Version May 2024
Anesthetic: Topical:
OTC products:
Cream: Apply a thin film to the affected area 3 to 4 times daily.
Gel, spray: Apply to affected areas ≤4 times daily.
Patch: Note: Additional patch products may be available with different frequency and duration of application instructions; also refer to manufacturer’s labeling.
Avalin, Lidozen: Apply patch to affected area ≤4 times daily. Patch may remain in place for up to 8 hours. Do not use for >5 consecutive days.
LenzaPro: Apply patch to affected area. Patch may remain in place for up to 12 hours.
LidoPatch: Apply patch to affected area. Patch may remain in place for up to 12 hours (maximum: 1 patch/24 hours).
Siterol: Apply patch to affected area. Patch may remain in place for up to 8 hours (maximum: 4 patches/24 hours). Do not use >5 consecutive days.
Terocin: Apply patch to affected area once or twice daily.
Rx products:
Cream: Apply a thin film to the affected area 2 or 3 times daily.
Gel: Apply to affected area up to 4 times daily.
Patch: Lidothol: Apply patch to affected area. Patch may remain in place for up to 12 hours (maximum: 4 patches/24 hours).
Spray: Apply to the affected area 2 or 3 times daily or as directed by a health care provider; consider smaller areas of treatment in debilitated patients.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
Spray (Rx): There are no dosage adjustments provided in the manufacturer's labeling. Consider smaller areas of treatment in patients with altered kidney function.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Lidocaine and menthol: Pediatric drug information")
Topical anesthetic: Note: Approved ages may vary with product, manufacturer, and market changes; consult labeling for specific information.
Prescription products: Product-specific labeling:
Ointment: Lidostream kit (lidocaine 5%/menthol 10% liquid): Children and Adolescents: Topical: For use on skin or oral mucous membranes; use lowest effective dose. Do not exceed lidocaine doses: 4.5 mg/kg/dose; maximum dose: 300 mg/dose; applied with cotton applicator, cotton pack, or gauze.
Patch: eg, Gen 7T Plus (lidocaine 3.5%/menthol 7%): Children ≥12 years and Adolescents: Topical: Apply 1 patch/day to affected area; remove patch after 12 hours of continuous use.
OTC products: Product-specific labeling:
Cream:
AvaDERM (lidocaine 4%/menthol 1%): Children ≥2 years and Adolescents: Topical: Apply a thin film to the affected area up to 3 to 4 times daily.
CBD Freeze Pump, Icy Hot Lidocaine Plus Menthol (lidocaine 4%/menthol 1%): Adolescents: Topical: Apply to affected area every 6 to 8 hours; do not exceed 3 applications/24 hours.
Spray: eg, 1st Relief (lidocaine 4%/menthol 1%): Children ≥2 years and Adolescents: Topical: Apply to affected areas up to 4 times daily.
Patch:
Lidozen, Siterol (lidocaine 4%/menthol 1%): Children ≥12 years and Adolescents: Topical: Apply 1 patch to affected area; remove patch after 8 hours of continuous use; maximum daily dose: 4 patches/day; do not use patch longer than 5 consecutive days.
Terocin (lidocaine 4%/menthol 4%): Children ≥12 years and Adolescents: Topical: Apply 1 patch to affected area once or twice daily.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see Lidocaine monograph. Frequency not defined.
Central nervous system: Burning sensation, localized warm feeling, paresthesia (localized), stinging sensation
Dermatologic: Localized erythema
Local: Localized edema
Hypersensitivity to lidocaine, menthol, local anesthetic of the amide type, or any component of the formulation; secondary bacterial infection at application site; traumatized mucosa. Contraindications may vary by product/formulation; also refer to manufacturer's labeling.
Concerns related to adverse effects:
• Hypersensitivity: Use with caution in patients with known drug sensitivities. Allergic reactions (cutaneous lesions, urticaria, edema, or anaphylactoid reactions) may be a result of sensitivity to lidocaine (rare) or preservatives used in formulations. Patients allergic to para-aminobenzoic acid derivatives (eg, procaine, tetracaine, benzocaine) have not shown cross sensitivity to lidocaine.
• Local effects: Irritation, sensitivity, burns (rare), and/or infection may occur at the site of application; discontinue use and institute appropriate therapy if local effects occur.
• Methemoglobinemia: Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment along with discontinuation of the anesthetic and other oxidizing agents. Onset may be immediate or delayed (hours) after anesthetic exposure. Patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, exposure to oxidizing agents or their metabolites, or infants <6 months of age are more susceptible and should be closely monitored for signs and symptoms of methemoglobinemia (eg, cyanosis, headache, rapid pulse, shortness of breath, lightheadedness, fatigue).
