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Description
Emla cream is used as a surface anesthesia for vaccinations and other injections, minor surgery, and catheterization of blood vessels. It is also used for various cosmetic procedures, for example, for epilation, biorevitalization, peeling, mesotherapy, botulinum therapy, during the performance of permanent makeup and tattoo, facial contour correction.
Active ingredients
Lidocaine + Prilocaine
Release form
Cream
Pharmacological effect
Preparation for surface anesthesia of the skin and mucous membranes. The action of the drug is provided by its constituent components - lidocaine and prilocaine, which are local anesthetics of the amide type. Local anesthetics, penetrating into the layers of the epidermis and dermis, cause anesthesia of the skin. The degree of anesthesia depends on the dose of the drug and the duration of application. After applying the cream on the intact skin for 1-2 hours, the duration of anesthesia after removing the occlusive dressing is 2 hours. During puncture biopsy, use of the cream Emla provides adequate anesthesia to intact skin in 90% of patients 60 minutes after application. Anesthesia of the mucous membrane of the genital organs is achieved faster than intact skin, due to more rapid absorption of the drug. In women, anesthesia is achieved 5-10 minutes after applying Emla cream on the mucous membrane of the genital organs, sufficient to relieve pain caused by the use of an argon laser, the duration of anesthesia is 15-20 minutes (taking into account individual characteristics from 5 to 45 minutes). trophic ulcers of the lower extremities, the duration of anesthesia after the application of the cream is up to 4 hours. There is no negative effect of the drug on the healing process of the ulcers or in relation to the bacterial flora.
Pharmacokinetics
Systemic absorption of the cream depends on the dose, duration of application and thickness of the skin (depends on the area of the body), as well as other skin characteristics. In adults, after applying 60 g of cream to the intact skin of the thigh 400 cm2 (0.2 g per 10 cm2) by 3 h systemic absorption of lidocaine is approximately 3%, prilocaine - 5%. Absorbed slowly. Cmax of lidocaine and prilocaine in the blood plasma was reached after about 4 hours from the moment of applying the cream and was 0.12 mcg / ml for lidocaine and 0.07 mcg / ml for prilocaine. When treating trophic ulcers of the lower extremities, Cmax reaches lidocaine (0.05-0.84 mcg / ml) and prilocain (0.02-0.8 mcg / ml) in the blood plasma is 1-2.5 hours from the moment of application of the drug on the ulcer surface (5-10 g of cream for 30 minutes).With repeated application of the cream to the ulcer surface, cumulation of prilocaine, lidocaine and their metabolites is not observed. When applying the cream on the mucous membrane of the genital organs, the time to reach Cmax of lidocaine and prilocaine (0.18 μg / ml and 1.15 μg / ml, respectively) is approximately 35 minutes after application drug on the mucous membrane of the vagina (10 g of cream for 10 minutes). Pharmacokinetics in special clinical situations in patients with common neurodermatitis, the rate of absorption increases.
Indications
Surface anesthesia: - skin for punctures and catheterization of vessels and superficial surgical interventions, - trophic ulcers of the lower extremities during surgical treatment (mechanical cleaning), - mucous membrane of the genital organs before carrying out painful manipulations and for anesthesia before injections of local anesthetics.
Contraindications
- hypersensitivity to local anesthetics of the amide type or any other component of the drug, - premature newborns born with a gestational age of less than 37 weeks, - newborns weighing less than 3 kg.
Precautionary measures
Care should be taken when applying Emla cream near the eyes, because the drug irritates the cornea.
Use during pregnancy and lactation
Emla may be used during pregnancy and lactation if indicated and in recommended doses. Lidocaine and prilocaine are excreted in breast milk in amounts that do not pose a risk to the infant.
Dosage and administration
Externally, on the skin or mucous membrane. The cream is applied under the occlusive dressing (available in the package) at least 1 hour before the procedure begins, the time of application is recorded on the dressing, and after removing the dressing, wipe the remnants of the cream with ethanol. For anesthesia of the skin: for adults (for carrying out "small" procedures) apply 1.5 g / 10 sq. cm for 1-5 h, on large surfaces - 1.5-2 g / 10 sq. cm for 2-5 h, for children from 3 to 11 months up to 1 g / 20 sq. cm Children older than 1 year - 1 g / 10 sq. Cm. Anesthesia of the genital organs - 5-10 g of cream for 5-10 minutes (without a tight dressing).
Side effects
Local reactions: often (> 1%) - pallor, hyperemia and swelling at the site of application of the drug (due to the effect on the superficial vessels), sometimes (<1% -> 0.1%) - slight burning and itching immediately after applying the drug,rarely (<0.1%) - hemorrhagic rash or point hemorrhages, especially after prolonged use in children with common neurodermatitis or molluscum contagiosum. Systemic reactions: rarely (<0.1%) - allergic reactions (in severe cases - anaphylactic shock), methemoglobinemia in children .
Overdose
Symptoms: excitation of the central nervous system, in severe cases - depression of the central nervous system and cardiac activity. In some cases, children developed a clinically significant methemoglobinemia. The administration of 125 mg of prilocain for a period of 5 hours caused the development of moderate methemoglobinemia in a three-month-old baby. The application of lidocaine at a dose of 8.6-17.2 mg / kg caused severe intoxication in the newborn. Treatment: the non-absorbed part of the preparation should be removed from the skin surface. If symptoms arise from the central nervous system (convulsions, depression of the central nervous system), symptomatic therapy is indicated, including the appointment of anticonvulsant therapy and, if necessary, mechanical ventilation. With the development of methemoglobinemia, methylene blue should be used as an antidote. It is necessary to ensure observation of the patient within a few hours after the start of treatment of intoxication due to the slow systemic absorption of the components of the drug.
Interaction with other drugs
With simultaneous use of the drug "Emla" with other local anesthetics and structurally similar drugs with them (including tocainide), the risk of systemic side effects may increase. With simultaneous use of the drug "Eml" and with drugs that induce the development of methemoglobinemia, drugs, containing sulfo group, it is possible to increase the concentration of methemoglobin in the blood.
special instructions
Do not use the cream if it can penetrate into the middle ear. Do not apply the cream on open wounds. Use in pediatrics In children under 3 months of age, the safety and effectiveness of Emla cream is determined after applying a single dose. In children of this age, after applying the cream, a temporary increase in the concentration of methemoglobin in the blood of up to 13 hours can be observed, which has no clinical significance. The effectiveness of the cream in newborns during the heel blood sampling procedure has not been established.