From the Guidelines
No, lidocaine patches should not be ordered BID (twice daily). According to the most recent and highest quality study, lidocaine patches cannot be used for more than 12 hours in a 24-hour period 1. The standard dosing is to apply up to 3 patches at once to the affected area for 12 hours, then remove them for 12 hours. This dosing schedule allows for adequate drug delivery while minimizing the risk of systemic absorption and toxicity.
Key Points to Consider
- Lidocaine patches work by providing local anesthetic effects to reduce pain, particularly neuropathic pain, by blocking sodium channels in nerve membranes 1.
- The medication is slowly released from the patch over the application period, providing sustained pain relief without significant systemic absorption when used as directed.
- The 12-hour patch-free period is important for skin recovery and to prevent cumulative absorption of lidocaine, which could lead to adverse effects.
Important Considerations for Use
- Lidocaine patches have limited data supporting their use in diabetic peripheral neuropathy (DPN) and are not effective in more widespread distribution of pain 1.
- However, they may be of use in individuals with nocturnal neuropathic foot pain.
- It is essential to follow the recommended dosing schedule to minimize the risk of adverse effects and ensure optimal pain relief.
From the FDA Drug Label
Directions Adults and children 2 years and older: apply externally to the affected area up to 3-4 times daily. The answer is no, you should not order lidocaine patch bid (twice daily) as the label recommends applying up to 3-4 times daily 2.
From the Research
Lidocaine Patch Usage
- The lidocaine patch is effective and well tolerated for the treatment of post-herpetic neuralgia (PHN) with a minimal risk of toxicity or drug-drug interactions 3.
- Topical lidocaine formulations have advanced over time and play an important role in the treatment of PHN, and other conditions such as lower back pain, carpal tunnel syndrome, diabetic peripheral neuropathy, and osteoarthritis joint pain 3.
- The use of topical lidocaine is supported by clinical practice guidelines, including first-line treatment by the American Academy of Neurology and the European Federation of Neurological Societies 3.
Dosage and Administration
- The FDA approved 5% lidocaine patches in 1999, and a 1.8% topical lidocaine system in 2018, both indicated for the treatment of pain secondary to PHN 3.
- The 1.8% system offers a more efficient delivery of lidocaine that is bioequivalent to 5% lidocaine patches, but with a 19-fold decrease in drug load and superior adhesion 3.
- There is no specific mention of bid (twice a day) dosage in the provided studies, but the studies suggest that lidocaine patches can be used for the treatment of various pain conditions, including acute localized pain and chronic pain 4, 5.
Safety and Efficacy
- Lidocaine patches were found to be more effective in controlling both musculoskeletal and neuropathic pain compared to placebo patches, with a similar risk of adverse events 4.
- Topical lidocaine has been shown to be a safe and effective option for the treatment of chronic pain, with limited absorption and relative lack of systemic adverse events 5.
- The use of lidocaine patches may be a great alternative alone or in addition to systemic drugs and non-pharmacological approaches for an optimized pain management and in multimodal analgesia 5.