Topical anesthetics
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Lidocaine and Tetracaine Cream Prescribing Information

Drug Detail:S-caine peel (Lidocaine and tetracaine cream)

Drug Class: Topical anesthetics

Contents
Uses Warnings Before Taking Dosage Side effects Interactions

Highlights of Prescribing Information

These highlights do not include all the information needed to use LIDOCAINE AND TETRACAINE CREAM safely and effectively. See full prescribing information for LIDOCAINE AND TETRACAINE CREAM.

LIDOCAINE AND TETRACAINE cream, for topical use

Initial U.S. Approval: 2006

Recent Major Changes

Dosage and Administration, Important Dosage and Administration Instructions ( 2.1) 12/2018
Dosage and Administration, Recommended Dosage ( 2.3) 12/2018
Warnings and Precautions, Methemoglobinemia ( 5.1) 11/2018

Indications and Usage for Lidocaine and Tetracaine Cream

Lidocaine and tetracaine cream is a combination of lidocaine, an amide local anesthetic, and tetracaine, an ester local anesthetic, indicated for use on intact skin in adults to provide topical local analgesia for superficial dermatological procedures such as dermal filler injection, pulsed dye laser therapy, facial laser resurfacing, and laser-assisted tattoo removal. ( 1)

Lidocaine and Tetracaine Cream Dosage and Administration

  • Apply only to intact skin. ( 2.1)
  • Do not exceed the recommended dose of drug or duration of application. ( 2.1)
  • Recommended duration of application ( 2.2):
For dermal filler injection ablative laser facial resurfacing, or pulsed-dye laser therapy20-30 minutes prior to procedure
For superficial dermatological procedures such as laserassisted tattoo removal60 minutes prior to procedure
  • See Full Prescribing Information for amount to apply based upon treatment site surface area. ( 2.3)

Dosage Forms and Strengths

Cream: 70 mg of lidocaine and 70 mg of tetracaine per gram (7%; 7%). ( 3)

Contraindications

  • Known history of sensitivity to lidocaine or tetracaine, or local anesthetics of the amide or ester type. ( 4)
  • Para-aminobenzoic acid (PABA) hypersensitivity. ( 4)

Warnings and Precautions

  • Methemoglobinemia: Cases of methemoglobinemia have been reported in association with local anesthetic use. ( 5.1)
  • Overexposure: To avoid overexposure that could lead to adverse effects,
    • do not use for longer duration or over larger surface areas than recommended. ( 5.2)
    • consider total amount of local anesthetics absorbed from all formulations. ( 5.2)
    • do not apply to mucous membranes or broken or inflamed skin. ( 5.2)
    • use with caution in patients who may be more sensitive to systemic effects of lidocaine and tetracaine cream, including acutely ill or debilitated or those with severe hepatic disease or pseudocholinesterase deficiency. ( 5.2)
  • Risk of Secondary Exposure to Children and Pets: Store and dispose of lidocaine and tetracaine cream out of reach of children and pets due to the risk of accidental exposure and resulting toxicity. ( 5)
  • Anaphylactic Reactions: Seek emergency help if an anaphylactic reaction occurs. ( 5.4)
  • Eye Irritation: Avoid contact with eyes. ( 5.5)

Adverse Reactions/Side Effects

Most common local reactions were erythema (47%), skin discoloration (16%), and edema (14%). ( 6.1)


To report SUSPECTED ADVERSE REACTIONS, contact Taro Pharmaceuticals U.S.A., Inc. at 1-866-923-4914 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Drug Interactions

  • Antiarrhythmic Drugs: Use with caution in patients receiving Class I antiarrhythmic drugs (such as tocainide and mexiletine) because the systemic toxic effects are thought to be additive and potentially synergistic with lidocaine and tetracaine. ( 7.1)

See 17 for PATIENT COUNSELING INFORMATION.

Revised: 4/2019

Related/similar drugs

lidocaine ophthalmic, cocaine nasal, bupivacaine

Full Prescribing Information

2. Lidocaine and Tetracaine Cream Dosage and Administration

2.2 Recommended Dosing Duration

  • For superficial dermatological procedures, such as dermal filler injection, non-ablative laser facial resurfacing, or pulsed-dye laser therapy, apply lidocaine and tetracaine cream to intact skin for 20 to 30 minutes prior to the procedure. See Table 1 for instructions on the amount to apply.
  • For superficial dermatological procedures, such as laser-assisted tattoo removal, apply lidocaine and tetracaine cream to intact skin for 60 minutes prior to the procedure. See Table 1 for instructions on the amount to apply.