• Systemic adverse effects: Potentially life-threatening side effects (eg, irregular heartbeat, seizures, coma, respiratory depression, death) have occurred when lidocaine is used prior to cosmetic procedures. Excessive dosing for any indication (eg, application to large areas, use above recommended dose, application to denuded or inflamed skin, applying longer than recommended), smaller patients, and/or impaired elimination may lead to increased absorption and systemic toxicity. Patient should adhere strictly to recommended dosage and administration guidelines; serious adverse effects may require the use of supportive care and resuscitative equipment; lidocaine toxicity may occur at blood concentrations >5 mcg/mL.
Special populations:
• Acutely ill patients: Use with caution; acutely ill patients should be given reduced doses commensurate with their age and physical status.
• Debilitated patients: Use with caution; debilitated patients should be given reduced doses commensurate with their age and physical status.
• Older adult: Use with caution; elderly patients should be given reduced doses commensurate with their age and physical status.
• Hepatic impairment: Use caution in patients with severe hepatic disease due to diminished ability to metabolize systemically absorbed lidocaine.
• Pediatric: Use with caution; children should be given reduced doses commensurate with their age and physical status.
Dosage form specific issues:
• Benzyl alcohol: Some dosage forms may contain benzyl alcohol and/or sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol and/or benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.
• Topical gel (Rx): Avoid exposing application site to external heat sources (eg, heating pad, electric blanket). Keep away from open flame and do not heat, microwave, or add to hot water; flammable.
• Topical patch: Avoid exposing application site to external heat sources (eg, heating pad, electric blanket, heat lamp, hot tub).
• Topical spray (Rx): Avoid exposing application site to external heat sources (eg, heating pad, electric blanket).
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication, discontinue use and contact health care provider if symptoms persist >7 days, condition worsens or recurs, or if rash, irritation, itching, or skin injury (eg, pain, swelling, blistering) develops. Do not use on open wounds, cuts, damaged or infected skin; in the eyes, mouth, genitals; or any other mucous membranes. Do not use in large quantities, particularly over raw or blistered areas. Some products are not recommended for use with bandages; consult specific product labeling.
The FDA recommends against using topical OTC medications for teething pain as some products may cause harm; the use of OTC topical anesthetics (eg, benzocaine) for teething pain is also discouraged by AAP and The American Academy of Pediatric Dentistry (AAP 2011; AAPD 2012). The AAP recommends managing teething pain with a chilled (not frozen) teething ring or gently rubbing/massaging with the caregiver's finger.
Topical patches (both used and unused) may cause toxicities in children; used patches still contain large amounts of lidocaine; store and dispose patches out of the reach of children.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
AvaDERM: Lidocaine 4% and menthol 1% (120 g) [contains cetearyl alcohol, propylene glycol, trolamine (triethanolamine)]
CBD4 Freeze Pump Maximum Str: Lidocaine 4% and menthol 1% (60 g [DSC]) [contains cetostearyl alcohol, methylparaben]
CBD4 Freeze Pump Vanish Scent: Lidocaine 4% and menthol 1% (60 g) [contains cetostearyl alcohol, methylparaben]
LevigoLT: Lidocaine 4% and menthol 1% (76.5 g) [paraben free; contains cetearyl alcohol, disodium edta]
Synvexia TC: Lidocaine 4% and menthol 1% (60 g [DSC]) [contains cetyl alcohol, naproxen, trolamine salicylate]
Zylotrol: Lidocaine 4% and menthol 1% (113 g [DSC]) [contains cetostearyl alcohol]
Zylotrol: Lidocaine 4% and menthol 1% (102 g) [contains cetyl alcohol]
Gel, External:
Lidothol: Lidocaine 4.5% and menthol 5% (99 g) [contains sd alcohol, trolamine (triethanolamine)]
LidozenGel: Lidocaine 4% and menthol 1% (120 mL) [contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine), polysorbate 80, trolamine (triethanolamine)]
NuLido: Lidocaine 4% and menthol 1% (120 mL) [contains isopropyl alcohol, trolamine (triethanolamine)]
Zylotrol: Lidocaine 4% and menthol 1% (118.3 g) [contains isopropyl alcohol, trolamine (triethanolamine)]
Generic: Lidocaine 4% and menthol 1% (120 g)
Kit, External:
Elemar Patch: Lidocaine 5% and menthol 6% [contains disodium edta, methylparaben, propylene glycol, propylparaben]
