LIDODERM- lidocaine patch

United States - English - NLM (National Library of Medicine)

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Active ingredient:
LIDOCAINE (UNII: 98PI200987) (LIDOCAINE - UNII:98PI200987)
Available from:
Lake Erie Medical DBA Quality Care Products LLC
INN (International Name):
LIDOCAINE
Composition:
LIDOCAINE 50 mg in 1 g
Administration route:
CUTANEOUS
Prescription type:
PRESCRIPTION DRUG
Therapeutic indications:
LIDODERM is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type, or to any other component of the product.
Product summary:
LIDODERM (lidocaine patch 5%) is available as the following: Carton of 30 patches, packaged into individual child-resistant envelopes NDC 49999-419-30 Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F). [See USP Controlled Room Temperature]. For more information, call Endo Pharmaceuticals at 1-800-462-3636. Manufactured for: Endo Pharmaceuticals Inc. Malvern, PA 19355 LIDODERM® is a registered trademark of Hind Health Care, Inc. © 2015 Endo Pharmaceuticals Inc.  All rights reserved. 114957 / January 2015
Authorization status:
New Drug Application
Authorization number:
49999-419-30

LIDODERM- lidocaine patch

Lake Erie Medical DBA Quality Care Products LLC

----------

LIDODERM®

(Lidocaine Patch 5%)

R only

DESCRIPTION

LIDODERM (lidocaine patch 5%) is comprised of an adhesive material containing 5% lidocaine, which

is applied to a non-woven polyester felt backing and covered with a polyethylene terephthalate (PET)

film release liner. The release liner is removed prior to application to the skin. The size of the patch is

10 cm × 14 cm.

Lidocaine is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl), has an

octanol: water partition ratio of 43 at pH 7.4, and has the following structure:

Each adhesive patch contains 700 mg of lidocaine (50 mg per gram adhesive) in an aqueous base. It also

contains the following inactive ingredients: dihydroxyaluminum aminoacetate, disodium edetate, gelatin,

glycerin, kaolin, methylparaben, polyacrylic acid, polyvinyl alcohol, propylene glycol, propylparaben,

sodium carboxymethylcellulose, sodium polyacrylate, D-sorbitol, tartaric acid, and urea.

CLINICAL PHARMACOLOGY

Pharmacodynamics

Lidocaine is an amide-type local anesthetic agent and is suggested to stabilize neuronal membranes by

inhibiting the ionic fluxes required for the initiation and conduction of impulses.

The penetration of lidocaine into intact skin after application of LIDODERM is sufficient to produce an

analgesic effect, but less than the amount necessary to produce a complete sensory block.

Pharmacokinetics

AbsorptionThe amount of lidocaine systemically absorbed from LIDODERM is directly related to both

the duration of application and the surface area over which it is applied. In a pharmacokinetic study,

three LIDODERM patches were applied over an area of 420 cm of intact skin on the back of normal

volunteers for 12 hours. Blood samples were withdrawn for determination of lidocaine concentration

x

during the application and for 12 hours after removal of patches. The results are summarized in Table 1.

Table 1

Absorption of lidocaine from LIDODERM

Normal volunteers (n = 15, 12-hour wearing time)

LIDODERM Patch Application Site

Area

(cm )

Dose Absorbed (mg)

C

(µg/mL)

T

(hr)

3 patches

(2100 mg)

Back

64 ± 32

0.13 ± 0.06 11 hr

When LIDODERM is used according to the recommended dosing instructions, only 3 ± 2% of the dose

applied is expected to be absorbed. At least 95% (665 mg) of lidocaine will remain in a used patch.

Mean peak blood concentration of lidocaine is about 0.13 µg/mL (about 1/10 of the therapeutic

concentration required to treat cardiac arrhythmias). Repeated application of three patches

simultaneously for 12 hours (recommended maximum daily dose), once per day for three days, indicated

that the lidocaine concentration does not increase with daily use. The mean plasma pharmacokinetic

profile for the 15 healthy volunteers is shown in Figure 1.

Figure 1

Mean lidocaine blood concentrations after three consecutive daily applications of three LIDODERM

patches simultaneously for 12 hours per day in healthy volunteers (n = 15).

Distribution

When lidocaine is administered intravenously to healthy volunteers, the volume of distribution is 0.7 to

2

max

max

2.7 L/kg (mean 1.5 ± 0.6 SD, n = 15). At concentrations produced by application of LIDODERM,

lidocaine is approximately 70% bound to plasma proteins, primarily alpha-1-acid glycoprotein. At much

higher plasma concentrations (1 to 4 µg/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.

