EMLA - Comprehensive Usage Guide: instructions, indications, composition, side effects

Active Ingredients: Lidocaine 2.5% and Prilocaine 2.5%

Excipients: May include carbomer, sodium hydroxide, polyoxyethylene hydrogenated castor oil, purified water, and other inactive ingredients depending on the formulation.

EMLA cream is available in various formulations, including:

• Tubes: Available in sizes such as 5 g and 30 g.
• Patches: Available in various sizes and configurations, typically containing a single-use application.

EMLA belongs to the pharmacological group of local anesthetics (ATC code: N01B B20).

• Pharmacodynamics: EMLA cream contains lidocaine and prilocaine, which are local anesthetics. When applied to the skin, these agents penetrate the epidermis and dermis, where they block nerve impulses by inhibiting sodium ion influx through cell membranes, thereby producing local anesthesia.
• Pharmacokinetics: Lidocaine and prilocaine are absorbed systemically to a minimal extent when applied to intact skin. The onset of action is typically within 1 hour, and the duration of anesthesia varies depending on factors such as application site and duration.

EMLA cream is indicated for:

• Topical anesthesia of the skin prior to needle insertion (e.g., venipuncture, intravenous cannulation, vaccination), superficial surgical procedures, and laser therapy.
• Topical anesthesia of genital mucosa in adults prior to minor surgical procedures (e.g., circumcision, removal of genital warts) or for relief of pain associated with conditions such as genital herpes and genital mucosal abrasions.

EMLA cream is contraindicated in individuals with a known history of hypersensitivity to lidocaine, prilocaine, or any component of the formulation, as well as those with methemoglobinemia or glucose-6-phosphate dehydrogenase (G6PD) deficiency. It should not be used on open wounds or mucous membranes with pre-existing irritation or inflammation.

EMLA cream may interact with other medications, particularly those that prolong the QT interval (e.g., class III antiarrhythmics, certain antibiotics, antipsychotics), potentially increasing the risk of systemic toxicity. Caution is advised when using EMLA cream concomitantly with such drugs.

EMLA cream should be applied in a thick layer to the intact skin surface intended for anesthesia and covered with an occlusive dressing to enhance absorption and efficacy. The application time varies depending on the procedure and site but typically ranges from 30 minutes to 2 hours. After removal of the cream, the treated area will be anesthetized for a period of time suitable for the planned procedure.

EMLA cream should be used with caution during pregnancy and breastfeeding, weighing the potential benefits against the risks to the fetus or infant. Limited data are available on the use of EMLA in pregnant or lactating women.

EMLA cream does not typically impair motor function when used as directed. However, patients should be advised to avoid accidental trauma or injury to the anesthetized area until sensation returns fully.

The dosage and administration of EMLA cream should be individualized based on the patient’s age, weight, medical condition, and the planned procedure. Healthcare providers will determine the appropriate application time and technique to achieve adequate anesthesia.

Systemic toxicity from EMLA cream is rare but may occur with excessive or prolonged application, particularly in infants and small children. Symptoms of lidocaine and prilocaine toxicity include central nervous system depression, seizures, cardiovascular collapse, and methemoglobinemia. Treatment is supportive and may include oxygen therapy, methylene blue administration, and cardiac monitoring.

Common side effects of EMLA cream may include transient skin reactions at the application site, such as erythema, edema, or blanching. Systemic adverse effects are rare but may occur, particularly with large doses or prolonged application.

EMLA cream should be stored at room temperature (15-30°C) in a dry place, protected from light and moisture. Tubes should be tightly closed when not in use. Check the expiration date on the packaging and discard any expired or unused medication.

These extended instructions provide comprehensive information on the composition, pharmacological properties, indications, contraindications, interactions, administration, side effects, storage, and usage of EMLA cream, aiding healthcare professionals and patients in safe and effective topical anesthesia. Always consult a healthcare provider for personalized medical advice.