Lidocaine cream is a topical anesthetic used to temporarily block nerve signals in the skin, providing localized relief from pain and itching. It works directly at the site of application, numbing the area to address discomfort from minor burns, scrapes, insect bites, or preparatory numbing for procedures like blood draws or tattooing. The cream’s availability varies significantly based on its concentration, which determines whether a purchase requires a prescription or can be made over the counter.
Over-the-Counter Retail Options
The most accessible forms of lidocaine cream are available without a prescription (OTC) and typically contain a maximum concentration of 4% to 5%. Consumers can purchase these creams at local pharmacies, large grocery stores, and major big-box retailers that feature a health and wellness section.
Many online marketplaces, including major pharmacy chains and e-commerce platforms, also stock OTC lidocaine creams. The most common strength is 4%, marketed for temporary relief of minor aches, pains, and itching, including discomfort associated with arthritis or post-shingles nerve pain. While 5% is the highest available OTC concentration, it is sometimes specifically labeled for anorectal use, such as hemorrhoid relief.
Prescription Access and Higher Concentrations
Acquiring lidocaine cream in concentrations higher than the standard OTC maximum requires a healthcare provider’s authorization. Concentrations of 5% or higher, such as 10% or even 20% in specialized formulations, are available by prescription only. These higher-strength products are reserved for conditions requiring deeper or more prolonged pain blockade, such as neuropathic pain or use before medical and cosmetic procedures.
The process begins with a consultation with a healthcare professional, such as a doctor or dermatologist, who determines the necessity for a stronger topical anesthetic. Prescriptions may be filled at a standard pharmacy or, for the highest strengths, at a compounding pharmacy. Compounding pharmacies specialize in creating customized formulations, allowing them to produce creams with concentrations that are not commercially mass-produced. These specialized creams are typically applied in a clinical setting under supervision.
Safety and Selection Guidelines
Selecting the appropriate lidocaine cream involves considering the intended application area, the severity of the pain, and the length of relief required. For minor, superficial pain, a standard 4% OTC cream is usually sufficient and is generally applied up to three times daily. It is important to read the package insert carefully, as the total daily dosage and application frequency are strictly limited to prevent systemic absorption.
A crucial safety guideline is to never apply lidocaine cream to large areas of the body, broken skin, or open wounds, as this significantly increases drug absorption into the bloodstream. Covering the application area with a dressing or wrap can also increase absorption and should be avoided unless specifically directed by a healthcare provider. Overuse can lead to local anesthetic systemic toxicity (LAST), which affects the central nervous system and cardiovascular system.
Signs of potential systemic toxicity require immediate medical attention and may include symptoms such as dizziness, lightheadedness, or ringing in the ears (tinnitus). More severe signs can progress to slurred speech, confusion, muscle twitching, or, in rare cases, a metallic taste in the mouth. Patients should also be aware that lidocaine, especially when combined with other anesthetics like prilocaine, can lead to methemoglobinemia, a rare condition indicated by a bluish or grayish discoloration of the skin, lips, or nails.