Can lidocaine with hydrocortisone be used during pregnancy?

Use of Lidocaine with Hydrocortisone During Pregnancy

Lidocaine with hydrocortisone can be used during pregnancy after the first trimester with caution, but should be avoided in the first trimester due to potential risks.

Safety Profile of Components

Lidocaine (Topical)

• The FDA label for topical lidocaine advises pregnant women to consult a healthcare professional before use 1
• Lidocaine is classified as FDA Category B (animal studies show no risk, but no adequate human studies) 2
• Limited systemic absorption occurs with topical application when used as directed
• Should not be used on large areas of the body or on cut, irritated, or swollen skin 1

Hydrocortisone (Topical)

• Topical corticosteroids have shown varying safety profiles during pregnancy:
  • Mild/moderate potency topical corticosteroids (like hydrocortisone) are preferred over potent/very potent ones during pregnancy 3
  • Most studies show no significant increase in congenital malformations or premature birth with topical corticosteroids 2
  • A large population-based cohort study found no association between mild/moderate topical corticosteroids and fetal growth restriction 3

Timing Considerations

First Trimester

• Avoid use during first trimester if possible
• Some older studies reported a potential 3-fold increased risk of isolated cleft lip/palate with first-trimester corticosteroid exposure 2
• More recent evidence suggests this risk may be overstated, with a nationwide cohort study of nearly 52,000 pregnancies showing no increased risk 2

Second and Third Trimesters

• Can be used with greater confidence after first trimester
• A study specifically examining tribenoside + lidocaine found it could be safely administered in pregnant women after the first trimester 4
• For hemorrhoids specifically, a prospective study showed topical hydrocortisone cream 1% improved symptoms of pain, swelling, bleeding, itching, and discomfort in pregnant women during the third trimester 5

Specific Recommendations

1. First-line alternatives:

   • Consider non-pharmacological approaches first (dietary modifications, increased fluid intake, sitz baths)
   • For hemorrhoids: bulk-forming agents like psyllium husk are safe during pregnancy 2

2. If medication is necessary:

   • Use the lowest effective dose for the shortest duration possible
   • Apply to the smallest affected area
   • Avoid occlusive dressings which can increase systemic absorption
   • Do not use continuously for more than 7 days without medical supervision 1

3. Monitoring:

   • Watch for signs of skin irritation or systemic absorption
   • Discontinue use if redness, irritation, or worsening of condition occurs 1

Special Considerations

• Hemorrhoids in pregnancy: Hydrocortisone has been specifically studied and shown effective for hemorrhoids in the third trimester 5
• Application method: Avoid internal application if possible; external application has lower risk of systemic absorption
• Duration: Short-term use (7-10 days) is preferred to minimize potential risks 1

When treating conditions during pregnancy, always weigh the benefits of symptom relief against potential risks, and use the mildest effective treatment at the lowest effective dose for the shortest duration necessary.