How long can a patient use a lidocaine (local anesthetic) patch for?

Duration of Lidocaine Patch Use

Lidocaine patches cannot be used for more than 12 hours in a 24-hour period, requiring a 12-hour on/12-hour off cycle. 1

Maximum Daily Duration

• The standard application protocol is 12 hours on, followed by 12 hours off, as established by the American Diabetes Association guidelines for diabetic peripheral neuropathy and supported by FDA labeling 1
• Up to 3-4 patches may be applied simultaneously to cover larger painful areas, but the 12-hour maximum duration still applies regardless of the number of patches used 2, 3

Application Schedule

• Apply patches to intact skin only over the painful area for the 12-hour treatment period 2, 4
• Remove all patches after 12 hours and allow a 12-hour patch-free interval before reapplying 1
• This cycle can be repeated daily for ongoing pain management without a specified maximum number of days, though efficacy is best established for localized neuropathic pain conditions 1, 5

Safety Considerations During Extended Use

• Monitor for signs of systemic absorption including dizziness, confusion, and bradycardia, particularly when using multiple patches 2, 4
• Perform periodic skin checks for irritation or sensitization at application sites 2
• Avoid excessive heat application over patch areas, as this increases systemic absorption and could lead to toxicity 2, 4, 6
• Pharmacokinetic studies demonstrate that systemic lidocaine levels remain within safe ranges with up to four patches applied for 12 hours 2

Important Limitations

• Lidocaine patches are most effective for well-localized neuropathic pain rather than widespread pain distribution 1, 7
• They may be particularly useful for nocturnal neuropathic foot pain in diabetic peripheral neuropathy 1
• The patches have limited data supporting use for mechanical or structural pain conditions like disc space narrowing 7

Common Pitfalls to Avoid

• Never exceed the 12-hour application period even if pain persists, as this increases risk of systemic toxicity without additional benefit 1
• Do not apply lidocaine patches within 4 hours of other local anesthetic interventions to prevent cumulative toxicity 2, 4
• Avoid using multiple forms of lidocaine simultaneously (cream plus patch) without accounting for total lidocaine dose 4
• Do not apply to broken, inflamed, or grossly contaminated skin 2, 4

Contraindications

• Advanced liver failure 2, 7
• Known hypersensitivity to amide anesthetics 2, 7, 4
• Application to non-intact skin 2, 4