What is Lidocaine and Prilocaine: Uses, Dosage, Side Effects and More

Lidocaine and prilocaine is a topical numbing medication that combines two local anesthetics to temporarily block pain signals in your skin. This cream or gel creates a numbing effect on the surface of your skin, making medical procedures more comfortable and less painful. You might know it by brand names like EMLA cream, which has been helping people manage procedural pain for decades.

What is Lidocaine and Prilocaine?

Lidocaine and prilocaine is a combination topical anesthetic that works by temporarily blocking nerve signals in your skin. Think of it as a temporary "off switch" for the pain receptors in the area where you apply it. The medication contains two different numbing agents that work together to provide effective pain relief.

This medication comes as a cream, gel, or patch that you apply directly to your skin. Unlike injected anesthetics, this topical form works gradually and only affects the surface layers of your skin. The combination of both lidocaine and prilocaine makes it more effective than either medication would be on its own.

What is Lidocaine and Prilocaine Used For?

Lidocaine and prilocaine is primarily used to numb your skin before minor medical procedures. Your healthcare provider might recommend it before inserting IV lines, drawing blood, or performing small surgical procedures. The medication helps reduce the pain and discomfort you might feel during these necessary medical interventions.

Beyond medical procedures, this combination can help with various skin-related discomforts. Here are some common situations where your doctor might suggest using this medication:

• Before needle procedures like blood draws, IV insertions, or injections
• Prior to minor skin surgeries or biopsies
• Before laser treatments or dermatological procedures
• For certain types of chronic nerve pain on the skin surface
• Before inserting catheters or other medical devices

Your doctor will determine if this medication is right for your specific situation. The goal is always to make necessary medical care as comfortable as possible for you.

How Does Lidocaine and Prilocaine Work?

Lidocaine and prilocaine works by temporarily blocking sodium channels in your nerve cells. These channels are like tiny doorways that allow pain signals to travel from your skin to your brain. When the medication blocks these doorways, the pain signals cannot get through, and you feel numbness instead of discomfort.

This is considered a moderate-strength topical anesthetic that provides reliable numbing effects. The medication penetrates through the outer layers of your skin to reach the nerve endings underneath. Unlike stronger anesthetics used in surgery, this combination is designed to work safely on intact skin without causing deep tissue effects.

The numbing effect typically begins within 30 to 60 minutes after application. The medication continues to work for several hours, giving your healthcare provider a comfortable window to perform necessary procedures. Your normal sensation returns gradually as your body naturally processes and eliminates the medication.

How Should I Take Lidocaine and Prilocaine?

You should apply lidocaine and prilocaine exactly as your healthcare provider or the package instructions direct. Clean the area gently with soap and water before application, then pat it dry completely. Apply a thick layer of the cream or gel to cover the entire area that needs numbing.

For the best results, you'll need to cover the treated area with plastic wrap or a special occlusive dressing. This covering helps the medication penetrate deeper into your skin and prevents it from rubbing off. Leave the medication on for the recommended time, usually 1 to 2 hours, depending on the procedure you're preparing for.

Here's what you should know about proper application:

• Apply to clean, dry, intact skin only
• Use enough cream to create a thick, even layer
• Cover with plastic wrap or the provided dressing
• Don't apply to broken, irritated, or infected skin
• Wash your hands thoroughly after application

Remove the medication and covering just before your procedure. Your healthcare provider will clean off any remaining cream before beginning the treatment.

How Long Should I Take Lidocaine and Prilocaine For?

Lidocaine and prilocaine is typically used for single procedures rather than ongoing treatment. You'll usually apply it once before a specific medical procedure and then remove it when the procedure begins. The duration of each application is usually 1 to 2 hours, depending on what your healthcare provider recommends.

If your doctor prescribes this medication for ongoing nerve pain, they'll give you specific instructions about how often to use it. Some people might use it several times per week, while others might only need it occasionally. Never use it more frequently than your healthcare provider recommends, as this can increase your risk of side effects.

For chronic conditions, your doctor will regularly evaluate whether you still need this medication. They might adjust the frequency or suggest alternative treatments as your condition changes. Always follow up with your healthcare provider if you've been using this medication for several weeks or months.

What Are the Side Effects of Lidocaine and Prilocaine?