2.3 Recommended Dosage

The dose of lidocaine and tetracaine cream that provides effective local dermal analgesia depends on the duration of the application. Although not specifically studied, a shorter duration of application may result in a less complete dermal analgesia or a shorter duration of adequate dermal analgesia.

Determine the amount of drug to apply

The amount (length) of lidocaine and tetracaine cream that should be dispensed is determined by the size of the area to be treated (see Table 1).

  1. Using the ruler on the applicator included in the carton, squeeze out and measure the amount of lidocaine and tetracaine cream that approximates the amount required to achieve proper coverage.
  2. Spread lidocaine and tetracaine cream evenly and thinly (approximately 1 mm or the thickness of a dime) across the treatment area using a flat-surfaced tool such as a metal spatula or tongue depressor.
  3. After waiting the required application time, remove the lidocaine and tetracaine cream by grasping a free-edge with your fingers and pulling it away from the skin.
Table 1. Amount of Lidocaine and Tetracaine Cream According to Treatment Site Surface Area
Surface Area of Treatment Site (inch 2) Length of Lidocaine and Tetracaine Cream for 1 mm Thickness (inch)Weight of Lidocaine and Tetracaine Cream Dispensed (g)
211
323
655
12911
161213
231820
312426
393033
473640
544246
624853

5. Warnings and Precautions

5.1 Methemoglobinemia

Cases of methemoglobinemia have been reported in association with local anesthetic use. Although all patients are at risk for methemoglobinemia, patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.

Signs of methemoglobinemia may occur immediately or may be delayed some hours after exposure, and are characterized by a cyanotic skin discoloration and/or abnormal coloration of the blood. Methemoglobin levels may continue to rise; therefore, immediate treatment is required to avert more serious central nervous system and cardiovascular adverse effects, including seizures, coma, arrhythmias, and death. Discontinue lidocaine and tetracaine cream and any other oxidizing agents. Depending on the severity of the signs and symptoms, patients may respond to supportive care, i.e., oxygen therapy, hydration. A more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.

5.2 Overexposure

  • Application of lidocaine and tetracaine cream for longer times than those recommended or application of lidocaine and tetracaine cream over larger surface areas than those recommended could result in absorption of lidocaine and tetracaine at doses that could lead to serious adverse effects [see Overdosage (10)] .
  • When lidocaine and tetracaine cream is used concomitantly with other products containing local anesthetic agents, consider the amount absorbed from all formulations since the systemic toxic effects are thought to be additive and potentially synergistic with lidocaine and tetracaine.
  • Lidocaine and tetracaine cream is not recommended for use on mucous membranes or on areas with a compromised skin barrier because these uses have not been adequately studied. Application to broken or inflamed skin may result in toxic blood concentrations of lidocaine and tetracaine from increased absorption.
  • Use lidocaine and tetracaine cream with caution in patients who may be more sensitive to the systemic effects of lidocaine and tetracaine, including the acutely ill or debilitated.
  • Patients with severe hepatic disease or pseudocholinesterase deficiency, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations of lidocaine and tetracaine.

5.3 Risks of Secondary Exposure to Children and Pets

Used lidocaine and tetracaine cream contains a large amount of lidocaine and tetracaine. The potential exists for a small child or pet to suffer serious adverse effects from ingesting lidocaine and tetracaine cream, although this risk with lidocaine and tetracaine cream has not been evaluated. After use, replace the cap securely on the tube. It is important to store and dispose of lidocaine and tetracaine cream out of the reach of children and pets.

5.4 Anaphylactic Reactions

Allergic or anaphylactic reactions have been associated with lidocaine and tetracaine and may occur with other components of lidocaine and tetracaine cream. They are characterized by urticaria, angioedema, bronchospasm, and shock. If an allergic reaction occurs, seek emergency help immediately.

