Over-the-Counter Lidocaine

Lidocaine is an anesthetic, and it causes a temporary loss of sensation (like pain) in the skin and surrounding tissues. Creams containing lidocaine are used to prevent and treat pain and discomfort during some medical procedures. It is also available as an over-the-counter (OTC) medication that can be used to help with itchiness and pain from minor burns, scrapes, and insect bites.

Creams and ointments that contain only lidocaine include AneCream, Aspercreme with Lidocaine, BenGay, CidalEaze, Ela-Max, LidaMantle, Lidosense 4, Lidotral, LMX 4, LMX 4 with Tegaderm, LMX 5, MENTHO-CAINE, RectaSmoothe, RectiCare, Solarcaine, SOLUPAK, and Xylocaine.

The difference between an ointment and a cream relates to its thickness. An ointment is 80% oil and 20% water, while a cream is 50% oil and 50% water.

Ointment on hand

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How to Use Lidocaine Cream

Before using lidocaine cream or ointment, wash your hands with soap and water. For medical use, apply topically by squeezing the amount needed onto a sterile gauze pad and applying it to the affected area. Wash your hands again very well after applying.

Although the chance of side effects with lidocaine cream or ointment is quite low, be careful, especially if using large amounts, since adverse side effects are directly related to the total dose of lidocaine that you apply.

Do not get lidocaine in your mouth, nose, or eyes. Getting it in your eyes can badly irritate them, and cause blurry vision and temporary vision loss. If any of the ointment gets in your eyes, wash them with water for at least 15 minutes. Do not touch or rub your eyes, and call your healthcare provider right away. Do not cover the areas treated with lidocaine with a bandage or plastic wrap without medical advice because wrapping the treated area increases absorption into your system.

Precautions

Children

Avoid using a dose larger than what your healthcare provider or the manufacturer recommends when applying lidocaine cream to large areas of injured skin. Do not let your child scratch or rub the skin while it is numb, and do not let the skin get very hot or very cold. When using lidocaine cream, avoid heat sources (such as electric blankets or heating pads). Also, don't let your child take long, hot baths or sunbathe because their temperature may rise and cause too much drug to be absorbed into their body.

For children younger than 3 years old, lidocaine should be used only when other treatments are not available. Always talk to your healthcare provider before applying lidocaine cream on a child. Health problems like seizures have occurred in children younger than 3 when it was not used properly or as recommended by a healthcare provider. Do not use it to treat infants and children with teething pain.

Pregnancy

While there have been some animal studies, there are no adequate and well-controlled studies that have demonstrated the safety of using lidocaine cream in pregnant women. Extra caution is therefore recommended, especially during early pregnancy, when the main development of the embryo’s organs takes place. It is not known whether lidocaine ointment is passed to an infant through breast milk, but because other drugs are found in nursing mothers’ milk, caution should be exercised when lidocaine is given to a nursing woman.

Elderly

Elderly patients should be given reduced doses depending on their age and physical condition. Lidocaine should also be used with caution in people with severe shock or heart block.

A study showed that although topical anesthetics are considered safe, the rate at which some people absorb lidocaine is unpredictable. The study also found that the concentration of lidocaine, the formulation of the drug, and an individual person's physical makeup all have significant effects on the amount of lidocaine that gets absorbed into the blood. Even OTC topical anesthetics should be supervised by a healthcare professional to avoid toxic effects and, in rare cases, death.

Side Effects

Call your healthcare provider if you experience any of the following side effects after applying a lidocaine cream:

  • Skin rash
  • Itching or hives
  • Swelling of the face, lips, or tongue
  • Breathing problems
  • Changes in vision
  • Confusion, excitability, nervousness, restlessness
  • Dizziness, drowsiness
  • Fever or chills
  • Headache
  • Irregular heartbeat
  • Nausea, vomiting
  • Seizure
  • Tremor

Rarely, frequent use of lidocaine can reduce the ability of iron in red blood cells to carry oxygen to tissues. This serious and even life-threatening condition is known as methemoglobinemia. Because the blood is not able to carry enough oxygen to tissues, people with this condition appear very pale or even blue, feel very tired, and have shortness of breath.

The type of lidocaine used in the mouth by dentists is not available over the counter. Do not swallow lidocaine cream or put lidocaine cream in your mouth. Lidocaine can cause numbness of the mouth and throat, which can lead to trouble swallowing and even choking. If a substantial amount is swallowed, enough can be absorbed into the bloodstream to affect vital organs, primarily the brain and heart.

Combination Products

Some products contain lidocaine in addition to other medications, such as additional pain relievers or steroids:

  • BLT (benzocaine, lidocaine, and tetracaine)
  • Denela Cream (lidocaine and prilocaine)
  • EMLA (lidocaine and prilocaine)
  • Evolution 10 (lidocaine and a local anesthetic)
  • Icy Hot Lidocaine (menthol and lidocaine)
  • LidaMantle (lidocaine and hydrocortisone)

Before using lidocaine ointment or cream, let your healthcare provider know if you have any of the following:

  • Heart problems
  • Infected, open, or damaged skin
  • An unusual or allergic reaction to lidocaine, other medicines, foods, dyes, or preservatives
  • If you are pregnant or trying to get pregnant
  • If you are breastfeeding
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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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