lidocaine/prilocaine (Rx)

Brand and Other Names:EMLA, Oraqix
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Dosing & Uses


Dosage Forms & Strengths


cream (EMLA)

  • (2.5%/2.5%)/30g

dental gel (Oraqix)

  • 2.5%/2.5%

Dermal Procedures

Minor dermatological procedures

  • Cream: Apply 2.5 g over 20-25 cm² of skin surface area for at least 1 hr

Painful dermatological procedures involving large areas (eg, split thickness skin graft harvesting)

  • Cream: Apply 2 g/10 cm² of skin and allow to remain in contact with the skin for at least 2 hr
  • Analgesia is achieved in 1 hr, reaches maximum in 2-3 hr, and persists 1-2 hr after removal

Topical Anesthetic on Genital Mucous Membranes

Superficial minor surgery on male genitalia and as pretreatment for infiltration anesthesia

  • Cream: Apply 1 g/10 cm² of skin for 15 min

Minor procedures on the female external genitalia (eg, condylomata acuminata) as well as for use as pretreatment for anesthetic infiltration

  • Cream: Apply 5-10 g for 5-10 min

Dental Procedures

Localized anesthesia in periodontal pockets during scaling and/or root planing

Dental gel: Apply one cartridge or less for one quadrant of dentition; do not exceed 5 cartridges per treatment session

Dosing Considerations


  • Gently squeeze cream out of the tube as a narrow strip that is 1.5 inches long and 0.2 inches wide; 1 strip corresponds to 1 g
  • Perform local anesthetic infiltration immediately after removal of cream
  • Male genital skin: Analgesia will increase up to 3 hours under occlusive dressing and persist 1-2 hours after cream removal
  • Female genital skin: Occlusive dressing is not necessary but will keep cream in place

Dental gel

  • Anesthetic effect lasts approximately 20 minute; if effect wears off, reapply if needed; one cartridge or less is sufficient for one quadrant of dentition



  • Apply a thick layer to intact skin and cover with occlusive dressing
  • Female genital skin: Patient should be lying down during administration, especially if no occlusion is used

Dental gel

  • Do not inject; only use product with blunt-tipped applicator
  • Apply on gingival margin around selected teeth using the blunt–tipped applicator included in package; wait 30 seconds, and fill the periodontal pockets with gel using the blunt–tipped applicator until it becomes visible at the gingival margin; wait another 30 seconds before starting treatment
  • If a gel has formed, place in refrigerator (do not freeze) until it becomes a liquid again; only administer when it is a liquid

Other Indications & Uses

Provides dermal analgesia through intact skin by release of local anesthetics through epidermis

Dosage Forms & Strengths


cream (EMLA)

  • (2.5%/2.5%)/30g

dental gel (Oraqix)

  • 2.5%/2.5%

Local Anesthetic Procedures


  • Neonates (gestation age <37 weeks): Use not recommended
  • <12 months: Do not use if receiving treatment with methemoglobinemia-inducing agents
  • 0-3 months (or <5 kg): Do not exceed 1 g total dose/application area > 10 cm²/>1 hr application time
  • 3-12 months (and >5 kg): Do not exceed 2 g total dose/application area > 20 cm²/>4 hr application time
  • 1-6 years (and >10 kg): Do not exceed 10 g total dose/application area > 100 cm²/>4 hr application time
  • 7-12 years (and >20 kg): Do not exceed 20 g total dose/application area > 200 cm²/>4 hr application time

Dosing Considerations


  • If patient >3 months does not meet minimum weight requirement, total dose should correspond to patient’s weight
  • Care must be taken to avoid accidental ingestion of cream; use secondary protective covering to present disruption of application site


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            Adverse Effects


            Pallor/blanching (37%)

            Application site erythema/pain (30%)

            Genital mucous membrane burning sensation (17%)

            Oral cavity, periodontal formulation (15%)


            Alterations in temperature sensations (7%)

            Application site edema (6-10%)

            Itching (2%)



            Myocardial dysfunction (rare)

            Methemoglobinemia (rare)

            Depression/excitation (rare)

            Seizure (rare)

            Frequency Not Defined

            Localized discrete purpuric or petechial reactions (rare)

            Localized hyperpigmentation (rare)

            Allergic reactions (eg, urticaria, angioedema, bronchospasm, shock)




            Hypersensitivity to components, amide-type local anesthetics


            Do not apply on open wounds

            Monitor child closely after administration; if child becomes very dizzy, excessively sleepy, or develops duskiness of the face or lips, remove cream immediately

            Exercise caution when applying over large areas for >2 hours due to risk of systemic absorption and adverse effects

            Monitor patients treated with class III anti-arrhythmic drugs (eg, amiodarone, bretylium, sotalol, dofetilide) due to additive cardiac effects; consider ECG monitoring

            Use of cream is not recommended in any clinical situation when penetration or migration beyond tympanic membrane into middle ear is possible due to ototoxic effects observed in animal studies

            Monitor acutely ill, debilitated, or elderly patients closely if administering repeated doses

            Lidocaine and prilocaine have been shown to inhibit viral and bacterial growth

            Instruct patient to avoid irritating or exposing treated area to extreme temperatures until complete sensation has returned

            Allergic and anaphylactic reactions associated with lidocaine or prilocaine can occur; these reactions may be characterized by urticaria, angioedema, bronchospasm, and shock; if reactions occur, they should be managed by conventional means

            Not to be used with standard dental syringes; only use with blunt‐tipped applicator and dispenser which is available from DENTSPLY Pharmaceutical

            Drug coming in contact with the eye should be avoided; animal studies have demonstrated severe eye irritation; a loss of protective reflexes may allow corneal irritation and potential abrasion; if eye contact occurs, immediately rinse eye with water or saline and protect it until normal sensation returns. In addition, the patient should be evaluated by an ophthalmologist, as indicated

            Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at greater risk of developing toxic plasma concentrations of lidocaine and prilocaine


            • Cases of methemoglobinemia reported in association with local anesthetic use; although all patients are at risk for methemoglobinemia, patients with glucose‐6‐phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
            • If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended; signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood
            • Methemoglobin levels may continue to rise; therefore, immediate treatment required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death
            • Discontinue therapy and any other oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, ie, oxygen therapy, hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.

            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excreted in breast milk; use not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.



            Mechanism of Action

            Amide-type local anesthetics stabilize neuronal membranes and prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold


            Positively correlated to degree of systemic absorption

            Peak plasma concentrations: 148-641 ng/mL (lidocaine); 40-346 ng/mL (prilocaine)


            Vd (IV administration): 1.1-2.1 L/kg (lidocaine); 0.7-4.4 L/kg (prilocaine)

            Protein bound: 70% (lidocaine); 55% (prilocaine)


            Unknown if metabolized in skin

            Systemic metabolism: hepatic (lidocaine); hepatic/renal (prilocaine)

            Metabolites: ester- and amide-type local anesthetics


            t1/2 (IV administration): 65-150 min (lidocaine); 10-150 min (prilocaine)

            Excretion (IV administration): Urine (98%) [lidocaine]



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