From the Guidelines
Lidocaine (Lidoderm) patches are indicated for the treatment of neuropathic pain, specifically postherpetic neuralgia (PHN) and allodynia, in an 87-year-old female patient.
Indications for Use
- The patches are used to manage neuropathic pain associated with PHN and allodynia, which are types of nerve pain that can occur after a patient has had shingles or other types of peripheral neuropathy 1.
- They can also be used for diabetic neuropathy, although the evidence for this is limited and they may not be effective for more widespread pain distribution 1.
- Additionally, lidocaine patches may be used for cancer-related pain, particularly for localized pain syndromes such as myalgias, arthralgias, and neuropathic pain 1.
Dosage and Administration
- The recommended dosage is a maximum of 3 patches daily for a maximum of 12-18 hours 1.
- The patches should not be used for more than 12 hours in a 24-hour period for diabetic neuropathy 1.
Benefits and Considerations
- Topical lidocaine has shown efficacy and excellent tolerability in patients with PHN and allodynia, with mild local reactions being the most common adverse effects 1.
- The lack of systemic absorption and drug interactions makes lidocaine patches a good option for older patients or those with complex neuropathic pain 1.
- However, the evidence for the use of lidocaine patches in certain conditions, such as diabetic neuropathy, is limited, and they may not be effective for more widespread pain distribution 1.
- Other treatment options, such as duloxetine and pregabalin, may be considered for neuropathic pain, particularly for diabetic neuropathy and postherpetic neuralgia 1.
The FDA Drug Labels for lidocaine (TD) do not address this question.
From the Research
Indications for Lidocaine Patch
The lidocaine patch, also known as Lidoderm, is indicated for the treatment of postherpetic neuralgia (PHN) 2, 3, 4, 5. PHN is a chronic pain syndrome that can occur after a patient has had herpes zoster (shingles) and is characterized by continuous burning or intense paroxysmal pain, often with tactile allodynia.
Use in Chronic Pain States
In addition to PHN, the lidocaine patch has been found to be effective in the treatment of other chronic pain states, including:
- Painful diabetic neuropathy (DN) 3
- Low-back pain (LBP) 3
- Other neuropathic or nociceptive pain syndromes, such as carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain 4
Use in Acute Localized Pain
The lidocaine patch has also been found to be effective in the treatment of acute localized pain, including musculoskeletal and neuropathic pain 6.
Safety and Tolerability
The lidocaine patch has been found to be safe and well-tolerated, with minimal systemic absorption and a low risk of systemic toxicities or drug-drug interactions 2, 4, 5. The most common adverse events are mild skin reactions, and there have been no reported serious adverse events or drug-drug interactions.
Considerations for Use in an 87-Year-Old Female Patient
Given the safety and efficacy profile of the lidocaine patch, it may be a suitable treatment option for an 87-year-old female patient with PHN or other chronic pain states, as it has a minimal risk of systemic adverse effects or drug-drug interactions 2, 5. However, as with any medication, the patient's individual medical history and current medications should be taken into consideration before initiating treatment.