Prescription lidocaine transdermal (Dermalid, Lidoderm, Ztildo) is used to relieve the pain of post-herpetic neuralgia (PHN; burning, stabbing pains, or aches that may last for months or years after a shingles infection). Nonprescription (over-the-counter) lidocaine (Absorbine Jr, Aspercreme, Lidocare, Salonpas, others) is also available to relieve minor pain in shoulders, arms, neck and legs in adults and children 12 years of age and older. Lidocaine is in a class of medications called local anesthetics. It works by stopping nerves from sending pain signals.

Prescription lidocaine transdermal comes as a 5% patch (Dermalid, Lidoderm) and as a 1.8% topical system (Ztlido) to apply to the skin. Prescription lidocaine transdermal is applied only once a day as needed for pain. Never apply more than 3 of the lidocaine 5% patch or lidocaine 1.8% topical systems at one time, and never wear them for more than 12 hours per day (12 hours on and 12 hours off). Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use lidocaine transdermal exactly as directed. Do not apply it more or less often than prescribed by your doctor.

Nonprescription lidocaine transdermal comes as a 4% patch (Absorbine Jr, Aspercreme, Lidocare, Salonpas, others) to apply to the skin. It is applied up to 3 times daily and for no more than 8 hours per application. Use nonprescription lidocaine patches exactly as directed. Do not use more or less of it or use it more often or for a longer period of time than directed by the package instructions.

Your doctor will tell you how many lidocaine patches or topical systems you may use at one time and the length of time you may wear the patches. Applying too many patches or topical systems or leaving them on for too long may cause serious side effects.

Apply the lidocaine patch or topical system to clean, dry, intact skin as directed. Choose an area where the patch will not be rubbed by tight clothing. Do not apply the patch or topical system to an open wound or cut, to skin that is irritated or red, or to skin that is affected by a rash, burn, or other skin problem. If irritation or a burning sensation occurs during lidocaine application, remove the lidocaine patch or system and do not reapply it until the irritation is gone. Prescription patches and topical systems may be cut into smaller sizes with scissors prior to removal of the release liner. Be sure to remove the current patch before you apply a new one.

Do not let lidocaine transdermal come in contact with your eyes. If lidocaine transdermal does touch your eye, immediately wash the eye with water or saline and protect the eye until sensation returns.

While you are wearing a lidocaine transdermal patch or system, protect the treated area from direct heat such as heating pads or electric blankets. You can apply the lidocaine 1.8% topical system after moderate heat exposure, such as 15 minutes of heating pad exposure on a medium setting. Do not bandage the affected area tightly.

Do not shower, bathe, or go swimming while you are wearing the prescription lidocaine 5% transdermal patch. If you are using the prescription lidocaine 1.8% topical system, you may shower for up to 10 minutes or wear it while immersed in water for up to 15 minutes. If the lidocaine 1.8% topical system becomes wet, gently pat the skin, but do not rub the skin or lidocaine 1.8% topical system.

If the lidocaine 1.8% topical system comes off completely or lifts at the edges, reattach it by pressing firmly on the edges of the topical system or lifted areas. If the lidocaine 1.8% topical system comes off completely more than once and does not stick to the skin, remove it and apply a new lidocaine topical system not to exceed 12 hours of total use.

Wash your hands after handling lidocaine patches or topical system.

Stop using nonprescription lidocaine 4% patch and call your doctor if your pain lasts for longer than 7 days or if your pain improves and then worsens.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Before using lidocaine transdermal,

• tell your doctor and pharmacist if you are allergic to lidocaine; other medications such as benzocaine. bupivacaine (Marcaine), etidocaine (Duranest), mepivacaine (Carbocaine, Prolocaine), prilocaine (Citanest), procaine, tetracaine, any other medications, or any of the ingredients in lidocaine transdermal. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: acetaminophen (Tylenol), chloroquine, dapsone (Aczone), disopyramide (Norpace), flecainide (Tambocor), medications applied to the skin or mouth to treat pain, metoclopramide (Reglan), mexiletine (Mexitil), moricizine (Ethmozine), nitrofurantoin (Furadantin), nitroglycerin (Nitro-Dur), nitroprusside (Nitropress), phenobarbital, phenytoin (Dilantin), primaquine, procainamide (Procanabid, Pronestyl), propafenone (Rhythmol), quinidine (Quinidex), quinine (Qualaquin), sulfasalazine (Azulfidine), and tocainide (Tonocard). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had glucose-6-phosphate dehydrogenase (G-6PD) deficiency (an inherited blood disorder), methemoglobinemia (a condition with defective red blood cells that are unable to carry oxygen to the tissues in the body), or heart, lung, or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using lidocaine patches or topical systems, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using lidocaine patches or topical systems.

This medication is usually used as needed. If your doctor has told you to use lidocaine patches or topical systems regularly, apply the missed patch or topical system as soon as you remember it. However, if it is almost time for the next dose, skip the missed patch and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.

If you wear too many lidocaine transdermal patches or topical systems or wear them for too long, too much lidocaine may be absorbed into your blood. In that case, you may experience symptoms of an overdose.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• lightheadedness
• nervousness
• inappropriate happiness
• confusion
• dizziness
• drowsiness
• ringing in the ears
• blurred or double vision
• vomiting
• feeling hot, cold, or numb
• twitching or shaking that you cannot control
• seizures
• loss of consciousness
• slow heartbeat

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not store patches and topical systems outside the sealed envelope. Fold used patches or topical systems so that the adhesive side sticks to itself and then safely discard into trash and where children and pets cannot get to them.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Unless your doctor tells you otherwise, continue your normal diet.

Lidocaine patches or topical systems may cause side effects. If any of these symptoms occur, remove your patch or topical system and do not put it back on until the symptoms go away. Tell your doctor if any of these symptoms are severe or do not go away:

• burning or discomfort in the place you applied the patch
• redness or swelling of the skin under the patch

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• hives
• rash
• itching
• blisters
• bruising
• difficulty breathing or swallowing
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• fast pulse or breathing
• unusual thirst
• nausea
• vomiting
• confusion
• weakness
• dizziness
• fainting
• pale, gray, or blue colored skin; headache; shortness of breath; lightheadedness; or fatigue

Lidocaine transdermal may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Absorbine Jr® Plus
• Aspercreme Patch®
• Dermalid®
• Lidocare®
• Lidoderm®
• Salonpas®
• Ztlido®
• Synera® (containing lidocaine and tetracaine)