From the FDA Drug Label
Lidocaine and prilocaine cream should not be applied to open wounds Lidocaine and prilocaine cream should be used with caution in patients who may be more sensitive to the systemic effects of lidocaine and prilocaine including acutely ill, debilitated, or elderly patients Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations of lidocaine and prilocaine Lidocaine and prilocaine cream should not be used in neonates with a gestational age less than 37 weeks nor in infants under the age of 12 months who are receiving treatment with methemoglobin-inducing agents
The following individuals should avoid Citanest:
- Patients with open wounds
- Patients with severe hepatic disease
- Neonates with a gestational age less than 37 weeks
- Infants under the age of 12 months who are receiving treatment with methemoglobin-inducing agents
- Patients who are allergic to para-aminobenzoic acid derivatives should use with caution, although cross-sensitivity to lidocaine and/or prilocaine has not been shown. 1 1
From the Research
Individuals who should avoid Citanest (prilocaine) include those with known allergies to prilocaine or other amide-type local anesthetics, as well as patients with severe heart block, severe liver disease, or methemoglobinemia, as supported by the most recent study 2 from 2018. When considering the use of Citanest, it is crucial to evaluate the patient's medical history and current medications to minimize risks.
- Patients with a history of allergic reactions to amide-type local anesthetics should be cautious, as cross-reactivity between these agents can occur, as noted in a study from 2009 3.
- Pregnant women, especially in the first trimester, should use Citanest with caution due to the lack of established safety during pregnancy.
- People with glucose-6-phosphate dehydrogenase deficiency are at increased risk of methemoglobinemia and should avoid Citanest.
- Patients taking medications like sulfonamides, acetaminophen, or nitrates should inform their healthcare provider before using Citanest, as these can increase the risk of methemoglobinemia, a condition where blood cannot effectively carry oxygen, as discussed in a study from 2008 4. The reason for these contraindications is that prilocaine can be metabolized to o-toluidine, which can oxidize hemoglobin to methemoglobin, potentially causing tissue hypoxia in susceptible individuals, as mentioned in a study from 1997 5. Always disclose your complete medical history and medication list to your healthcare provider before receiving Citanest, and consider alternative local anesthetics if necessary, as suggested by a case report from 2018 2.