5.5 Eye Irritation

Avoid contact of lidocaine and tetracaine cream with the eyes based on the findings of severe eye irritation with the use of similar products in animals. Also, the loss of protective reflexes may predispose to corneal irritation and potential abrasion. If eye contact occurs, immediately wash out the eye with water or saline and protect the eye until sensation returns.

5.6 Vaccinations

Lidocaine has been shown to inhibit viral and bacterial growth. The effect of lidocaine and tetracaine cream on intradermal injections of live vaccines has not been determined.

6. Adverse Reactions/Side Effects

The following adverse reactions are described elsewhere in the labeling:

  • Methemoglobinemia [see Warnings and Precautions (5.1)]
  • Overexposure [see Warnings and Precautions (5.2)]
  • Risks of Secondary Exposure in Children and Pets [see Warnings and Precautions 5.3)]
  • Anaphylactic Reactions [see Warnings and Precautions (5.4)]
  • Eye Irritation [see Warnings and Precautions (5.5)]

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

However, the adverse reaction information from clinical trials does provide a basis for identifying the adverse events that appear to be related to drug use and for approximating their incidence in clinical practice.

Lidocaine and tetracaine cream has been evaluated for safety in 2159 persons undergoing a superficial dermal procedure. Lidocaine and tetracaine cream was studied in 11 placebo-controlled and 1 active-controlled trials, and in open-label safety trials. All 2159 persons were exposed to only a single application of lidocaine and tetracaine cream.

Adverse reactions were assessed by collecting spontaneously reported adverse reactions, and observations made on formal evaluation of the skin for specific reactions.

Most common adverse reactions in clinical trials

Localized Reactions: In clinical studies, the most common local reactions were erythema (47%), skin discoloration (e.g., blanching, ecchymosis, and purpura) (16%), and edema (14%). There were no serious adverse reactions. However, one patient withdrew due to burning pain at the treatment site.

Other Localized Reactions: The following dermal adverse reactions occurred in 1% or less of lidocaine and tetracaine cream-treated patients: ecchymosis, petechial rash, vesiculobullous rash, perifollicular erythema, perifollicular edema, pruritus, rash, maculopapular rash, dry skin, contact dermatitis, and acne.

Systemic (Dose-Related) Reactions: Across all trials, 19 subjects experienced a systemic adverse reaction, 15 of whom were treated with lidocaine and tetracaine cream and 4 with placebo. The frequency of systemic adverse reactions was greater for the lidocaine and tetracaine cream group (1%) than the placebo group (0.3%). The most common systemic adverse events were headache, vomiting, dizziness, and fever, all of which occurred with a frequency of <1%. Other systemic reactions were syncope, nausea, confusion, dehydration, hyperventilation, hypotension, nervousness, paresthesia, pharyngitis, stupor, pallor, and sweating.

Systemic adverse reactions of lidocaine and tetracaine are similar in nature to those observed with other amide and ester local anesthetic agents, including CNS excitation and/or depression (lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensation of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest). Excitatory CNS reactions may be brief or not occur at all, in which case the first manifestation may be drowsiness merging into unconsciousness. Signs of CNS toxicity may start at plasma concentrations of lidocaine at 1000 ng/mL. The plasma concentrations at which tetracaine toxicity may occur are less well characterized; however, systemic toxicity with tetracaine is thought to occur with much lower plasma concentrations compared with lidocaine. The toxicity of co-administered local anesthetics is thought to be at least additive. Cardiovascular manifestations may include bradycardia, hypotension and cardiovascular collapse leading to arrest.

7. Drug Interactions

7.1 Antiarrhythmic Drugs

Lidocaine and tetracaine cream should be used with caution in patients receiving Class I antiarrhythmic drugs (such as tocainide and mexiletine) since the systemic toxic effects are thought to be additive and potentially synergistic with lidocaine and tetracaine.

7.2 Local Anesthetics

When lidocaine and tetracaine cream is used concomitantly with other products containing local anesthetic agents, the amount absorbed from all formulations should be considered since the systemic toxic effects are thought to be additive and potentially synergistic with lidocaine and tetracaine.

