All women and girls strive to look perfect. To do this, they spare no effort or time. One of the rather serious problems that have to be solved in the struggle for beauty is getting rid of unnecessary vegetation. The depilation procedure is a rather unpleasant task, and besides, it is also painful.

Some relate to such sensations quite calmly, while for others it is unbearable torment. How to avoid or at least reduce pain symptoms during hair removal procedures? Today there is a large number of suggestions that will help not only relieve pain, but also completely block it.

Leg hair removal

"Emla" - a drug for local anesthesia during depilation

All methods that allow you to reduce the level of pain during depilation are conventionally divided into non-drug and drug. When using painkillers, there are 3 options for their use:

• application to the skin;
• ingestion;
• subcutaneous injections.

Among the most popular anesthetics that are used during depilation for application to the surface of the skin, Emla cream can be called. User reviews cannot be called unambiguously positive, since this tool does not help everyone. The composition of the anesthetic includes substances used for local anesthesia: lidocaine and prilocaine . They begin to work as an anesthetic when they penetrate the skin. And the degree of their impact depends both on the dose of the drug applied to the surface, and on the duration of the drug being on it.

"Emla" - a drug for local anesthesia during depilation

Each package is accompanied by instructions for the use of the drug, detailing what needs to be done to get the desired result:

• the main condition is to apply the cream in a thick layer;
• cover the treated surface, on which the cream is applied, with a special sticky sticker attached to the package. This is necessary so that the moisture that is part of the product does not evaporate and ensures better penetration of the anesthetic into the skin. When depilating a large surface, you can use a regular film instead of stickers.

Using Emla cream, you need to remember that the action of the composition does not begin instantly, but only after 20-25 minutes. The maximum effect of the anesthetic is achieved after an hour and can last up to 5 hours.

The action of the cream begins only 20-25 minutes after application to the body.

This composition is specifically designed to be applied to the surface of the skin. The instruction explains that in the case of anesthesia penetrating to a depth of 2 mm, the composition must be applied under the bandage for at least 60 minutes. And if you need to penetrate 3 mm, then the time is doubled - up to 2 hours. Periodically, you will have to update the layer of anesthetic under the bandage. It is very convenient that Emla cream can be applied in advance, before visiting the salon, and with the help of a sticker, create conditions under which the composition is well absorbed into the skin and does not stain clothes. Reviews about this drug, as usual, vary: there are simply enthusiastic ones, but there are clearly negative ones.

When is painkiller used?

with lidocaine "Emla" is used for such salon procedures as:

• piercing;
• tattoo;
• depilation;
• epilation;
• any cosmetic procedures requiring injections.

Emla cream should not be applied around the eyes.

Instructions for use means "Emla" warns users about the following points:

• it is forbidden to apply the cream around the eyes;
• can not be used on damaged skin and open wounds (scratches, abrasions, inflammation);
• it is necessary to ensure that the cream does not get into the ear;
• the appearance of overexcitation, disruption of cardiac activity or, conversely, depression nervous system serves as a signal to immediately stop the procedure: you need to remove the stickers or dressings and remove all remaining cream from the treated area.

During the use of "Emla" can provoke the following side effects:

• pallor;
• allergy;
• itching and burning;

• puffiness;
• hyperemia;
• hemorrhagic rash;
• pinpoint hemorrhages.

Contraindications

A contraindication to the use of Emla may be the presence of methemoglobinemia and the reaction of the body to its components. If all the recommendations specified in the instructions are followed, an overdose is unlikely. It should be noted that many users, leaving their reviews of the anesthetic, talk about complete anesthesia and advise using this particular option for depilation.

In case of allergic reactions to the components of the drug, it is always possible to find a replacement in the form of other painkillers. It can be: "Menovazin", "Anestezol", "Dentinoks", "Kamistad" and others.

A contraindication to the use of Emla may be the presence of methemoglobinemia and the reaction of the body to its components.

During the removal of unnecessary vegetation, Emla patches are also used. The disadvantage of this option is that the patches are small. And if you consider that only 3 pieces can be used at a time, then the scope of its application is significantly narrowed. They are mainly used on small and most painful areas: the armpit and bikini area. Reviews of those who used Emla are mostly positive. Pain relief is clear and the result lasts long enough for hair removal to take place.

Other pain medications

In addition to "Emla", in today's market of anesthetics for hair removal there are more and more new names that are not inferior in their qualities to traditional and well-known anesthetics.

