaine include:

Migraine medications such as dihydroergotamine
Antiarrhythmics for irregular heartbeat
Medications prescribed for HIV, such as saquinavir

The above list does not include all the medicines that can have interactions with lidocaine prilocaine. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medications.

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