Lmx 4% Plus Kit
It is used to manage pain.It is used to treat signs of hemorrhoids or rectal irritation. It may be given to you for other reasons. Talk with the doctor.
Drug Class
Local Anesthetic
Pharmacologic Class
Voltage-gated sodium channel blocker
Pregnancy Category
Category B
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
LMX 4% Plus Kit contains lidocaine, a medicine that numbs the skin. It works by temporarily blocking nerve signals in the area where it's applied, helping to relieve pain or discomfort before certain procedures or for minor skin irritations.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Adhere to the guidelines below for the specific type of product you are using.
Rectal Products:
1. Wash your hands before and after applying the medication.
2. Apply the medication to clean, dry skin as directed by your doctor or according to the package labeling.
Skin Products:
1. Do not ingest this medication. Use it only on your skin.
2. Avoid getting the medication in your mouth, nose, or eyes, as it may cause irritation. If accidental contact occurs, rinse the affected area thoroughly with water.
3. Wash your hands before and after applying the medication, unless your hand is the treated area, in which case you should not wash it after application.
4. Clean and dry the affected area before applying the medication.
5. Apply the medication to clean, dry, healthy skin.
6. Do not cover the treated area with bandages or dressings unless instructed to do so by your doctor.
Storage and Disposal
1. Store the medication at room temperature.
2. Do not freeze the medication.
3. Keep all medications in a safe place, out of the reach of children and pets.
4. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so.
5. Consult your pharmacist for guidance on the best way to dispose of medications. You may also want to explore drug take-back programs in your area.
Missed Dose
If you use this medication on a regular basis and miss a dose, apply it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not apply two doses at once or use extra doses. If you use this medication as needed, do not use it more frequently than directed by your doctor.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Adhere to the guidelines below for the specific type of product you are using.
Rectal Products:
1. Wash your hands before and after applying the medication.
2. Apply the medication to clean, dry skin as directed by your doctor or according to the package labeling.
Skin Products:
1. Do not ingest this medication. Use it only on your skin.
2. Avoid getting the medication in your mouth, nose, or eyes, as it may cause irritation. If accidental contact occurs, rinse the affected area thoroughly with water.
3. Wash your hands before and after applying the medication, unless your hand is the treated area, in which case you should not wash it after application.
4. Clean and dry the affected area before applying the medication.
5. Apply the medication to clean, dry, healthy skin.
6. Do not cover the treated area with bandages or dressings unless instructed to do so by your doctor.
Storage and Disposal
1. Store the medication at room temperature.
2. Do not freeze the medication.
3. Keep all medications in a safe place, out of the reach of children and pets.
4. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so.
5. Consult your pharmacist for guidance on the best way to dispose of medications. You may also want to explore drug take-back programs in your area.
Missed Dose
If you use this medication on a regular basis and miss a dose, apply it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not apply two doses at once or use extra doses. If you use this medication as needed, do not use it more frequently than directed by your doctor.
Lifestyle & Tips
- Clean and dry the skin area before applying the cream.
- Apply a thin layer of cream only to intact skin, as directed by your doctor or pharmacist.
- Do not apply to large areas of the body, open wounds, or damaged skin unless specifically instructed by a healthcare professional.
- Do not cover the treated area with bandages or plastic wrap unless specifically instructed, as this can increase absorption and risk of side effects.
- Wash hands thoroughly after applying the cream.
- Avoid contact with eyes, nose, mouth, and other mucous membranes.
- Keep out of reach of children and pets.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Apply a thin layer to intact skin, typically 3 to 4 times daily, as directed by a healthcare professional. Do not exceed recommended total daily dose or application area.
Condition-Specific Dosing:
generalPainRelief:
Apply to affected area as needed, up to 3-4 times daily. Maximum recommended application area and total dose per 24 hours should not be exceeded (e.g., typically not more than 50g per 24 hours for 4% cream, or 0.5g per 5cm x 5cm area, but refer to specific product labeling).
Pediatric Dosing
Neonatal:
Not established (Use with extreme caution and under medical supervision due to risk of systemic toxicity)
Infant:
Not established (Use with extreme caution and under medical supervision due to risk of systemic toxicity)
Child:
Use with extreme caution and under medical supervision. Dosing is typically weight-based and limited by surface area to prevent systemic toxicity (e.g., for 4% cream, typically not more than 7g per 24 hours for children 3-12 years, or 0.1g/kg per dose, not exceeding 3-4 doses per 24 hours, and not on large areas). Consult specific product labeling and pediatric guidelines.
Adolescent:
Similar to adult dosing, but caution advised regarding total dose and application area, especially for younger adolescents.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required for topical use on intact skin, but caution if large areas or prolonged use due to potential for systemic absorption.
