Drugs List

Therapeutic Indications

Uses

Symptomatic relief of post-herpetic neuralgia after lesions have healed

Contraindications

Children under 18 years

Precautions and Warnings

Breastfeeding
Pregnancy
Severe cardiac dysfunction
Severe hepatic impairment
Severe renal impairment

Contains hydroxybenzoate
Contains propylene glycol: may cause irritation
Avoid broken or inflamed skin
Avoid contact with eyes
Avoid contact with mucous membranes
Reassess need for continued treatment at regular intervals

The affected area must have a plaster-free interval for at least 12 hours.

Treatment should be discontinued if there is no response to therapy after 2 to 4 weeks.

Pregnancy and Lactation

Pregnancy

Use lidocaine with caution in pregnancy.

At the time of writing there is limited published information regarding the use of lidocaine medicated plasters during pregnancy in humans. Lidocaine does cross the placenta, however animal studies have not shown any teratogenic effects when used in pregnancy, even at doses greater than six times the recommended human dose (Briggs et al, 2015).

The manufacturer suggests to only administer lidocaine in pregnancy if clearly necessary.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use lidocaine with caution in breastfeeding.

At the time of writing there is limited published information regarding the use of lidocaine medicated plasters during breastfeeding. Lidocaine is excreted in breast milk, however it is readily metabolised therefore only small insignificant quantities of lidocaine is expected to be excreted.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Application site reaction
Burning sensation (local)
Dermatitis
Erythema at application site
Hypersensitivity reactions
Pruritus
Rash
Skin irritation
Skin lesions
Vesicles

Presentation

Medicated plaster containing lidocaine.

Drugs List

Therapeutic Indications

Uses

Symptomatic relief of post-herpetic neuralgia after lesions have healed

Dosage

Adults

Contraindications

Children under 18 years

Precautions and Warnings

Breastfeeding
Pregnancy
Severe cardiac dysfunction
Severe hepatic impairment
Severe renal impairment

Contains hydroxybenzoate
Contains propylene glycol: may cause irritation
Avoid broken or inflamed skin
Avoid contact with eyes
Avoid contact with mucous membranes
Reassess need for continued treatment at regular intervals

The affected area must have a plaster-free interval for at least 12 hours.

Treatment should be discontinued if there is no response to therapy after 2 to 4 weeks.

Pregnancy and Lactation

Pregnancy

Use lidocaine with caution in pregnancy.

At the time of writing there is limited published information regarding the use of lidocaine medicated plasters during pregnancy in humans. Lidocaine does cross the placenta, however animal studies have not shown any teratogenic effects when used in pregnancy, even at doses greater than six times the recommended human dose (Briggs et al, 2015).

The manufacturer suggests to only administer lidocaine in pregnancy if clearly necessary.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use lidocaine with caution in breastfeeding.

At the time of writing there is limited published information regarding the use of lidocaine medicated plasters during breastfeeding. Lidocaine is excreted in breast milk, however it is readily metabolised therefore only small insignificant quantities of lidocaine is expected to be excreted.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Application site reaction
Burning sensation (local)
Dermatitis
Erythema at application site
Hypersensitivity reactions
Pruritus
Rash
Skin irritation
Skin lesions
Vesicles

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Versatis Medicated Plaster. Grunenthal Ltd. Revised November 2014.

Summary of Product Characteristics: Ralvo 700mg Medicated Plaster. Grunenthal Ltd. Revised February 2017.#

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 June 2017