How to prescribe a lidocaine (5% patch) for localized pain management?

Prescribing Lidocaine 5% Patch for Localized Pain Management

The lidocaine 5% patch should be prescribed for localized neuropathic pain with application of up to 3 patches to cover the painful area for 12 hours per day, with patches removed for the remaining 12 hours in a 24-hour period. 1, 2

Indications and Usage

• FDA-approved indication: Postherpetic neuralgia 1
• Common off-label uses:
  • Diabetic neuropathy
  • Chronic low back pain
  • Osteoarthritis
  • Bone metastasis pain
  • Other localized neuropathic pain syndromes 1, 3

Dosing Instructions

• Number of patches: Up to 3 patches simultaneously (maximum 4 patches in special circumstances) 1, 2
• Application area: Apply directly to the most painful area 4
• Duration of application: 12 hours on, 12 hours off within a 24-hour period 2, 5
• Treatment duration: Initial trial of 2-4 weeks to assess efficacy 4

Application Technique

1. Clean and dry the affected area
2. Remove the patch from its protective pouch
3. Remove the clear plastic liner from the adhesive side
4. Apply to intact, non-irritated skin covering the most painful area
5. The patch can be cut to fit the affected area if needed (before removing the liner)
6. Ensure good adhesion by pressing firmly
7. Wash hands after application
8. Remove after 12 hours and discard 2, 5

Safety Considerations

• Contraindications:

  • Advanced liver failure (due to decreased lidocaine clearance) 1
  • Known hypersensitivity to lidocaine or amide-type local anesthetics
  • Application to broken or damaged skin 1

• Adverse effects:

  • Most common: mild skin redness or irritation at application site
  • Systemic effects are rare due to minimal absorption 6, 7

• Drug interactions:

  • Minimal risk for drug-drug interactions due to low systemic absorption
  • Mean maximum plasma concentrations remain well below toxic levels 7

Monitoring

• Assess skin for irritation or allergic reactions
• Monitor pain relief using standardized pain scales
• Evaluate for adequate pain control within 7-14 days of initiating therapy 4

Patient Education Points

• Patches should not be worn during bathing/showering
• Do not apply heat sources (heating pads, hot tubs) over the patch
• Patches should be folded with adhesive sides together after removal and discarded safely away from children and pets
• Patches may be worn during normal daily activities 4

Clinical Pearls

• The lidocaine patch works by blocking sodium channels in damaged nerves, providing local anesthesia without causing numbness in normal sensation 2
• Efficacy may be seen as early as day 7 of treatment, with approximately 66% of patients reporting improvement in pain intensity by this time 4
• For patients who don't respond by day 7, approximately 43% may experience improvement by day 14 4
• The lidocaine patch is particularly valuable in elderly patients due to minimal systemic effects and lack of drug interactions 1, 7
• The patch can be used as monotherapy or in combination with other analgesics for enhanced pain control 4

Prescription Example

Rx: Lidocaine patch 5%
Disp: #30 patches
Sig: Apply up to 3 patches to affected area(s) for 12 hours daily, then remove for 12 hours.
Refills: 2