Moderate:
No specific adjustment required for topical use on intact skin, but caution if large areas or prolonged use due to potential for systemic absorption.
Severe:
No specific adjustment required for topical use on intact skin, but caution if large areas or prolonged use due to potential for systemic absorption. Monitor for signs of systemic toxicity.
Dialysis:
Considerations: Systemic absorption is generally low with proper topical use. If significant systemic absorption occurs, lidocaine and its metabolites are dialyzable, but clinical significance for topical use is low.
Hepatic Impairment:
Mild:
No specific adjustment required for topical use on intact skin, but caution if large areas or prolonged use due to potential for systemic absorption.
Moderate:
Caution advised. Lidocaine is primarily metabolized by the liver. Increased systemic exposure may occur with large area application or prolonged use. Monitor for signs of systemic toxicity.
Severe:
Contraindicated or use with extreme caution. Significant hepatic impairment can lead to accumulation and systemic toxicity even with topical application if absorption occurs. Monitor closely for signs of systemic toxicity.
Confidence:
Medium
Pharmacology
Mechanism of Action
Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action. It specifically blocks voltage-gated sodium channels, preventing the propagation of action potentials.
Pharmacokinetics
Absorption:
Bioavailability:
Variable (low with intact skin, increases with damaged skin, large surface area, occlusion, or prolonged application).
Tmax:
Variable (typically 2-6 hours after topical application, depending on formulation, site, and duration of application).
FoodEffect:
Not applicable (topical administration).
Distribution:
Vd:
Approximately 1.1 L/kg (systemic absorption).
ProteinBinding:
Approximately 60-80% (primarily to alpha-1-acid glycoprotein and albumin).
CnssPenetration:
Limited (with proper topical use); significant with systemic absorption.
Elimination:
HalfLife:
Approximately 1.5-2 hours (systemic).
Clearance:
Approximately 0.95 L/min (systemic).
ExcretionRoute:
Renal (primarily as metabolites).
Unchanged:
Less than 10% (systemic).
Pharmacodynamics
OnsetOfAction:
Within 3-5 minutes (for topical cream).
PeakEffect:
Variable, typically 20-60 minutes after application.
DurationOfAction:
Approximately 1-2 hours after removal of cream, depending on application duration and site.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ Irregular heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Signs of methemoglobinemia, a rare but potentially life-threatening condition, such as:
+ Blue or gray discoloration of the lips, nails, or skin
+ Irregular heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling extremely tired or weak
+ Shortness of breath
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
Trouble breathing, slow breathing, or shallow breathing
Severe numbness and tingling
Feeling lightheaded, sleepy, confused, or experiencing blurred vision
Seizures
Changes in vision
Feeling nervous and excitable
Dizziness or fainting
Ringing in the ears
Nausea or vomiting
Feeling hot or cold
Shakiness
Twitching
Slow heartbeat
Chest pain
Additional Side Effects of Rectal Products
If you are using a rectal product, you may also experience:
Bleeding from the rectum
Rectal pain
Other Possible Side Effects
Not everyone will experience side effects, and many people may only have minor side effects. However, if you experience any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:
Irritation at the site of application
Swelling
Redness
Changes in skin color
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of acidosis (too much acid in the blood), such as:
+ Confusion
+ Fast breathing
+ Fast heartbeat
+ Irregular heartbeat
+ Severe stomach pain, nausea, or vomiting
+ Excessive sleepiness
+ Shortness of breath
+ Feeling extremely tired or weak
Signs of methemoglobinemia, a rare but potentially life-threatening condition, such as:
+ Blue or gray discoloration of the lips, nails, or skin
+ Irregular heartbeat
+ Seizures
+ Severe dizziness or fainting
+ Severe headache
+ Excessive sleepiness
+ Feeling extremely tired or weak
+ Shortness of breath
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
Trouble breathing, slow breathing, or shallow breathing
Severe numbness and tingling
Feeling lightheaded, sleepy, confused, or experiencing blurred vision
Seizures
Changes in vision
Feeling nervous and excitable
Dizziness or fainting
Ringing in the ears
Nausea or vomiting
Feeling hot or cold
Shakiness
Twitching
Slow heartbeat
Chest pain
Additional Side Effects of Rectal Products
If you are using a rectal product, you may also experience:
Bleeding from the rectum
Rectal pain
Other Possible Side Effects
Not everyone will experience side effects, and many people may only have minor side effects. However, if you experience any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:
Irritation at the site of application
Swelling
Redness
Changes in skin color
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Dizziness or lightheadedness
- Drowsiness or unusual tiredness
- Confusion or disorientation
- Ringing in the ears (tinnitus)
- Blurred or double vision
- Tremors or muscle twitching
- Numbness or tingling around the mouth
- Unusual metallic taste in the mouth
- Slow or irregular heartbeat
- Difficulty breathing
- Seizures
- Severe skin irritation, rash, or blistering at the application site
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
The presence of an infection at the site where the medication will be applied.