Metabolism

It is not known if lidocaine 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. A minor metabolite,

2,6-xylidine, has unknown pharmacologic activity but is carcinogenic in rats. The blood concentration

of this metabolite is negligible following application of LIDODERM (lidocaine patch 5%). Following

intravenous administration, MEGX and GX concentrations in serum range from 11 to 36% and from 5 to

11% of lidocaine concentrations, respectively.

Excretion

Lidocaine and its metabolites are excreted by the kidneys. Less than 10% of lidocaine is excreted

unchanged. The half-life of lidocaine elimination from the plasma following IV administration is 81 to

149 minutes (mean 107 ± 22 SD, n = 15). The systemic clearance is 0.33 to 0.90 L/min (mean 0.64 ±

0.18 SD, n = 15).

CLINICAL STUDIES

Single-dose treatment with LIDODERM was compared to treatment with vehicle patch (without

lidocaine), and to no treatment (observation only) in a double-blind, crossover clinical trial with 35 post-

herpetic neuralgia patients. Pain intensity and pain relief scores were evaluated periodically for 12

hours. LIDODERM performed statistically better than vehicle patch in terms of pain intensity from 4 to

12 hours.

Multiple-dose, two-week treatment with LIDODERM was compared to vehicle patch (without

lidocaine) in a double-blind, crossover clinical trial of withdrawal-type design conducted in 32 patients,

who were considered as responders to the open-label use of LIDODERM prior to the study. The

constant type of pain was evaluated but not the pain induced by sensory stimuli (dysesthesia).

Statistically significant differences favoring LIDODERM were observed in terms of time to exit from

the trial (14 versus 3.8 days at p-value <0.001), daily average pain relief, and patient's preference of

treatment. About half of the patients also took oral medication commonly used in the treatment of post-

herpetic neuralgia. The extent of use of concomitant medication was similar in the two treatment groups.

INDICATION AND USAGE

LIDODERM is indicated for relief of pain associated with post-herpetic neuralgia. It should be applied

only to intact skin.

CONTRAINDICATIONS

LIDODERM is contraindicated in patients with a known history of sensitivity to local anesthetics of the

amide type, or to any other component of the product.

WARNINGS

Accidental Exposure in Children

Even a used LIDODERM patch contains a large amount of lidocaine (at least 665 mg). The potential

exists for a small child or a pet to suffer serious adverse effects from chewing or ingesting a new or

used LIDODERM patch, although the risk with this formulation has not been evaluated. It is important

for patients to store and dispose of LIDODERM out of the reach of children, pets and others. (See

HANDLING AND DISPOSAL)

Excessive Dosing

Excessive dosing by applying LIDODERM to larger areas or for longer than the recommended wearing

time could result in increased absorption of lidocaine and high blood concentrations, leading to serious

adverse effects (see ADVERSE REACTIONS, Systemic Reactions). Lidocaine toxicity could be

expected at lidocaine blood concentrations above 5 µg/mL. The blood concentration of lidocaine is

determined by the rate of systemic absorption and elimination. Longer duration of application,

application of more than the recommended number of patches, smaller patients, or impaired elimination

may all contribute to increasing the blood concentration of lidocaine. With recommended dosing of

LIDODERM, the average peak blood concentration is about 0.13 µg/mL, but concentrations higher than

0.25 µg/mL have been observed in some individuals.

PRECAUTIONS

General

Hepatic Disease

Patients with severe hepatic disease are at greater risk of developing toxic blood concentrations of

lidocaine, because of their inability to metabolize lidocaine normally.

Allergic Reactions

Patients allergic to para-aminobenzoic acid derivatives (procaine, tetracaine, benzocaine, etc.) have not

shown cross sensitivity to lidocaine. However, LIDODERM should be used with caution in patients

with a history of drug sensitivities, especially if the etiologic agent is uncertain.

Non-intact Skin

Application to broken or inflamed skin, although not tested, may result in higher blood concentrations of

lidocaine from increased absorption. LIDODERM is only recommended for use on intact skin.

External Heat Sources

Placement of external heat sources, such as heating pads or electric blankets, over LIDODERM patches

is not recommended as this has not been evaluated and may increase plasma lidocaine levels.

