Strongest Prescription Lidocaine Patch
The strongest lidocaine patch available by prescription is the 5% lidocaine patch (containing 700 mg of lidocaine). 1
Evidence for Lidocaine Patch Concentrations
- The 5% lidocaine patch is specifically mentioned in clinical guidelines as an effective topical treatment for neuropathic pain, particularly for post-herpetic neuralgia (PHN) 1
- Over-the-counter lidocaine patches are available in 4% concentration, while the 5% strength requires a prescription 2, 3
- The prescription 5% lidocaine patch contains 700 mg of lidocaine in a soft, stretchy adhesive patch (10 by 14 cm) 4
Mechanism of Action and Clinical Use
- Lidocaine provides analgesic relief by blocking neuronal sodium channels, which inhibits the initiation and conduction of pain signals 2
- The 5% lidocaine patch is most appropriate for well-localized neuropathic pain and is unlikely to benefit patients with central neuropathic pain 1
- Topical application allows for local anesthetic effect with minimal systemic absorption, making it particularly advantageous in older patients or those with complex pain conditions 1
Application Guidelines
- The 5% lidocaine patch should be applied to intact skin only, not on broken or inflamed areas 2
- Up to 3-4 patches can be worn simultaneously for 12-24 hours per day, depending on the size of the painful area 2, 5
- The patch should typically be worn for 12 hours followed by a 12-hour patch-free period 6
Efficacy and Safety Profile
- Clinical trials have demonstrated that the 5% lidocaine patch significantly reduces pain intensity and improves quality of life in patients with post-herpetic neuralgia 6, 5
- The most common adverse effects are mild skin reactions (redness or irritation) at the application site 4
- Systemic absorption is minimal, with the highest blood lidocaine levels measured at only 0.1 μg/mL, well below therapeutic levels for cardiac effects 5
- The excellent safety profile with minimal systemic side effects or drug interactions makes the 5% lidocaine patch suitable as a first-line therapy for certain neuropathic pain conditions 7
Clinical Pearls
- For patients who do not respond to the lidocaine patch by day 7, approximately 43% may experience improvement by day 14, suggesting that an adequate trial should last at least 2 weeks 6
- The lidocaine patch can be used alone or in combination with other analgesic agents for enhanced pain relief 6
- Early initiation of therapy may lead to better outcomes, although the patch has shown efficacy even in longstanding neuropathic pain 6
Cautions and Contraindications
- Contraindications include advanced liver failure, application to broken skin, and known hypersensitivity to amide anesthetics 2
- Patients should be monitored for signs of systemic absorption such as dizziness, confusion, and bradycardia, though these are rare at recommended usage 2
- Excessive heat application over areas where lidocaine is applied should be avoided as it may increase systemic absorption 2