Any broken skin or open wounds at the site of application.
Swollen skin, numbness, or loss of sensation at the site of application, as this may affect the medication's absorption or increase the risk of side effects.
If a large area of skin needs to be treated, as this may require special consideration or dosage adjustments.
Additionally, this medication may interact with other drugs or health conditions. Therefore, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or supplements you are using
Vitamins you are taking
* Any health problems or medical conditions you have
Your doctor will help you determine whether it is safe to take this medication with your other drugs and health conditions. Do not start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
The presence of an infection at the site where the medication will be applied.
Any broken skin or open wounds at the site of application.
Swollen skin, numbness, or loss of sensation at the site of application, as this may affect the medication's absorption or increase the risk of side effects.
If a large area of skin needs to be treated, as this may require special consideration or dosage adjustments.
Additionally, this medication may interact with other drugs or health conditions. Therefore, it is crucial to provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or supplements you are using
Vitamins you are taking
* Any health problems or medical conditions you have
Your doctor will help you determine whether it is safe to take this medication with your other drugs and health conditions. Do not start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
There is a risk of developing a severe blood condition called methemoglobinemia associated with this type of drug. Certain factors may increase this risk, including:
- Having a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD)
- Pre-existing heart or lung problems
- Taking specific other medications
- Being an infant under 6 months of age
If you have a history of methemoglobinemia, be sure to discuss this with your doctor.
Before using any other medications or skin products, including soaps, consult with your doctor.
Adhere to your doctor's instructions regarding the duration of use for this medication. Do not exceed the recommended treatment period.
While using this medication, avoid scratching or rubbing the treated skin area, as it may be numb. Additionally, protect the area from extreme temperatures.
Unless instructed by your doctor, do not apply this medication to cuts, scrapes, or damaged skin.
To minimize the risk of increased drug absorption, avoid exposure to heat sources such as:
- Sunlamps
- Tanning beds
- Heating pads
- Electric blankets
- Heat lamps
- Saunas
- Hot tubs
- Heated waterbeds
Also, avoid taking long, hot baths or sunbathing, as these activities can cause your body temperature to rise.
If this medication is accidentally ingested, seek immediate medical attention or contact a poison control center.
When considering the use of this medication in children, it is crucial to consult with a doctor, as different brands may be suitable for different age groups. Children may be at a higher risk for certain side effects, so caution is advised.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, discuss the potential benefits and risks of using this medication with your doctor to make an informed decision.
There is a risk of developing a severe blood condition called methemoglobinemia associated with this type of drug. Certain factors may increase this risk, including:
- Having a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD)
- Pre-existing heart or lung problems
- Taking specific other medications
- Being an infant under 6 months of age
If you have a history of methemoglobinemia, be sure to discuss this with your doctor.
Before using any other medications or skin products, including soaps, consult with your doctor.
Adhere to your doctor's instructions regarding the duration of use for this medication. Do not exceed the recommended treatment period.
While using this medication, avoid scratching or rubbing the treated skin area, as it may be numb. Additionally, protect the area from extreme temperatures.
Unless instructed by your doctor, do not apply this medication to cuts, scrapes, or damaged skin.
To minimize the risk of increased drug absorption, avoid exposure to heat sources such as:
- Sunlamps
- Tanning beds
- Heating pads
- Electric blankets
- Heat lamps
- Saunas
- Hot tubs
- Heated waterbeds
Also, avoid taking long, hot baths or sunbathing, as these activities can cause your body temperature to rise.
If this medication is accidentally ingested, seek immediate medical attention or contact a poison control center.
When considering the use of this medication in children, it is crucial to consult with a doctor, as different brands may be suitable for different age groups. Children may be at a higher risk for certain side effects, so caution is advised.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, planning to become pregnant, or breastfeeding, discuss the potential benefits and risks of using this medication with your doctor to make an informed decision.
Overdose Information
Overdose Symptoms:
- Severe dizziness or lightheadedness
- Nausea and vomiting
- Tremors, muscle twitching, or seizures
- Difficulty breathing or respiratory arrest
- Slow or irregular heartbeat (bradycardia)
- Low blood pressure (hypotension)
- Coma
What to Do:
If you suspect an overdose, seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222.