7.3 Drugs That May Cause Methemoglobinemia When Used with Lidocaine and Tetracaine Cream

Patients who are administered local anesthetics are at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics:

Examples of Drugs Associated with Methemoglobinemia:

ClassExamples
Nitrates/Nitritesnitric oxide, nitroglycerin, nitroprusside, nitrous oxide
Local anestheticsarticaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine
Antineoplastic agentscyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase
Antibioticsdapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides
Antimalarialschloroquine, primaquine
Anticonvulsantsphenobarbital, phenytoin, sodium valproate
Other drugsacetaminophen, metoclopramide, quinine, sulfasalazine

8. Use In Specific Populations

8.1 Pregnancy

Risk Summary

There are no available data on lidocaine and tetracaine cream use in pregnant women to determine a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Available data from an epidemiologic study and case series with parenteral lidocaine use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. Published data on tetracaine use in pregnant women are not sufficient to determine any drug-associated risks. The amount of lidocaine and tetracaine systemically absorbed from lidocaine and tetracaine cream is low compared to the parenteral route of administration and is not expected to result in significant fetal exposure. Systemic exposure of lidocaine and tetracaine cream is directly related to both the duration of application and the surface area over which it is applied [see Clinical Pharmacology (12.3)].

In a published animal reproduction study, pregnant rats administered lidocaine by continuous subcutaneous infusion at doses approximately 1.3 times the maximum recommended human dose (MRHD) of 53 grams of lidocaine and tetracaine cream during the period of organogenesis resulted in lower fetal body weights. In a published animal reproduction study, pregnant rats administered lidocaine, containing 1:100,000 epinephrine, injected into the masseter muscle of the jaw or into the gum of the lower jaw on Gestation Day 11 at 0.02 times the MRHD of lidocaine and tetracaine cream resulted in developmental delays in neonates. Subcutaneous administration of tetracaine to pregnant rats and rabbits during organogenesis did not produce adverse embryofetal effects at 0.03 times the MRHD of lidocaine and tetracaine cream (see Data) .

The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.

Data

Animal Data

Lidocaine administered by subcutaneous injection to pregnant rats during organogenesis was not teratogenic at doses up to 60 mg/kg (0.16 times the level of lidocaine contained in the MRHD of 53 grams of lidocaine and tetracaine cream based on a mg/m 2 body surface area (BSA) comparison). Lidocaine administered by subcutaneous injection to pregnant rabbits during organogenesis was not teratogenic at doses up to 15 mg/kg (0.08 times the level of lidocaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis).

In a published study, lidocaine administered to pregnant rats by continuous subcutaneous infusion during the period of organogenesis at 100, 250, and 500 mg/kg/day, did not produce any structural abnormalities, but did result in lower fetal weights at 500 mg/kg/day dose (approximately 1.3 times the level of lidocaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis) in the absence of maternal toxicity.

Tetracaine administered by subcutaneous injection to pregnant rats during organogenesis was not teratogenic at doses up to 10 mg/kg or in rabbits at doses up to 5 mg/kg (equivalent to 0.03 times of tetracaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis).

Lidocaine and tetracaine administered by subcutaneous injection to pregnant rats during organogenesis as a 1:1 eutectic mixture of 10 mg/kg each (equivalent to 0.03 times the active components in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis) was not teratogenic. Lidocaine and tetracaine by subcutaneous injection to pregnant rabbits during organogenesis as a 1:1 eutectic mixture of 5 mg/kg each was not teratogenic in rabbits (equivalent to 0.03 times the active components in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis).

Lidocaine containing 1:100,000 epinephrine at a dose of 6 mg/kg (approximately 0.02 times the level of lidocaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis) injected into the masseter muscle of the jaw or into the gum of the lower jaw of pregnant Long-Evans hooded rats on Gestation Day 11, lead to developmental delays in neonatal behavior among offspring. Developmental delays were observed for negative geotaxis, static righting reflex, visual discrimination response, sensitivity and response to thermal and electrical shock stimuli, and water maze acquisition. The developmental delays of the neonatal animals were transient with responses becoming comparable to untreated animals later in life. The clinical relevance of the animal data is uncertain.

Pre- and post-natal maturational, behavioral, or reproductive development was not affected by maternal subcutaneous administration of tetracaine during gestation (Gestation Day 6 to Post-Partum Day 20) and lactation up to doses of 7.5 mg/kg (equivalent to 0.02 times the level of tetracaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis).