Most people tolerate lidocaine and prilocaine well, but like all medications, it can cause side effects. The most common side effects happen right where you apply the medication and are usually mild and temporary. These local reactions typically resolve on their own within a few hours after removing the cream.

Common side effects you might experience include:

• Redness or irritation at the application site
• Mild burning or stinging when first applied
• Temporary color changes in the skin (lighter or darker)
• Swelling or puffiness in the treated area
• Itching or mild rash

These reactions are generally not serious and indicate that the medication is working. However, you should contact your healthcare provider if these symptoms are severe or don't improve after removing the medication.

More serious side effects are rare but require immediate medical attention. Watch for signs of allergic reactions, such as widespread rash, difficulty breathing, or swelling of your face, lips, or throat. If you experience dizziness, irregular heartbeat, or feel confused after using this medication, seek medical help right away.

Very rarely, some people might experience methemoglobinemia, a condition where your blood cannot carry oxygen effectively. This is more likely in infants, people with certain genetic conditions, or those using large amounts of the medication. Signs include blue-gray skin color, especially around the lips and fingernails, along with breathing difficulties.

Who Should Not Take Lidocaine and Prilocaine?

Lidocaine and prilocaine isn't suitable for everyone, and your healthcare provider will consider your medical history before recommending it. You should not use this medication if you're allergic to lidocaine, prilocaine, or any local anesthetic medications. People with certain genetic conditions that affect how their body processes these medications should also avoid this treatment.

Several health conditions and situations require special caution or alternative treatments:

• Infants under 12 months old (higher risk of serious side effects)
• People with glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Those with methemoglobinemia or a family history of this condition
• Individuals taking certain medications that affect blood oxygen levels
• People with severe heart, liver, or kidney problems
• Those with broken, infected, or severely irritated skin

Pregnancy and breastfeeding require special consideration, though this medication is generally considered safe when used as directed. Your doctor will weigh the benefits against any potential risks for you and your baby. Always inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements.

Lidocaine and Prilocaine Brand Names

The most well-known brand name for lidocaine and prilocaine is EMLA cream, which stands for "Eutectic Mixture of Local Anesthetics." This has been the standard topical anesthetic for many medical procedures for over 30 years. EMLA is available in both cream and patch forms, depending on your specific needs.

Other brand names include Oraqix, which is specifically designed for dental procedures, and various generic formulations. LidaMantle and Prilox are additional brand names you might encounter. The active ingredients and effectiveness are the same across these different brands, though the inactive ingredients might vary slightly.

Your pharmacy might substitute a generic version unless your doctor specifically prescribes a brand name. Generic versions contain the same active ingredients and work just as effectively as brand-name products. Your pharmacist can help you understand any differences between the products available to you.

Lidocaine and Prilocaine Alternatives

Several alternatives exist if lidocaine and prilocaine isn't suitable for you or doesn't provide adequate relief. Topical lidocaine alone is available in various strengths and might be appropriate for some situations. Benzocaine-based products offer another option, though they work differently and may not be as effective for all procedures.

For people who cannot use topical anesthetics, your healthcare provider might suggest:

• Topical cooling sprays that numb through cold rather than medication
• Vibrating devices that distract nerve signals during procedures
• Prescription-strength topical anesthetics with different active ingredients
• Injectable local anesthetics for more extensive procedures
• Oral pain medications taken before procedures

Your doctor will help you find the best alternative based on your specific medical needs and the type of procedure you're having. Sometimes combining different approaches provides the most comfortable experience.

Is Lidocaine and Prilocaine Better Than Lidocaine Alone?

Lidocaine and prilocaine combination is generally more effective than lidocaine alone for topical numbing. The combination of two different anesthetic agents provides deeper penetration and more complete pain relief than either medication would achieve on its own. This makes it particularly valuable for procedures that require reliable, consistent numbing.

The eutectic mixture (EMLA) creates a special formulation where both medications work together at the molecular level. This allows the combination to penetrate intact skin more effectively than single-agent products. Studies have shown that the combination provides faster onset and longer-lasting numbing effects.

However, lidocaine alone might be preferable in certain situations. Some people are allergic to prilocaine but can tolerate lidocaine, making the single-agent option their only choice. Lidocaine alone is also available in higher concentrations for specific medical needs and may be less expensive than combination products.

Your healthcare provider will choose the best option based on your specific procedure, medical history, and individual response to different medications. Both options are effective when used appropriately for the right situations.