Eye Exposure

The contact of LIDODERM with eyes, although not studied, should be avoided based on the findings of

severe eye irritation with the use of similar products in animals. If eye contact occurs, immediately

wash out the eye with water or saline and protect the eye until sensation returns.

Drug Interactions

Antiarrhythmic Drugs

LIDODERM should be used with caution in patients receiving Class I antiarrhythmic drugs (such as

tocainide and mexiletine) since the toxic effects are additive and potentially synergistic.

Local Anesthetics

When LIDODERM is used concomitantly with other products containing local anesthetic agents, the

amount absorbed from all formulations must be considered.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenesis

A minor metabolite, 2,6-xylidine, has been found to be carcinogenic in rats. The blood concentration of

this metabolite is negligible following application of LIDODERM.

Mutagenesis

Lidocaine HCl is not mutagenic in Salmonella/mammalian microsome test nor clastogenic in

chromosome aberration assay with human lymphocytes and mouse micronucleus test.

Impairment of Fertility

The effect of LIDODERM on fertility has not been studied.

Pregnancy

Teratogenic Effects

Pregnancy Category B.

LIDODERM (lidocaine patch 5%) has not been studied in pregnancy. Reproduction studies with

lidocaine have been performed in rats at doses up to 30 mg/kg subcutaneously and have revealed no

evidence of harm to the fetus due to lidocaine. There are, however, no adequate and well-controlled

studies in pregnant women. Because animal reproduction studies are not always predictive of human

response, LIDODERM should be used during pregnancy only if clearly needed.

Labor and Delivery

LIDODERM has not been studied in labor and delivery. Lidocaine is not contraindicated in labor and

delivery. Should LIDODERM be used concomitantly with other products containing lidocaine, total

doses contributed by all formulations must be considered.

Nursing Mothers

LIDODERM has not been studied in nursing mothers. Lidocaine is excreted in human milk, and the

milk:plasma ratio of lidocaine is 0.4. Caution should be exercised when LIDODERM is administered to

a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

ADVERSE REACTIONS

Application Site Reactions

During or immediately after treatment with LIDODERM (lidocaine patch 5%), the skin at the site of

application may develop blisters, bruising, burning sensation, depigmentation, dermatitis, discoloration,

edema, erythema, exfoliation, irritation, papules, petechia, pruritus, vesicles, or may be the locus of

abnormal sensation. These reactions are generally mild and transient, resolving spontaneously within a

few minutes to hours.

Allergic Reactions

Allergic and anaphylactoid reactions associated with lidocaine, although rare, can occur. They are

characterized by angioedema, bronchospasm, dermatitis, dyspnea, hypersensitivity, laryngospasm,

pruritus, shock, and urticaria. If they occur, they should be managed by conventional means. The

detection of sensitivity by skin testing is of doubtful value.

Other Adverse Events

Due to the nature and limitation of spontaneous reports in postmarketing surveillance, causality has not

been established for additional reported adverse events including:

Asthenia, confusion, disorientation, dizziness, headache, hyperesthesia, hypoesthesia, lightheadedness,

metallic taste, nausea, nervousness, pain exacerbated, paresthesia, somnolence, taste alteration,

vomiting, visual disturbances such as blurred vision, flushing, tinnitus, and tremor.

Systemic (Dose-Related) Reactions

Systemic adverse reactions following appropriate use of LIDODERM are unlikely, due to the small

dose absorbed (see CLINICAL PHARMACOLOGY, Pharmacokinetics). Systemic adverse effects of

lidocaine are similar in nature to those observed with other amide local anesthetic agents, including

CNS excitation and/or depression (light headedness, nervousness, apprehension, euphoria, confusion,

dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations 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. Cardiovascular manifestations may include bradycardia, hypotension and

cardiovascular collapse leading to arrest.

OVERDOSAGE

Lidocaine overdose from cutaneous absorption is rare, but could occur. If there is any suspicion of

lidocaine overdose (see ADVERSE REACTIONS, Systemic Reactions), drug blood concentration

should be checked. The management of overdose includes close monitoring, supportive care, and

symptomatic treatment. Dialysis is of negligible value in the treatment of acute overdose with lidocaine.

In the absence of massive topical overdose or oral ingestion, evaluation of symptoms of toxicity should

include consideration of other etiologies for the clinical effects, or overdosage from other sources of

lidocaine or other local anesthetics.

