What are the alternatives to Lidoderm (lidocaine) cream?

Alternatives to Lidoderm (Lidocaine) Cream

Lidocaine patches (4-5%), capsaicin cream, amitriptyline-ketamine combinations, and topical NSAIDs like diclofenac are effective alternatives to Lidoderm cream, with selection based on the specific pain condition and patient factors. 1, 2

First-Line Topical Alternatives

Lidocaine-Based Alternatives

• Lidocaine patches (OTC 4% or prescription 5%) - Preferred over cream for larger areas and longer duration of action 1, 2
  • Provides gradual release over 12 hours (apply for 12 hours, remove for 12 hours)
  • More practical for use on flat surfaces like feet or hands
  • Available as OTC products (e.g., TopCare with 4% lidocaine) 3

Non-Lidocaine Alternatives

1. Capsaicin cream/patches 1, 4

   • Mechanism: Desensitizes pain receptors
   • Application: Apply 3-4 times daily for best results
   • Particularly effective for neuropathic pain

2. Compounded amitriptyline-ketamine combinations 1

   • Applied up to 3 times daily to affected areas
   • Particularly helpful for erythromelalgia and neuropathic pain

3. Topical NSAIDs (e.g., diclofenac) 2

   • Strongly recommended for osteoarthritis pain
   • Advantage: Fewer gastrointestinal adverse events than oral NSAIDs

4. Counterirritants 2

   • Products containing menthol, camphor, or methyl salicylate
   • Provide temporary relief through sensory distraction

Selection Based on Pain Type

For Neuropathic Pain

• First choice: Lidocaine patches (5%) 5, 6
  • Supported by clinical practice guidelines
  • Particularly effective for post-herpetic neuralgia
  • Minimal risk of toxicity or drug interactions

For Musculoskeletal Pain

• First choice: Topical NSAIDs 2
  • Particularly effective for joint pain near the surface
  • Less effective for deep joints (e.g., hip)

For Acute Pain (e.g., minor procedures)

• First choice: Lidocaine cream/gel 1
  • Faster onset than patches
  • Can be used proactively before procedures

Special Populations

Pediatric Patients

• Topical lidocaine is recommended as first-line for minor dermatologic procedures and laceration repair 1
• Consider heat-activated systems for faster onset (10-20 minutes vs. 30-60 minutes)

Elderly Patients

• Lidocaine patches preferred over oral medications to minimize systemic effects 2
• Particularly beneficial for those with polypharmacy concerns

Application Guidelines

1. Duration of trial: Use for at least 4 weeks before determining efficacy 1
2. Application technique:
   • Apply directly to most painful area
   • For patches: Apply for 12 hours, remove for 12 hours to allow skin recovery 2
   • For creams: Apply thin layer 3-4 times daily 4

Safety Considerations

• Contraindications: Allergy to amide anesthetics, non-intact skin 1
• Monitoring: Watch for local skin reactions (redness, irritation) 2
• Advantage: Minimal systemic absorption compared to oral medications 6, 7
• Risk ratio for adverse events: Similar to placebo (0.90; 95% CI: 0.48-1.67) 2

Common Pitfalls to Avoid

1. Inadequate trial period - Many clinicians discontinue too early before full effect is achieved
2. Improper application - Ensure adequate coverage of the painful area
3. Not removing patches - Always remove lidocaine patches before starting IV lidocaine 2
4. Expecting complete pain relief - Topical treatments typically reduce rather than eliminate pain

By selecting the appropriate topical alternative based on pain type and patient factors, you can provide effective pain relief while minimizing systemic side effects.