12. Lidocaine and Tetracaine Cream - Clinical Pharmacology

12.3 Pharmacokinetics

Absorption: The amount of lidocaine and tetracaine systemically absorbed from lidocaine and tetracaine cream is directly related to both the duration of application and the surface area over which it is applied, Table 2.

Application of 59 g of lidocaine and tetracaine cream over 400 cm 2 (62 inch 2) for up to 120 minutes to adults produces peak plasma concentrations of lidocaine of 220 ng/mL.

Tetracaine plasma levels were not measurable (<0.9 ng/mL). Systemic exposure to lidocaine, as measured by C max and AUC 0-24, was proportional to the application area, and increased with application time up to 60 minutes.

Table 2. Absorption of lidocaine and tetracaine following application of lidocaine and tetracaine cream
Lidocaine and Tetracaine Cream (g)Area
(cm 2) 		Age Range
(yr) 		nApplication Time (min)Drug Content
(g) 		Mean C max
(ng/mL) 		Mean T max
(hr)
na=not applicable
400 cm 2 = approximately 62 inch 2
2140018-64430Lidocaine, 1.5494.0
Tetracaine, 1.5<0.9na
3340018-64460Lidocaine, 2.3962.8
Tetracaine, 2.3<0.9na
31400≤ 65660Lidocaine, 2.2483.8
Tetracaine, 2.2<0.9na

Distribution: When lidocaine is administered intravenously to healthy volunteers, the steady-state volume of distribution is approximately 0.8 to 1.3 L/kg. At lidocaine concentrations observed following the recommended product application, approximately 75% of lidocaine is bound to plasma proteins, primarily alpha-1-acid glycoprotein. At much higher plasma concentrations (1 to 4 mg/mL of free base) the plasma protein binding of lidocaine is concentration dependent. Lidocaine crosses the placental and blood brain barriers, presumably by passive diffusion. CNS toxicity may typically be observed around 5000 ng/mL of lidocaine; however, a small number of patients reportedly may show signs of toxicity at approximately 1000 ng/mL [ see Overdosage (10)]. Volume of distribution and protein binding have not been determined for tetracaine due to rapid hydrolysis in plasma.

Metabolism: It is not known if lidocaine or tetracaine is metabolized in the skin. Lidocaine is metabolized rapidly by the liver to a number of metabolites, including monoethylglycinexylidide (MEGX) and glycinexylidide (GX), both of which have pharmacologic activity similar to, but less potent than that of lidocaine. The major metabolic pathway of lidocaine, sequential N-deethylation to MEGX and GX, is primarily mediated by CYP1A2 with a minor role of CYP3A4. The metabolite, 2,6- xylidine, has unknown pharmacologic activity. Following intravenous administration of lidocaine, MEGX and GX concentrations in serum range from 11% to 36% and from 5% to 11% of lidocaine concentrations, respectively. Serum concentrations of MEGX were about one-third the serum lidocaine concentrations.

Tetracaine undergoes rapid hydrolysis by plasma esterases. Primary metabolites of tetracaine include para-aminobenzoic acid and diethylaminoethanol, both of which have an unspecified activity.

Elimination: The half-life of lidocaine elimination from the plasma following intravenous administration is approximately 1.8 hr. Lidocaine and its metabolites are excreted by the kidneys. More than 98% of an absorbed dose of lidocaine can be recovered in the urine as metabolites or parent drug. Less than 10% of lidocaine is excreted unchanged in adults, and approximately 20% is excreted unchanged in neonates. The systemic clearance is approximately 8 to 10 mL/min/kg. During intravenous studies, the elimination half-life of lidocaine was statistically significantly longer in elderly patients (2.5 hours) than in younger patients (1.5 hours). The half-life and clearance for tetracaine has not been established for humans, but hydrolysis in the plasma is rapid.

Special Populations

Elderly: After application of 31g of lidocaine and tetracaine cream over 400 cm 2 (62 inch 2) for 60 minutes, mean peak plasma levels of lidocaine were 48 ng/mL for elderly patients (>65 years of age, mean 68.0 ± 3.2 years, n = 6). These levels are similar to or lower than those for younger patients receiving similar amounts of lidocaine and tetracaine cream.