LidoStream: Lidocaine 5% and menthol 10% [contains isopropyl alcohol, propylene glycol]
Zylotrol Plus: Lidocaine 4% and menthol 1% [DSC] [contains methylparaben, polysorbate 80, propylene glycol]
Liquid, External:
Lidotral-Menthol: Lidocaine 5% and menthol 3% (30 mL) [contains benzyl alcohol]
1st Relief Spray: Lidocaine 4% and menthol 1% (118 mL [DSC]) [contains sodium benzoate]
Lotion, External:
Gen7T Plus: Lidocaine 3.5% and menthol 7% (120 g) [contains edetate (edta) disodium, trolamine (triethanolamine)]
Ointment, External:
Transderm-iQ: Lidocaine 4% and menthol 1% (121 g [DSC]) [contains cetyl alcohol, edetate (edta) sodium (tetrasodium), trolamine (triethanolamine)]
Patch, External:
Asperflex Max: Lidocaine 4% and menthol 1% (5 ea) [contains polysorbate 80, propylene glycol]
AvaLin: Lidocaine 4% and menthol 1% (15 ea [DSC]) [contains polysorbate 80]
Exigence One Patch: Lidocaine 4% and menthol 1% (1 ea [DSC])
Gen7T Plus: Lidocaine 3.5% and menthol 7% (10 ea, 15 ea) [contains propylene glycol]
Lidocaine Plus Menthol: Lidocaine 4% and menthol 1% (15 ea)
LidoPatch Pain Relief: Lidocaine 3.99 % and menthol 1.25% (3 ea) [contains disodium edta, iodopropynyl butylcarbamate, methylparaben, polysorbate 80, propylparaben]
LidoPatch Pain Relief: Lidocaine 3.6% and menthol 1.25% (3 ea [DSC], 30 ea [DSC]) [contains disodium edta, methylparaben, polysorbate 80, propylparaben]
Lidothol: Lidocaine 4.5% and menthol 5% (1 ea, 15 ea) [contains propylene glycol, trolamine (triethanolamine)]
LidozenPatch: Lidocaine 4% and menthol 1% (5 ea [DSC]) [contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine), polysorbate 80, trolamine (triethanolamine)]
LidozenPatch: Lidocaine 4% and menthol 1% (5 ea) [contains methylparaben, polysorbate 80, propylene glycol]
LidozenPatch: Lidocaine 4% and menthol 1% (5 ea [DSC]) [contains polysorbate 80, propylene glycol]
Limencin: Lidocaine 4% and menthol 4% (10 ea) [contains edetate (edta) disodium, iodopropynyl butylcarbamate, methylparaben, polysorbate 80, propylparaben]
LM Plus Relief: Lidocaine 3.5% and menthol 7% (15 ea) [contains propylene glycol]
MaL Patch: Lidocaine 4% and menthol 5% (15 ea) [contains disodium edta, iodopropynyl butylcarbamate, methylparaben, polysorbate 80, propylparaben]
Point Relief Lidospot: Lidocaine 4% and menthol 1% (5 ea) [contains methylparaben, polysorbate 80, propylene glycol, propylparaben]
Prolida: Lidocaine 4% and menthol 1% (15 ea) [contains polysorbate 80]
Siterol: Lidocaine 3.99% and menthol 1% (15 ea) [contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine), polysorbate 80]
Terocin: Lidocaine 4% and menthol 4% (10 ea) [contains edetate (edta) disodium, iodopropynyl butylcarbamate, methylparaben, polysorbate 80, propylparaben]
ValleMent: Lidocaine 4% and menthol 4% (5 ea [DSC])
Venia: Lidocaine 4% and menthol 4% (10 ea) [contains polysorbate 80]
Zeruvia: Lidocaine 4% and menthol 1% (15 ea, 30 ea) [contains disodium edta, polysorbate 80]
Zylotrol: Lidocaine 4% and menthol 1% (15 ea); Lidocaine 4% and menthol 4% (15 ea [DSC])
Zylotrol: Lidocaine 4% and menthol 1% (15 ea) [contains edetate (edta) disodium, polysorbate 80, propylene glycol]
Generic: Lidocaine 4% and menthol 4% (5 ea, 10 ea [DSC])
Therapy Pack, External:
LidoMet-10: Lidocaine 4% and menthol 4% (10 ea [DSC])
MenthoReal-10: Lidocaine 4% and menthol 4% (10 ea [DSC])
Yes
Cream (Zylotrol External)
4-1% (per gram): $4.90
Gel (Lidocaine-Menthol External)
4-1% (per gram): $3.96
Gel (Lidothol External)
4.5-5% (per gram): $9.57
Gel (LidozenGel External)
4-1% (per mL): $4.04
Gel (NuLido External)
4-1% (per mL): $4.17
Gel (Zylotrol External)
4-1% (per gram): $4.22
Kit (Elemar Patch External)
5-6% (per each): $1,250.00
Liquid (Lidotral-Menthol External)
5-3% (per mL): $71.00
Patch (Asperflex Max External)
4-1% (per each): $0.92
Patch (Gen7T Plus External)
3.5-7% (per each): $63.27
Patch (Lidocaine-Menthol External)
4-4% (per each): $48.40
Patch (LidoPatch Pain Relief External)
3.99-1.25% (per each): $9.00
Patch (Lidothol External)
4.5-5% (per each): $57.11
Patch (LidozenPatch External)
4-1% (per each): $48.00
Patch (LM Plus Relief External)
3.5-7% (per each): $63.27
Patch (NuLido External)
4-1% (per each): $49.93
Patch (Point Relief Lidospot External)
4-1% (per each): $3.80
Patch (Venia External)
4-4% (per each): $42.10
Patch (Zylotrol External)
4-1% (per each): $52.35
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Topical: For external use only; not for ophthalmic, oral, or genital use; do not use on open wounds, cuts, damaged or infected skin, or on mucous membranes. Some products are not recommended for use with bandages; consult specific product labeling.