Light dep anesthetic cosmetic cream

A novelty is Light Dep - a combined version of an anesthetic that can successfully replace Emla in case of individual intolerance to any of its components. The principle of action of Light Dep is to block the main pain receptors located in the epidermis. But at the same time, the sensitivity of the skin to external factors such as temperature changes or touch remains. The use of this tool is absolutely harmless to health, does not cause side effects and allergic reactions.

Significantly reduces pain when depilating, taking medications such as tempalgin, ibuprofen or analgin. It is also recommended to take them in advance - at least 40 minutes before the start of depilation.

Special scrubs, ointments and gels that exfoliate skin particles near the hair follicles, thereby freeing them and making the removal almost painless, help well for pain relief.

Lidocaine Asept Topical Spray

For local anesthesia during depilation, in addition to the above options, such medicinal solutions are widely used: lidocaine and prilocaine.

Lidocaine solution is usually applied to the surface of the problem area, and is also used in the form of subcutaneous injections, which begin to work within 15 minutes. But when lubricating the surface - as the required amount of medicine accumulates. The period required for this is usually individual for each individual client and depends on a number of components. For example, the thickness of subcutaneous fat, body temperature, the amount of solution on the surface, the time it has been there.

Emla is an anesthetic cream used for depilation, surgical and cosmetic procedures. The tool provides a local anesthetic effect, helping to carry out the procedure without pain and discomfort.

Cream "Emla" (Emla)- This is a special cream designed to anesthetize the skin during various manipulations. A special combination of anesthetic substances allows the use of this remedy to relieve pain in adults and children.

The effectiveness of the drug Emla and the degree of pain relief depends on compliance with the instructions for use. Proper use, timing or application of occlusion will achieve the desired result. Therefore, before using the cream, read the instructions for use.

EMLA abbreviation in English translated as a mixture of local anesthetics, and the remedy itself is an equal proportion of lidocaine and prilocaine. The preparations dissolve in water with the addition of additional substances, due to which they form a creamy substance.

What is it used for?

The anesthetic perfectly penetrates the skin, due to which it anesthetizes it. It is used not only for skin but also for mucous membranes. The tool is a unique and safe product and can be used for young children, as well as pregnant women.

1. Anesthesia of the epidermis during vascular puncture and catheter placement;
2. Superficial surgical intervention;
3. During painful operations on skin tissues and mucous membranes;
4. Trophic ulcers and their treatment;
5. With injections and vaccinations in children;
6. During skin transplantation by splitting a tissue flap over large areas;
7. Pain relief during epilation;
8. cosmetic salon procedures with laser and mesotherapy;
9. For tattooing;
10. During surgical operations in gynecology and urology;
11. In pediatrics during numerous painful manipulations (injections, blood sampling, punctures).

Instructions for use

The use of Emla cream should be correct and timely. To do this, you should learn certain rules:

1. Read the instructions for use carefully before you start using this drug.
2. Use the drug in advance so that it has time to act before the start of the manipulation.
3. Apply the product to the entire area of ​​the skin.
4. Be sure to cover the place with a special impervious sticker that is included in the package.
5. Follow the instructions for use and the exposure time of the application.
6. For better anesthesia, use a thick layer of emulsion, spreading it evenly.

It is very important to follow the dosage. This is necessary in order for the anesthetics to act at a sufficient level and area of ​​the skin. Otherwise, there may be pain during the procedure.

The sticker is necessary for better penetration of substances into the skin. Since the most favorable conditions for the absorption of the cream are high humidity, the use of an occlusive dressing is mandatory. Thus, the impermeable film retains moisture and anesthesia begins to act.

The level of anesthesia and the time of its action depends on the duration of the application and the dosage of Emla cream. The drug does not begin to act immediately, so it is applied 1 to 2 hours before the procedure. After the bandage is removed, the anesthesia time is from 2 to 4 hours.

Emla cream, when applied to the mucous membranes of the genital organs of women, begins to act faster. It takes 15-20 minutes to anaesthetize the mucosa when using a laser.

After the application and waiting for the prescribed time, the bandage is removed and the remnants of the product are wiped off with a napkin. Next, the manipulation that is necessary is carried out. For example, for vaccination, the injection site is disinfected and an injection is given. It's okay if the sticker is removed before the procedure. The effect of anesthesia remains and you can wait 30 minutes - 1 hour without losing the result.