Cardiac, Renal and Hepatic Impairment: No specific pharmacokinetic studies were conducted. The half-life of lidocaine may be increased in patients with cardiac or hepatic dysfunction. There is no established half-life for tetracaine due to rapid hydrolysis in the plasma.

13. Nonclinical Toxicology

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenesis: Long-term studies in animals have not been performed to evaluate the carcinogenic potential of either lidocaine or tetracaine.

Mutagenesis: The mutagenic potential of lidocaine base and tetracaine base has been determined in the in vitro Ames bacterial reverse mutation assay, the in vitro chromosome aberration assay using Chinese hamster ovary cells, and the in vivo mouse micronucleus assay. Lidocaine was negative in all three assays. Tetracaine was negative in the in vitro Ames assay and the in vivo mouse micronucleus assay. In the in vitro chromosome aberration assay, tetracaine was negative in the absence of metabolic activation, and equivocal in the presence of metabolic activation.

Impairment of Fertility: Lidocaine did not affect fertility in female rats when given via continuous subcutaneous infusion via osmotic minipumps up to doses of 250 mg/kg/day (0.66 times the level of lidocaine in the MRHD of lidocaine and tetracaine cream based on a mg/m 2 body surface area comparison). Lidocaine treatment did not affect overall fertility in male rats when given as subcutaneous doses up to 60 mg/kg (0.16 times the level of lidocaine contained in the MRHD of lidocaine and tetracaine cream based on a mg/m 2 basis), although the treatment caused an increased copulatory interval and led to a dose-related decrease in homogenization resistant sperm head count, daily sperm production, and spermatogenic efficiency. Tetracaine did not affect fertility in male or female rats when given as subcutaneous doses up to 7.5 mg/kg (equivalent to 0.04 times the level of tetracaine in the MRHD of lidocaine and tetracaine cream on a mg/m 2 basis).

Distributed by: Innovida Pharmaceutique Corporation, Charleston, WV 25301

Made in Canada
Revised: April 2019
LPK-8646-3
40

Instructions for Use

Lidocaine (lye' doe kane)
and Tetracaine
(te' tra kane) Cream

Read and follow this Instructions for Use before applying lidocaine and tetracaine cream.

Lidocaine and tetracaine cream is a prescription medicine used on adults to numb your skin to reduce the pain associated with medical procedures on the skin. After lidocaine and tetracaine cream is applied to your skin, it will form a film (or mask) that is removed before your procedure.

Important Information:

  • Keep lidocaine and tetracaine cream out of the reach of children and away from pets.
  • Do not apply lidocaine and tetracaine cream to skin that is broken, cut, scratched, irritated (red) or has a rash.
  • Do not apply lidocaine and tetracaine cream to a procedure site after the procedure has been performed.
  • Do not use more lidocaine and tetracaine cream than prescribed.
  • Do not leave lidocaine and tetracaine cream on your skin for longer than 120 minutes (2 hours).
  • Avoid getting lidocaine and tetracaine cream in your eyes or on your lips. If contact occurs, rinse immediately with water and if irritation occurs, seek medical advice.
  • Always wash your hands after handling lidocaine and tetracaine cream.
  • Do not cover lidocaine and tetracaine cream with waterproof (occlusive) dressing or overdosage may occur.
  • Store lidocaine and tetracaine cream in the refrigerator. Lidocaine and tetracaine cream may be stored at room temperature for up to 3 months.

Step 1: Check the skin where the cream will be applied.

  • Check the skin area to be treated to make sure the skin is intact.
  • Read and follow Important Information notices in grey box above.

Step 2: Estimate the amount of lidocaine and tetracaine cream to apply.

  • Apply lidocaine and tetracaine cream exactly as your healthcare provider tells you to. Your healthcare provider will tell you the area to be treated, when to apply the cream, and how long to leave it on your skin.
  • Estimate the area of the skin to be treated and the amount of lidocaine and tetracaine cream to apply using the table below and the ruler on the applicator included in the carton. Break the cream length into smaller segments that fit inside the treatment area.
Approximate size of area to be treatedLength of cream (inches) based on 30-gram tube
1 inch × 1 inch¾ inch
2 inches × 2 inches3 inches
2 inches × 3 inches (size of a credit card)5 inches
3 inches × 5 inches (size of a 3 inch × 5 inch photo)12 inches (½ tube)
4 inches × 6 inches (size of a 4 inch × 6 inch postcard)18 inches (⅔ tube)
Half of your face1 tube
6 inches × 8 inches (size of two 4 inch × 6 inch postcards) 1½ tubes
Full face2 tubes

Step 3: Open the tube and apply lidocaine and tetracaine cream to your skin.