Gel (Rx): Clean and dry affected area prior to administration; wash hands after application. Clothing may be worn over treatment area. Keep away from open flame and do not heat, microwave, or add to hot water; flammable. Avoid exposing application site to external heat sources (eg, heating pad, electric blanket).
Patch: Clean and dry affected area prior to administration; remove protective film and apply. Wash hands after application. Avoid exposing application site to external heat sources (eg, heating pad, electric blanket, heat lamp, hot tub). Some patches may be cut to a smaller size. Also refer to manufacturer’s labeling for additional product-specific administration information.
Spray (Rx): Apply to intact skin and cover the most painful area. Avoid exposing application site to external heat sources (eg, heating pad, electric blanket). If using concomitantly with other local anesthetic agents, consider the total amount absorbed of all formulations.
Topical: For external use only; not for ophthalmic, oral, or genital use; do not use on open wounds, cuts, damaged, or infected skin or any OTC products on mucous membranes. Some products are not recommended for use with bandages; consult specific product labeling. Wash hands after application. Avoid exposing application site to external heat sources (eg, heating pad, electric blanket, heat lamp, hot tub).
Patch: Clean and dry affected area prior to administration; remove protective film and apply. Some products (eg, Gen 7T Plus) may be cut to size of affected area; discard unused pieces.
Anesthetic, topical:
OTC products:
Cream, gel, and spray: Temporary relief of pain and itching associated with minor burns and cuts, scrapes, sunburn, insect bites, or skin irritations.
Patch: Temporary relief of mild to moderate muscles/joint aches and pains (eg, arthritis, simple backache, bursitis, tendinopathy, muscle soreness/stiffness/strains, sprains, bruises); temporary relief of pain associated with minor cuts, scrapes, or skin irritations. Specific indications may vary based on product; also refer to manufacturer's labeling.
Rx products:
Cream: Relief of abrasions, minor burns, insect bites, pain, pruritic eczemas, pruritus, soreness, and discomfort due to anal fissures, hemorrhoids, pruritus ani, pruritus vulvae, and similar conditions of the skin and mucous membranes.
Gel: Relief of pain associated with arthritis, backache, cramps, discomfort, neckache, soreness, sprains, or strains.
Patch: Treatment of mild to moderate acute or chronic aches or pain (eg, muscle or ligament strains, backache, tendonitis, osteoarthritis, rheumatoid arthritis, peripheral neuropathies such as diabetic neuropathy or post herpetic neuralgia, other complex regional pains).
Spray: Relief of itching and pain associated with minor burns, minor cuts, insect bites, scrapes, minor skin irritation, and sunburn; treatment of mild to moderate acute or chronic aches or pain (eg, muscle or ligament strains, backache, tendonitis, osteoarthritis, rheumatoid arthritis, peripheral neuropathies such as diabetic neuropathy or post herpetic neuralgia, other complex regional pains).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Antiarrhythmic Agents (Class IB): Lidocaine (Topical) may enhance the adverse/toxic effect of Antiarrhythmic Agents (Class IB). Risk C: Monitor therapy
Cimetidine: May increase the serum concentration of Lidocaine (Topical). Risk C: Monitor therapy
Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy
Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy
Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy
Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy
Animal reproduction studies have not been conducted with this combination. See individual agents.
It is not known if lidocaine or menthol is present in breast milk following use of this preparation. The manufacturer recommends that caution be exercised when administering lidocaine/menthol to breastfeeding women. See individual agents.
Lidocaine: Blocks both initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction.
Menthol: Dilates the blood vessels, causing a sensation of coldness followed by an analgesic effect; relieves itching.
Refer to individual agents.
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