![]() As such, they lack individual pharmacokinetic and efficacy data as well as comparative trial data with prescription products. OTC products are not regulated by the FDA and usually have not been subject to the same clinical trials required for prescription products. ![]() ![]() 16 OVER-THE-COUNTER (OTC) TOPICAL PATCHES (E.G., LIDOCARE® 4%, ASPERCREME® 4%) 14 ZTlido is designed with a more efficient delivery of lidocaine with less residual left in the patch after normal use 15 – it is also promoted as having improved adhesion to skin compared to Lidoderm. 13 In comparison, a single 1.8% ZTlido patch contains 36 mg lidocaine yet provides equivalent lidocaine absorption. At least 95% (665 mg) of lidocaine will remain in a used patch. When used according to the recommended dosing instructions, approximately 3 % of the dose applied is expected to be absorbed. 13Ī single 5% Lidoderm patch contains 700 mg lidocaine. Patches may be cut into smaller sizes with scissors prior to removal of the release liner.Patch(es) may remain in place for up to 12 hours in any 24-hour period, leaving a patch-free period of at least 12 hours. Up to 3 patches may be applied in a single application. A release liner covers the DIA layer and is removed before application. 4 These products have a drug-in-adhesive (DIA) system with two layers, a backing layer (furthest from the skin) and the drug-in-adhesive layer. Lidoderm 5% and ZTlido 1.8% patches are FDA approved for postherpetic neuralgia, however, are used off-label for general topical anesthesia of skin. Dose and application limitations in the product prescribing information exist to prevent systemic lidocaine toxicity, however Lidoderm systemic absorption when used according to package instructions is low and several pharmacokinetic studies have shown that systemic lidocaine levels remain safe, even with extended dosing (18-24 hours) and up to 4 patches per application. Perhaps the truth lies somewhere in between. 5 Although many literature sources and drug information databases categorize prescription lidocaine patches as transdermal, they are technically FDA-approved as topical, 6-7 delivering medication to the outer surface of the body. The transdermal route is defined as “administration through the dermal layer of the skin to the systemic circulation by diffusion”. 4 PRESCRIPTION (RX) TRANSDERMAL PATCHES (E.G., LIDODERM® 5%, ZTLIDO® 1.8%) Lidocaine is available in creams, ointments, gels, lotions, and patches. These include arthralgia (e.g., osteoarthritis, rheumatoid arthritis), low back pain, and neuropathic pain (e.g., diabetic neuropathy, localized peripheral neuropathic pain, post-herpetic neuralgia). Chronic conditions however are more common in the hospice and palliative population and may respond to local lidocaine application. 1Īcute ailments include strains, sprains, tendonitis, acute back pain, and muscle aches. Topical analgesics, like lidocaine, offer a solution to limit systemic adverse effects and should be considered whenever pain is localized, and the severity allows for achievable pain relief with topical application. Adverse effects from systemic analgesics (e.g., via oral or parenteral routes) contribute to and often exacerbate suffering and limit dose titration, thus hindering effectiveness. This month, we compare prescription (Rx) and over-the-counter (OTC) lidocaine patches in response to the frequently asked question, “ Do OTC lidocaine patches require the same “off time” as Rx Lidoderm® 5% patches?” LOCALIZED PAINĪcute and chronic pain are significant sources of suffering in advanced illness.
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