The oral LD of lidocaine HCl is 459 (346-773) mg/kg (as the salt) in non-fasted female rats and 214

(159-324) mg/kg (as the salt) in fasted female rats, which are equivalent to roughly 4000 mg and 2000

mg, respectively, in a 60 to 70 kg man based on the equivalent surface area dosage conversion factors

between species.

DOSAGE AND ADMINISTRATION

Apply LIDODERM to intact skin to cover the most painful area. Apply the prescribed number of

patches (maximum of 3), only once for up to 12 hours within a 24 hour period. Patches may be cut into

smaller sizes with scissors prior to removal of the release liner. (See HANDLING AND DISPOSAL)

Clothing may be worn over the area of application. Smaller areas of treatment are recommended in a

debilitated patient, or a patient with impaired elimination.

If irritation or a burning sensation occurs during application, remove the patch(es) and do not reapply

until the irritation subsides.

When LIDODERM is used concomitantly with other products containing local anesthetic agents, the

amount absorbed from all formulations must be considered.

LIDODERM may not stick if it gets wet. Avoid contact with water, such as bathing, swimming or

showering.

HANDLING AND DISPOSAL

Hands should be washed after the handling of LIDODERM, and eye contact with LIDODERM should

be avoided. Do not store patch outside the sealed envelope. Apply immediately after removal from the

protective envelope. Fold used patches so that the adhesive side sticks to itself and safely discard used

patches or pieces of cut patches where children and pets cannot get to them. LIDODERM should be

kept out of the reach of children.

HOW SUPPLIED

LIDODERM (lidocaine patch 5%) is available as the following:

Carton of 30 patches, packaged into individual child-resistant envelopes

NDC 49999-419-30

Store at 25°C (77°F); excursions permitted to 15°-30°C (59°-86°F). [See USP Controlled Room

Temperature].

For more information, call Endo Pharmaceuticals at 1-800-462-3636.

Manufactured for:

Endo Pharmaceuticals Inc.

Malvern, PA 19355

LIDODERM is a registered trademark of Hind Health Care, Inc.

© 2015 Endo Pharmaceuticals Inc. All rights reserved.

114957 / January 2015

LIDODERM

lidocaine patch

Product Information

Product T ype

HUMAN PRESCRIPTION DRUG

Ite m Code (Source )

NDC:49 9 9 9 -419 (NDC:6 348 1-6 8 7)

Route of Administration

CUTANEOUS

Active Ingredient/Active Moiety

Ingredient Name

Basis of Strength

Stre ng th

LIDO CAINE (UNII: 9 8 PI20 0 9 8 7) (LIDOCAINE - UNII:9 8 PI20 0 9 8 7)

LIDOCAINE

50 mg in 1 g

Inactive Ingredients

Ingredient Name

Stre ng th

UREA (UNII: 8 W8 T178 47W)

EDETATE DISO DIUM (UNII: 7FLD9 1C8 6 K)

GELATIN (UNII: 2G8 6 QN327L)

Lake Erie Medical DBA Quality Care Products LLC

GLYCERIN (UNII: PDC6 A3C0 OX)

METHYLPARABEN (UNII: A2I8 C7HI9 T)

PO LYVINYL ALCO HO L, UNSPECIFIED (UNII: 532B59 J9 9 0 )

PRO PYLENE GLYCO L (UNII: 6 DC9 Q16 7V3)

PRO PYLPARABEN (UNII: Z8 IX2SC1OH)

CARBO XYMETHYLCELLULO SE SO DIUM (UNII: K6 79 OBS311)

TARTARIC ACID (UNII: W48 8 8 I119 H)

Packag ing

#

Item Code

Package Description

Marketing Start Date

Marketing End Date

1

NDC:49 9 9 9 -419 -30

30 in 1 CARTON

11/30 /20 0 5

1

1 g in 1 POUCH; Type 0 : No t a Co mbinatio n Pro duct

Marketing Information

Marke ting Cate gory

Application Numbe r or Monograph Citation

Marke ting Start Date

Marke ting End Date

NDA0 20 6 12

11/30 /20 0 5

Labeler -

Lake Erie Medical DBA Quality Care Products LLC (831276758)

Establishment

Name

Ad d re s s

ID/FEI

Busine ss Ope rations

Lake Erie Medical DBA Quality Care Pro ducts LLC

8 31276 758

re la be l(49 9 9 9 -419 )

Revised: 2/2019

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