From the Guidelines
Lidocaine patches can be used safely in patients with an eGFR of 32% without dose adjustment, as they provide primarily local analgesia with minimal systemic absorption. The standard dosing of lidocaine 5% patch (Lidoderm) is to apply up to 3 patches to the affected area once for up to 12 hours within a 24-hour period 1. Since lidocaine patches have minimal systemic absorption, they are generally considered safe in patients with reduced kidney function. Only about 3% of the applied lidocaine is systemically absorbed, and the liver metabolizes most of this amount before it reaches the systemic circulation. This makes lidocaine patches a good option for pain management in patients with chronic kidney disease. However, it's still important to monitor for any signs of lidocaine toxicity such as confusion, seizures, or cardiac arrhythmias, especially if the patient is using other local anesthetics concurrently or has severe liver dysfunction. The patches should be applied to intact skin only, avoiding application to broken or inflamed skin which could increase systemic absorption.
Some key points to consider when using lidocaine patches in patients with reduced kidney function include:
- Monitoring renal function using the CKD-EPI equation, as recommended by the European Society of Cardiology working group on cardiovascular pharmacotherapy 1
- Being aware of the potential for increased exposure and risk of adverse drug reactions in patients with reduced renal function
- Considering the use of alternative equations, such as CKD-EPI Cr-cystatin C, which may be more accurate in older patients with reduced muscle mass and renal function 1
- Avoiding the use of lidocaine patches in patients with severe liver dysfunction, as the liver metabolizes most of the systemically absorbed lidocaine.
Overall, lidocaine patches are a safe and effective option for pain management in patients with chronic kidney disease, but require careful monitoring and consideration of individual patient factors.
From the Research
Lidocaine Patch and eGFR 32%
- The use of lidocaine patch in patients with reduced eGFR (estimated glomerular filtration rate) is a concern due to the potential for altered pharmacokinetics and increased risk of adverse effects 2, 3.
- A study published in 2006 found that lidocaine kinetic parameters were altered in patients with severe renal insufficiency (eGFR < 30 mL/min), with a significant decrease in clearance and increase in half-life 2.
- Another study from 1975 found that lidocaine infusion in uremic patients was safe, with no abnormal cumulation of lidocaine or its metabolite MEGX, but GX levels may increase progressively 3.
- The relationship between eGFR and lidocaine patch use is not well established, but it is recommended to exercise caution when using lidocaine in patients with impaired renal function 4, 5.
- A study on the effect of lidocaine on renal function found that it can cause significant reductions in renal blood flow, glomerular filtration rate, and urine and sodium excretion 6.
Key Findings
- Lidocaine pharmacokinetics are altered in patients with severe renal insufficiency 2.
- Lidocaine infusion is safe in uremic patients, but GX levels may increase progressively 3.
- Impaired renal function is associated with an elevated risk of major adverse renal events 5.
- Lidocaine can cause significant reductions in renal blood flow and glomerular filtration rate 6.
Considerations for Lidocaine Patch Use
- Patients with eGFR 32% may be at risk for altered lidocaine pharmacokinetics and increased adverse effects 2, 3.
- Close monitoring of renal function and lidocaine levels may be necessary in patients with impaired renal function 4, 5.
- The use of lidocaine patch in patients with eGFR 32% should be approached with caution and under close medical supervision 2, 3, 6.