The dosage of Emla cream should not exceed the following:

• From birth to 3 months - 1 g on a maximum skin area of ​​10 cm2 (no more than 1 hour);
• Up to a year - 2 g maximum per 20 cm2 (for 1 hour of application);
• From 1 year to 6 years - 10 g per 100 cm2 of skin (from 1 to 5 hours of dressing);
• 6 - 12 years - 20 g in a maximum area of ​​200 cm2 (from 1 to 5 hours).

EMLA cream is safe to use for adults and children. This has been proven by numerous laboratory examinations. Local pallor or redness may occur, as well as slight swelling, rarely itching. However, this does not affect the analgesic effect of this drug.

Contraindications

There are a number of contraindications:

• Methemoglobinemia (increased content of methemoglobin);
• Use for premature babies who were born at less than 37 weeks' gestation;
• Special individual intolerance to anesthetics contained in the cream;
• Up to 3 months, children are given a one-time test.

Precautionary measures

Be careful and take the following precautions:

1. Do not use on open skin lesions (only if necessary to treat ulcers on the lower extremities;
2. Do not reuse an open tube of Emla cream when applied to trophic ulcers;
3. With atopic dermatitis, reduce the exposure of the occlusive dressing to half an hour;
4. With extreme caution, it is recommended to apply to the mucous membranes in children, since their absorption of the drug is reduced;
5. Do not apply to the ear area if it is possible for the emulsion to enter the middle ear;
6. Avoid the eye area and contact with the mucous membrane of the eye.

Price

How much does Emla cream cost? The price of Emla cream is 300 - 400 rubles per tube of 5 g. You can buy it at a pharmacy or order it in an online store. The cream has no similar analogue. Remember, you should get not only the tube, but also the sticker and detailed instructions on the use of anesthetic cream Emla for depilation.

Local anesthetic for surface anesthesia

Active ingredients

Release form, composition and packaging

◊ Cream for local and external use white color, homogeneous.

Excipients: macrogol glycerylhydroxystearate (Arlaton 289) - 19 mg, carbomer 974P (carboxypolymethylene) - 10 mg, sodium hydroxide - 5.2 mg (to bring the pH to 8.7-9.7), purified water - up to 1 g.

5 g - aluminum tubes (5) - packs of cardboard with the control of the first opening.
30 g - aluminum tubes (1) - packs of cardboard.

pharmachologic effect

Dosage

Outwardly on the skin, locally on the mucous membrane.

adults

Superficial anesthesia of intact skin

Indication	Dose and method of application	Application time
When inserting a needle, for example, during vascular catheterization and when taking blood samples	half a 5 g tube (approx. 2 g) per 10 cm2	1 hour, maximum 5 hours
For minor surgical procedures, such as molluscum contagiosum scraping, wart removal, minor cosmetic procedures, and epilation	1.5-2 g / 10 cm 2 apply a thick layer on the skin and cover with an occlusive dressing	1 hour, maximum 5 hours
On large areas of freshly shaved skin (on an outpatient basis), incl. before hair removal	the maximum recommended dose is 60 g, the maximum recommended application area is 600 cm 2 ; apply a thick layer on the skin and cover with an occlusive dressing	1 hour, maximum 5 hours
In superficial procedures over large areas (in stationary conditions), for example, taking the skin using the split flap method	1.5-2 g / 10 cm 2 apply a thick layer on the skin and cover with an occlusive dressing	2 hours, maximum 5 hours

Surface anesthesia trophic ulcers lower extremities

During surgical treatment (mechanical cleaning) of trophic ulcers of the lower extremities: a single dose of about 1-2 g / 10 cm 2; apply the cream in a thick layer on the ulcerative surface, no more than 10 g of cream per procedure. Apply an occlusive dressing. Application time: at least 30 min.

The opened tube of cream is intended for single use, the tube with the remains of the cream should be discarded after use in one patient.

In the case of treatment of ulcers, in the tissues of which the penetration of the drug is difficult, the duration of the application can be increased to 60 minutes. Mechanical cleaning must begin no later than 10 minutes after removing the cream.

When manipulating ulcers of the lower extremities, Emla cream was used up to 15 times within 1-2 months without reducing the effectiveness and increasing the frequency of local reactions.

Superficial anesthesia of the genital organs

Genital skin

Pain relief before local anesthetic injections.Men - 1 g / 10 cm 2; apply the cream in a thick layer on the skin; application time - 15 min. Women- 1-2 g / 10 cm 2; apply the cream in a thick layer on the skin; application time - 60 min.

