|EMLA (EUTECTIC MIXTURE OF LIDOCAINE AND PRILOCAINE)
Classifications: local anesthetic; Therapeutic: local anesthetic
Pregnancy Category: B
2.5% lidocaine/2.5% prilocaine cream
EMLA cream is a mixture of lidocaine and prilocaine. The mixture forms a liquid at room temperature. Concentration of anesthetic
in liquid versus an emulsifier is 80% versus 20%.
EMLA is a topical analgesic.
Topical anesthetic on normal intact skin for local anesthesia.
Topical anesthetic prior to leg ulcer debridement; treatment of postherpetic neuralgia.
Patients with known sensitivity to local anesthetics; patients with congenital or idiopathy methemoglobinemia; tympanic membrane
perforation; children <1 mo of age.
Acutely ill, debilitated, or older adult patients; severe liver disease; pregnancy (category B), lactation.
Route & Dosage
Adult/Child (>1 mo): Topical Apply 2.5 g of cream (? of 5 g tube) over 2025 cm2 of skin, cover with occlusive dressing and wait at least 1 h, then remove dressing and wipe off cream, cleanse area with
an antiseptic solution and prepare patient for the procedure
- Apply a thick layer to skin (approximately ? of 5-g tube per 2025 cm2 or 2 x 2 in) at site of procedure. Apply an occlusive dressing. Do not spread out cream. Seal edges of dressing
well to avoid leakage.
- Apply EMLA cream 1 h before routine procedure and 2 h before painful procedure.
- Remove EMLA cream prior to skin puncture and clean area with an aseptic solution.
- Store at room temperature 15°30° C (59°86° F).
Adverse Effects (≥1%)Hematologic:
Methemoglobinemia, especially in infants, small children, and patients with G6PD deficiency. Skin: Blanching and redness,
itching, heat sensation. Body as a Whole:
Edema, soreness, aching, numbness, heaviness. Other:
The adverse effects of lidocaine could occur with large doses or if there is significant systemic absorption.
May cause additive toxicity
with class i antiarrhythmics
; may increase risk of developing methemoglobin when used with acetaminophen, chloroquine, dapsone, fosphenytoin, nitrates
, nitric oxide, nitrofurantoin, nitroprusside, pamaquine, phenobarbital, phenytoin, primaquine, quinine,
Penetrates intact skin. Onset:
1560 min. Peak:
23 h. Duration:
12 h after removal of cream. Distribution:
Crosses bloodbrain barrier and placenta, distributed into breast milk. Metabolism:
In liver. Elimination:
98% of absorbed dose is excreted in urine. Half-Life:
Assessment & Drug Effects
- Monitor for local skin reactions including erythema, edema, itching, abnormal temperature sensations, and rash. These reactions
are very common and usually disappear in 12 h.
- Note: Patients taking Class 1 antiarrhythmic drugs may experience toxic effects on the cardiovascular system. EMLA should be used
with caution in these patients.
- Wash immediately with water or saline if contact with the eye occurs; protect the eye until sensation returns.
Patient & Family Education
- Skin analgesia lasts for 1 h following removal of the occlusive dressing. Analgesia may be accompanied by temporary loss of
all sensation in the treated skin. Advise caution until sensation returns.