  • Open the tube by pushing down the cap while turning counter-clockwise.
  • Using the table above and the ruler on the applicator included in the carton as a guide, squeeze out the amount of lidocaine and tetracaine cream needed for your prescribed dose directly onto your treatment area.
  • Put the cap back on tightly.
  • Using the applicator included in the carton, spread lidocaine and tetracaine cream in an even white layer, about the thickness of a dime, over the treatment area.
  • If you get lidocaine and tetracaine cream on an area you do not intend to cover, wash the cream from that area.
  • Do not rub lidocaine and tetracaine cream into your skin.
  • Do not touch lidocaine and tetracaine cream after application. Let it air dry.
  • Wash your hands.
Figure
Figure
Figure
Figure

Step 4: Leave lidocaine and tetracaine cream on your skin for the recommended time.

  • Your healthcare provider will tell you how long to leave lidocaine and tetracaine cream on your skin. Ask your healthcare provider if you are not sure how long to leave lidocaine and tetracaine cream on your skin.
  • If skin irritation or a burning sensation happens after applying lidocaine and tetracaine cream, remove the lidocaine and tetracaine cream right away. Wash the cream off with soap and water. Tell your healthcare provider if your skin irritation does not go away.

Step 5: Remove and throw away (discard) the dried lidocaine and tetracaine cream.

  • After leaving lidocaine and tetracaine cream on your skin the recommended amount of time, carefully peel the dried cream off your skin starting at the edges, wipe off any excess cream with a tissue or paper towel, and then throw it all away in the household trash.
  • Wash your hands after removing or touching lidocaine and tetracaine cream.
  • The treated area of your skin may be numb up to 9 hours.
  • Be careful with the treated skin area.
    Do not scratch the treated skin area. Keep the treated skin area protected from extreme heat or cold until sensation returns.

Figure
Figure
Figure
Figure

Step 6: Clean and Store Applicator

  • Wash the applicator with soap and water to remove any lidocaine and tetracaine cream remaining on the applicator.
  • Dry the applicator.
  • Store the applicator in the carton with the tube of lidocaine and tetracaine cream for future use.
FigureFigure

This Instructions for Use has been approved by the U.S. Food and Drug Administration
Issued: 04/2019

LIDOCAINE AND TETRACAINE
lidocaine and tetracaine cream
Product Information
Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:71800-631
Route of AdministrationTOPICAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
LIDOCAINE (UNII: 98PI200987) (LIDOCAINE - UNII:98PI200987) LIDOCAINE70 mg in 1 g
TETRACAINE (UNII: 0619F35CGV) (TETRACAINE - UNII:0619F35CGV) TETRACAINE70 mg in 1 g
Inactive Ingredients
Ingredient NameStrength
ANHYDROUS DIBASIC CALCIUM PHOSPHATE (UNII: L11K75P92J)
METHYLPARABEN (UNII: A2I8C7HI9T)
PETROLATUM (UNII: 4T6H12BN9U)
POLYVINYL ALCOHOL, UNSPECIFIED (UNII: 532B59J990)
PROPYLPARABEN (UNII: Z8IX2SC1OH)
WATER (UNII: 059QF0KO0R)
SORBITAN MONOPALMITATE (UNII: 77K6Z421KU)
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:71800-631-151 in 1 CARTON12/11/201804/30/2021
130 g in 1 TUBE; Type 0: Not a Combination Product
2NDC:71800-631-044 in 1 CARTON04/18/2018
230 g in 1 TUBE; Type 0: Not a Combination Product
3NDC:71800-631-088 in 1 CARTON04/18/2018
330 g in 1 TUBE; Type 0: Not a Combination Product
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
NDA authorized genericNDA02171705/03/2017
Labeler - Innovida Pharmaceutique Corporation (080892908)

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