From the Guidelines
Lidocaine cream is a topical treatment used to manage pain, particularly neuropathic pain, by desensitizing the skin and blocking neuronal impulses.
Key Characteristics of Lidocaine Cream
- The cream is available in various concentrations, with 5% being a common strength for prescription use 1.
- It is used to control skin pain, especially in conditions like erythromelalgia and postherpetic neuralgia (PHN) 2, 1.
- Lidocaine cream works by blocking sodium channels, which are required for the initiation and conduction of neuronal impulses, thus providing pain relief 2.
Comparison with Other Forms of Lidocaine
- Lidocaine patches are also available and may be more effective than the cream or ointment because they deliver lidocaine gradually over hours 2.
- The 5% lidocaine patch has shown efficacy and excellent tolerability in randomized controlled trials (RCTs) involving patients with PHN and allodynia 1.
Usage and Application
- When used in conjunction with capsaicin, lidocaine 4% can be applied for 60 minutes before capsaicin to reduce the pain associated with capsaicin application 3.
- The application of lidocaine cream or patch should be done according to the prescribed dosage and duration to avoid adverse effects 1.
From the Research
Definition and Composition of Lidocaine Cream
- Lidocaine cream is a topical formulation containing lidocaine, a local anesthetic, which provides dermal anesthesia/analgesia following application 4.
- The cream is available in various concentrations, including 5% lidocaine patches, 1.8% topical lidocaine system, and 5% lidocaine hydrochloride cream 5, 6.
- Some formulations also combine lidocaine with other ingredients, such as prilocaine (e.g., eutectic lidocaine/prilocaine cream) or menthol (e.g., transdermal lidocaine 3.6% combined with menthol 1.25%) 7, 8.
Mechanism of Action and Effects
- Topical lidocaine works by targeting peripheral nociceptive pathways, minimizing absorption into the plasma and reducing the risk of systemic adverse effects 5.
- The cream produces an analgesic effect without causing a complete sensory block, making it suitable for various pain management applications 5.
- Studies have shown that lidocaine cream can provide effective pain relief for conditions such as post-herpetic neuralgia, lower back pain, carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain 5, 8, 6.
Safety and Tolerability
- Lidocaine cream has a favorable tolerability profile, with transient and mild skin blanching and erythema being the most frequent adverse events 4.
- However, the potential for inducing methaemoglobinaemia, attributed to a metabolite of the prilocaine component, prohibits its use in infants younger than 6 months 4.
- Clinical trials have found lidocaine cream to be well-tolerated, with minimal risk of toxicity or drug-drug interactions 5, 6.