Combined Lidocaine and NSAID Patches
Currently, there are no FDA-approved transdermal patches that combine lidocaine (or other local anesthetics) with NSAIDs in a single formulation. 1
Available Separate Topical Formulations
The evidence supports using these agents separately, not in combination patches:
Lidocaine Patches
- 5% lidocaine patches (prescription) are FDA-approved for postherpetic neuralgia and provide localized anesthetic effect through sodium channel blockade 1, 2
- 4% lidocaine patches are available over-the-counter for localized pain 2
- Apply up to 3-4 patches simultaneously to intact skin for 12 hours on, 12 hours off 3, 2
- Minimal systemic absorption occurs even with multiple patches (blood levels remain at 0.1 micrograms/ml) 2
NSAID Patches and Gels
- Diclofenac patches (180 mg) can be applied once or twice daily 1
- Diclofenac gel applied 3 times daily is an alternative topical NSAID formulation 1
- These work through local anti-inflammatory mechanisms distinct from lidocaine's sodium channel blockade 1
Clinical Approach: Sequential or Concurrent Use
When both mechanisms are needed, apply the agents to separate areas or use them sequentially rather than expecting a combination product. 1
Multimodal Strategy for Neuropathic Pain
- Start with lidocaine patch for the neuropathic component (well-localized burning, shooting pain) 1, 4, 2
- Add oral NSAIDs for inflammatory pain components rather than relying on topical NSAID patches 1
- Consider adding gabapentinoids (gabapentin 100-300 mg nightly, titrate to 900-3600 mg daily) if lidocaine alone is insufficient 1, 2
Safety Considerations When Using Both
- Contraindications for lidocaine patches: advanced liver failure, broken skin, hypersensitivity to amide anesthetics 3, 4, 2
- Avoid excessive heat over lidocaine patches as this increases systemic absorption 3, 2
- Monitor for systemic lidocaine toxicity (dizziness, confusion, bradycardia) though rare at recommended doses 3, 4, 2
- Remove lidocaine patches before IV lidocaine therapy and avoid within 4 hours of other local anesthetic interventions 2
Evidence Quality
The recommendation against combination patches is based on the absence of such products in current guidelines and FDA approvals 1, 3, 4, 2. Guidelines consistently describe lidocaine patches and NSAID topicals as separate therapeutic options used in multimodal pain management, not as combined formulations. 1
Recent systematic reviews confirm lidocaine patches are effective for acute localized pain compared to placebo, with similar efficacy to oral NSAIDs when compared head-to-head, but no studies evaluate combination patches 5.