Superficial anesthesia of the genital mucosa

When removing genital warts and for pain relief before injections of local anesthetics. Approximately 5-10 g of cream, depending on the area to be treated. The cream should be applied to the entire surface of the mucous membrane, including the folds of the mucous membrane. An occlusive dressing is not required. Application time: 5-10 min. Carry out the procedure immediately after removing the cream.

Children

Pain relief when inserting a needle (including during vaccination), when scraping molluscum contagiosum and other minor superficial surgical manipulations.

Apply the cream in a thick layer on the skin and cover with an occlusive dressing. The dose should correspond to the treated surface and should not exceed 1 g of cream per 10 cm 2

A strip of Emla cream 3.5 cm long approximately corresponds to a dose of 1 g.

Increasing the application time reduces anesthesia. In children with atopic dermatitis application time should be reduced to 30 minutes.

Apply the cream in a thick layer on the skin and cover with an occlusive dressing.

1. Pierce the protective membrane of the aluminum tube using the screw cap, squeeze out a sufficient amount of cream from the tube and apply to the site of the proposed procedure. When anesthesia of the skin, it is possible to use occlusal stickers (attached to the package 5 × 5 g).

2. a. Take one of the occlusal stickers and remove its central part.

b. Separate the paper lining from the paper edging with reverse side bandages

For anesthesia of trophic ulcers of the lower extremities, use an occlusive PVC dressing.

3. Cover the applied cream with a bandage so that the layer of cream under it is thick and does not squeeze out from under the bandage. Gently smooth the edges of the dressing to avoid cream leakage.

4. If using the occlusal sticker supplied with the package, remove the paper frame. The time of application of the drug can be recorded directly on the dressing.

Side effects

When applied to intact skin

When applied to trophic ulcers of the lower extremities

Overdose

Symptoms intoxications are probably the same as with the use of other local anesthetics, for example, excitation of the central nervous system, and in severe cases, depression of the central nervous system and cardiac activity.

In rare cases, the development of clinically significant methemoglobinemia has been noted. Prilocaine in high doses can cause an increase in methemoglobin.

Surface application of 125 mg of prilocaine for 5 hours caused the development of moderate methemoglobinemia in a child aged 3 months. Surface application of lidocaine at a dose of 8.6-17.2 mg/kg caused serious intoxication in newborns.

Treatment: severe neurological symptoms (convulsions, CNS depression) require symptomatic treatment, incl. prescribing anticonvulsants and, if necessary, mechanical ventilation. In the case of the development of methemoglobinemia, the antidote is methylthioninium chloride (methylene blue).

Due to the slow systemic absorption of the drug, patients should be monitored for several hours after the start of intoxication treatment.

drug interaction

In patients receiving drugs that induce the development of methemoglobinemia (for example, drugs containing a sulfo group), Emla cream may increase the concentration of methemoglobin in the blood.

When treating with other local anesthetics and drugs structurally similar to them (including tocainide), the risk of increased systemic effects when using high doses of Emla cream should be taken into account.

Special studies evaluating the interaction of lidocaine / prilocaine with class III antiarrhythmic drugs have not been conducted, caution should be exercised when using drugs together.

Drugs that reduce the clearance of lidocaine (for example, or beta-blockers) can cause potentially toxic plasma concentrations when repeated high doses of lidocaine are used over an extended period of time. This interaction is not clinically significant in short-term therapy with lidocaine (eg, Emla cream) at recommended doses.

Pharmaceutical interaction not found.

special instructions

Patients with glucose-6-phosphate dehydrogenase deficiency or hereditary or idiopathic methemoglobinemia are more susceptible to drug-dependent methemoglobinemia.

The effectiveness of the cream in newborns during the procedure for taking blood samples from the heel has not been established.

Care should be taken when applying Emla cream to the skin around the eyes, as the drug causes eye irritation. elimination protective reflexes may cause irritation or damage to the cornea. If the cream gets into the eyes, immediately rinse the eyes with water or a 0.9% solution, and protect the eyes until protective reflexes are restored.

Care must be taken when applying the drug to the skin with atopic dermatitis; application time should be reduced (15-30 min).

Patients taking class III antiarrhythmic drugs (for example, amiodarone) should be under constant observation and ECG monitoring, because. possible effect on cardiac activity.

Emla cream should not be applied to a damaged eardrum or in other cases of possible penetration of the cream into the middle ear.

Do not apply cream to open wounds.

