Lidocaine Tetracaine

Lidocaine Tetracaine Brand Names- Pliaglis | Synera

What is Lidocaine Tetracaine

Lidocaine, an amide-type local anesthetic, and tetracaine, an ester-type local anesthetic, are used together in a topical preparation for local anesthesia. Multiple dosage forms are available for clinical use.

A patch (Synera™) contains 70 mg of each anesthetic; the cream (Pliaglis™) contains 70 mg of each anesthetic per gram. Synera™ patch is an emulsion that becomes warm once the outer packaging is removed.

The warming occurs from a chemical reaction that is initiated with oxygen exposure and is intended to enhance local anesthetic delivery. The skin temperature under the patch may increase by up to approximately 5 degrees C, but maximum skin temperature will not exceed 40 degrees C.

The lidocaine tetracaine patch is applied for 20—30 minutes before a procedure. Lidocaine tetracaine cream is applied for 20—30 minutes before superficial procedures such as dermal filler injections or facial laser resurfacing, and for 60 minutes before procedures such as laser-assisted tattoo removal.

The cream is designed to form a pliable peel on the skin when exposed to air.

The FDA approved the Synera™ patch in June 2005 and Pliaglis™ cream in June 2006.

Indications

  • local anesthesia
  • topical anesthesia

Cream dose based on treatment site surface area:

  • Area of 2 inch2: 1 inch (equivalent to 1 gram)
  • Area of 3 inch2: 2 inches (equivalent to 3 grams)
  • Area of 6 inch2: 5 inches (equivalent to 5 grams)
  • Area of 12 inch2: 9 inches (equivalent to 11 grams)
  • Area of 16 inch2: 12 inches (equivalent to 13 grams)
  • Area of 23 inch2: 18 inches (equivalent to 20 grams)
  • Area of 31 inch2: 24 inches (equivalent to 26 grams)
  • Area of 39 inch2: 30 inches (equivalent to 33 grams)
  • Area of 47 inch2: 36 inches (equivalent to 40 grams)
  • Area of 54 inch2: 42 inches (equivalent to 46 grams)
  • Area of 62 inch2: 48 inches (equivalent to 53 grams)

For use as local anesthesia to provide topical anesthesia to normal intact skin

for superficial dermatological procedures such as excision, electrodesiccation, and shave biopsy of skin lesions

Side Effects

  1. acne vulgaris
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. anxiety
  6. arrhythmia exacerbation
  7. blurred vision
  8. bradycardia
  9. bronchospasm
  10. bullous rash
  11. cardiac arrest
  12. coma
  13. confusion
  14. contact dermatitis
  15. dehydration
  16. diaphoresis
  17. dizziness
  18. drowsiness
  19. ecchymosis
  20. edema
  21. erythema
  22. euphoria
  23. fever
  24. headache
  25. hyperventilation
  26. hypotension
  27. maculopapular rash
  28. methemoglobinemia
  29. nausea
  30. pallor
  31. paresthesias
  32. pharyngitis
  33. pruritus
  34. rash
  35. respiratory arrest
  36. respiratory depression
  37. restlessness
  38. seizures
  39. skin discoloration
  40. syncope
  41. tinnitus
  42. tremor
  43. urticaria
  44. vesicular rash
  45. vomiting

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • accidental exposure
  • amide local anesthetic hypersensitivity
  • breast-feeding
  • burns
  • cardiac disease
  • children
  • eczema
  • ester local anesthetic hypersensitivity
  • G6PD deficiency
  • geriatric
  • heart failure
  • hepatic disease
  • hepatic encephalopathy
  • hepatitis
  • infants
  • magnetic resonance imaging (MRI)
  • methemoglobinemia
  • neonates
  • occlusive dressing
  • ocular exposure
  • para-aminobenzoic acid, PABA hypersensitivity
  • paraben hypersensitivity
  • pregnancy
  • pseudocholinesterase deficiency
  • pulmonary disease
  • skin abrasion

Interactions

  • Adapalene; Benzoyl Peroxide
  • Benzocaine
  • Benzocaine; Butamben; Tetracaine
  • Benzoyl Peroxide
  • Benzoyl Peroxide; Clindamycin
  • Benzoyl Peroxide; Erythromycin
  • Benzoyl Peroxide; Sulfur
  • Chloroxylenol; Hydrocortisone; Pramoxine
  • Dibucaine
  • Ethyl Chloride
  • Hydrocortisone; Pramoxine
  • Pramoxine