From the Guidelines
Lidocaine patches can be used cautiously in patients with stage 4 chronic kidney disease (CKD), but dose adjustment and monitoring are recommended. For patients with stage 4 CKD, the standard lidocaine patch 5% can be used at the recommended dose of up to 3 patches applied once for up to 12 hours within a 24-hour period, but with reduced frequency and limited treatment duration when possible 1. Patients should be monitored for signs of lidocaine toxicity, including confusion, dizziness, drowsiness, nervousness, numbness around the mouth, or seizures.
Key Considerations
- Lidocaine patches provide localized pain relief with minimal systemic absorption, reducing the risk of adverse effects in CKD patients 1.
- Since lidocaine is primarily metabolized by the liver rather than excreted by the kidneys, it poses less direct risk to patients with kidney disease compared to many other pain medications 1.
- However, accumulated metabolites can still be problematic in advanced CKD, emphasizing the need for cautious use and monitoring 1.
Comparison with Other Options
- Fentanyl and buprenorphine via transdermal route or intravenously are considered the safest opioids of choice in patients with chronic kidney disease stages 4 or 5 (estimated glomerular filtration rate <30 ml/min) 1.
- Lidocaine patches are generally preferred over oral analgesics in CKD patients due to their localized action and minimal systemic absorption 1.
Monitoring and Dose Adjustment
- Patients should be closely monitored for signs of lidocaine toxicity and for efficacy of pain relief 1.
- Dose adjustment may be necessary based on individual patient response and kidney function 1.
From the Research
Lidocaine Patches and Stage 4 CKD
- There is limited direct evidence on the use of lidocaine patches in patients with stage 4 chronic kidney disease (CKD) 2, 3, 4, 5, 6.
- However, it is known that patients with CKD stage 4 are at increased risk of progressing to end-stage renal disease (ESRD) or dying prior to the development of ESRD compared with patients with less severe CKD 3.
- For pain management in CKD, nonpharmacologic therapies and nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and TCA, may be considered based on pain cause and type, with careful dose considerations in kidney disease 4.
- Topical analgesics, such as lidocaine patches, may be a suitable option for pain management in patients with CKD, but the evidence is limited and more research is needed to guide optimal clinical practice 4, 6.
- The use of anti-inflammatory agents in CKD has been studied, but the evidence does not support their use to reduce cardiovascular risk or CKD progression, and further dedicated studies in this population are warranted 5.
Considerations for Lidocaine Patch Use
- When considering the use of lidocaine patches in patients with stage 4 CKD, it is essential to weigh the potential benefits against the potential risks, including the risk of adverse effects and interactions with other medications 2, 4.
- Patients with CKD stage 4 should be closely monitored for signs of lidocaine toxicity, such as numbness, tingling, or dizziness, and the dose should be adjusted accordingly 2.
- The use of lidocaine patches in patients with CKD stage 4 should be guided by the individual patient's needs and medical history, and in consultation with a healthcare professional 4, 6.