Drug Interactions
Major Interactions
- Class I antiarrhythmics (e.g., tocainide, mexiletine): Increased risk of cardiac adverse effects if significant systemic absorption of lidocaine occurs.
- Other local anesthetics: Increased risk of systemic toxicity (additive effects).
Moderate Interactions
- Beta-blockers (e.g., propranolol): May reduce hepatic blood flow, potentially decreasing lidocaine clearance and increasing systemic levels if significant absorption occurs.
- Cimetidine: May inhibit lidocaine metabolism, potentially increasing systemic levels if significant absorption occurs.
- Phenytoin: May alter lidocaine metabolism.
- Drugs that induce or inhibit CYP1A2 or CYP3A4: Potential for altered lidocaine metabolism if significant systemic absorption occurs.
Confidence Interactions
Monitoring
Baseline Monitoring
Skin integrity of application site
Rationale: To assess risk of increased systemic absorption.
Timing: Prior to first application.
Patient's medical history (especially cardiac, hepatic, renal, and seizure disorders)
Rationale: To identify contraindications or conditions predisposing to toxicity.
Timing: Prior to first application.
Routine Monitoring
Signs and symptoms of systemic toxicity (CNS: dizziness, drowsiness, confusion, tinnitus, blurred vision, tremors, seizures; Cardiovascular: bradycardia, hypotension, arrhythmias)
Frequency: During and after application, especially with large areas, prolonged use, or compromised skin.
Target: Absence of symptoms.
Action Threshold: Any new or worsening neurological or cardiovascular symptoms warrant immediate medical attention and discontinuation of product.
Local skin reactions (e.g., redness, swelling, itching, rash)
Frequency: Daily or with each application.
Target: Absence of severe reactions.
Action Threshold: Discontinue use if severe irritation or allergic reaction occurs.
Symptom Monitoring
- Dizziness
- Drowsiness
- Confusion
- Tinnitus
- Blurred vision
- Tremors
- Muscle twitching
- Seizures
- Bradycardia
- Hypotension
- Arrhythmias
- Numbness around mouth
- Metallic taste
- Skin irritation (redness, swelling, itching, rash)
Special Patient Groups
Pregnancy
Lidocaine is considered Category B for pregnancy. Studies in animals have not shown harm to the fetus, but there are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits outweigh the potential risks.
Trimester-Specific Risks:
First Trimester:
Generally considered low risk, but use with caution and only if necessary.
Second Trimester:
Generally considered low risk, but use with caution and only if necessary.
Third Trimester:
Generally considered low risk, but use with caution and only if necessary. Avoid large doses or prolonged use near term due to potential for fetal bradycardia or other effects.
Lactation
Lidocaine is excreted into breast milk in small amounts. The amount transferred to the infant is generally considered low and unlikely to cause adverse effects when used topically as directed. L2 (Safer) classification.
Infant Risk:
Low risk of adverse effects to the breastfed infant with proper topical use. Monitor infant for unusual drowsiness or feeding difficulties if concerns arise.
Pediatric Use
Use with extreme caution, especially in infants and young children, due to increased risk of systemic toxicity from higher surface area to volume ratio and potentially immature metabolic pathways. Strict adherence to weight-based dosing and limited application areas is crucial. Not recommended for routine use in neonates or infants without specific medical guidance.
Geriatric Use
Use with caution. Elderly patients may be more susceptible to systemic adverse effects due to potential for decreased hepatic function, reduced renal clearance of metabolites, and underlying cardiovascular conditions. Start with lower doses and monitor closely for signs of toxicity.
Clinical Information
Clinical Pearls
- Topical lidocaine is for external use only. Do not ingest.
- The 'Plus Kit' may include occlusive dressings; if so, follow instructions carefully as occlusion significantly increases systemic absorption.
- Never apply to broken, irritated, or inflamed skin unless specifically directed by a healthcare professional, as this greatly increases systemic absorption and risk of toxicity.
- Avoid using heating pads or external heat over the application site, as this can also increase absorption.
- Systemic toxicity from topical lidocaine, though rare with proper use, can be severe and life-threatening. Educate patients thoroughly on warning signs.
- Patients should be advised to wash their hands thoroughly after applying the cream to avoid accidental transfer to eyes or mucous membranes.
Alternative Therapies
- Benzocaine topical
- Diclofenac topical (for pain/inflammation)
- Capsaicin topical
- Ice packs/cold therapy
- Oral analgesics (e.g., NSAIDs, acetaminophen)
Cost & Coverage
Average Cost:
Variable per kit
Generic Available:
Yes
Insurance Coverage:
Tier 2 or 3 (often covered by insurance, but may require prior authorization for specific kits or higher concentrations)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.