Lidocaine and prilocaine in concentrations above 0.5-2% have bactericidal and antiviral properties. In this regard, it is recommended to take special care when applying the cream before subcutaneous administration of a live vaccine (eg BCG).

Pediatric use

The safety and efficacy of Emla cream was determined after the application of a single dose. In these children, after application of the cream, a temporary increase in the content of methemoglobin in the blood, lasting up to 13 hours, was often observed. However, the observed increase in the content of methemoglobin in the blood probably has no clinical significance.

Influence on the ability to drive vehicles and mechanisms

Does not affect the ability to drive vehicles and work with machinery.

Pregnancy and lactation

Pregnancy

There is insufficient data on the use of Emla cream in pregnant women. In the course of studies in animals, no direct or indirect negative effects of the drug on pregnancy were revealed, intrauterine development fetus, the process of childbirth or postnatal development. Lidocaine and prilocaine cross the placental barrier and can be absorbed into the tissues of the fetus. No specific reproductive disorders have been reported, such as an increase in the incidence of malformations or other direct or indirect adverse effects on the fetus.

Lactation

Lidocaine and prilocaine are excreted from breast milk in quantities that do not pose a risk to the child, when using the drug in therapeutic doses.

Application in childhood

Contraindication: premature newborns born at a gestational age of less than 37 weeks; newborns weighing less than 3 kg.

Due to the lack of data on the absorption of the drug, it is not recommended to apply the cream to the mucous membrane of the genital organs in children.

At children under the age of 3 months The safety and efficacy of Emla cream was determined after a single dose application. In these children, after application of the cream, a temporary increase in the content of methemoglobin in the blood, lasting up to 13 hours, was often observed. However, the observed increase in the content of methemoglobin in the blood probably has no clinical significance.

Terms of dispensing from pharmacies

The drug is released without a prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children at temperatures below 30°C. Do not freeze. Shelf life - 3 years. Do not use after the expiry date stated on the packaging.

Instructions for use

Emla instructions for use

Dosage form

Cream for local and external use, white, homogeneous

Compound

lidocaine 25 mg

Prilocaine 25 mg

Excipients: macrogol glyceryl hydroxystearate (Arlaton 289), carbomer 974P (carboxypolymethylene), sodium hydroxide (to maintain a pH level of 8.7-9.7), purified water.

Pharmacodynamics

Emla is a drug for superficial anesthesia of the skin and mucous membranes. The action of the drug is provided by its 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 the application.

After applying Emla cream to intact skin for 1-2 hours, the duration of anesthesia after removing the occlusive dressing is 2 hours. When puncture biopsy, the use of Emla cream provides adequate anesthesia of intact skin in 90% of patients 60 minutes after application.

Anesthesia of the genital mucosa is achieved faster than intact skin due to faster absorption of the drug. In women, 5-10 minutes after applying Emla cream to the mucous membrane of the genital organs, anesthesia is achieved that is 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).

When treating trophic ulcers of the lower extremities, the duration of anesthesia after applying the cream is up to 4 hours. There was no negative effect of the drug on the healing process of ulcers or on the bacterial flora.

Side effects

Local reactions: often - pallor, hyperemia and swelling at the site of application of the drug (due to the action on superficial vessels); sometimes - a slight burning sensation and itching immediately after applying the drug; rarely - hemorrhagic rash or petechial hemorrhages, especially after prolonged application in children with widespread neurodermatitis or molluscum contagiosum.

Systemic reactions: rarely - allergic reactions (in severe cases - anaphylactic shock), methemoglobinemia in children.

Selling Features

Released without a prescription

Indications

Surface anesthesia:

Skin for punctures and catheterization of blood vessels and superficial surgical interventions;

Trophic ulcers of the lower extremities during surgical treatment (mechanical cleaning);

The mucous membrane of the genital organs before painful manipulations and for pain relief before injections of local anesthetics.

Contraindications

Methemoglobinemia;

Premature babies born at a gestational age of less than 37 weeks;

Hypersensitivity to local anesthetics of the amide type or any other component of the drug

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Mode of application

Dosage

For adults, for surface anesthesia of intact skin, Emla cream is applied to the skin under an occlusive dressing. The dose of the drug and the time of application depend on the manipulation being performed.

Type of manipulation

Application time

Puncture or catheterization of the vessel

1 hour (maximum 5 hours)

Minor surgical interventions

1.5-2 g/10 cm2

1 hour (maximum 5 hours)

Superficial surgical interventions on a large area of ​​the skin surface (for example, when taking the skin using the split flap method)

1.5-2 g/10 cm2

2 hours (maximum 5 hours)

For surface anesthesia of trophic ulcers of the lower extremities, before their surgical treatment (mechanical cleaning), the cream should be applied in a thick layer on the ulcer surface under an occlusive PVC bandage at a dose of 1-2 g / 10 cm2 (no more than 10 g per procedure) for 30 minutes. If the penetration of the drug into the ulcer tissue is difficult, the duration of the application can be increased to 60 minutes. Mechanical cleaning of the ulcer should begin no later than 10 minutes after removing the cream.

For superficial anesthesia of the genital organs, before injections of local anesthetics, the cream should be applied in a thick layer to the skin for men at a dose of 1-2 g / 10 cm2 for 15 minutes, for women at a dose of 1 g / 10 cm2 for 60 minutes.

For superficial anesthesia of the mucous membrane of the genital organs during the removal of genital warts and before injections of local anesthetics, 5-10 g of cream (depending on the area of ​​the treated surface) is applied to the entire surface of the mucous membrane, including folds. Application time 5-10 minutes. The procedure should be carried out immediately after removing the cream.

For children, for surface anesthesia of intact skin, before vascular puncture or superficial surgical interventions, Emla cream is applied in a thick layer on the skin under an occlusive dressing. The dose of the drug should correspond to the treated surface and should not exceed 1 g of cream per 10 cm2.

The dose and time of application depend on the age of the child.

Release form: Soft dosage forms. Cream.

General characteristics. Compound:

Active substances: lidocaine 25.0 mg, prilocaine 25.0 mg;
excipients: macrogol glyceryl hydroxystearate (ARLATON 289) 19.0 mg, carbomer 974 R (carboxypolymethylene) 10.0 mg, sodium hydroxide 5.2 mg to bring the pH to 8.7 - 9.7, purified water to 1.0 g .
Description: homogeneous white cream.

Pharmacological properties:

Pharmacodynamics. EMLA cream contains as active ingredients lidocaine and prilocaine, which are local anesthetics of the amide type. skin is caused by the penetration of lidocaine and prilocaine into the layers of the epidermis and dermis. The degree of anesthesia depends on the dose of the drug and the duration of the application.

intact skin

After applying EMLA cream to intact skin for 1-2 hours, the duration of anesthesia after removing the occlusive dressing is 2 hours. There were no differences in efficacy (including the time to achieve analgesic effect) and safety when applied to intact skin between elderly (65-96 years) and younger patients.

Due to the action of EMLA cream on superficial vessels, temporary blanching or redness of the skin is possible. Similar reactions in patients with widespread neurodermatitis (atopic dermatitis) may occur faster, as early as 30-60 minutes after applying the cream, which indicates a faster penetration of the cream through the skin.

In a needle biopsy (4 mm in diameter), the use of EMLA cream provides adequate anesthesia of intact skin in 90% of patients 60 minutes after applying the cream when the needle is inserted to a depth of 2 mm and after 120 minutes when the needle is inserted to a depth of 3 mm. The effectiveness of EMLA cream does not depend on the color or pigmentation of the skin (skin type I-IV).

The use of EMLA cream does not affect the mean antibody titer, the rate of appearance or disappearance of specific antibodies in the blood serum, or the number of patients who achieve a protective or positive antibody titer after immunization, when vaccinated against infections such as - rubella - mumps, or when using intramuscular vaccines against -pertussis- - as well as infections caused by Haemophilius influenzae b, or when vaccinated against B.

The mucosa of the genital organs

Anesthesia of the genital mucosa is achieved faster compared to anesthesia of intact skin due to faster absorption of the drug.

In women, 5-10 minutes after applying EMLA cream to the genital mucosa, anesthesia is 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

After applying the cream during the treatment of the lower extremities, the duration of anesthesia is up to 4 hours. There was no negative effect of the drug on the healing process of ulcers or on the bacterial flora.

Pharmacokinetics. Systemic absorption of EMLA cream depends on the dose, duration of application and thickness of the skin (depending on the area of ​​the body), as well as other skin characteristics.

Intact skin:

In adults, after applying 60 g of cream to intact skin of the thigh with an area of ​​400 cm2 (1.5 g per 10 cm) for 3 hours, systemic absorption for lidocaine was approximately 3% and for prilocaine 5%. Suction is slow. Peak plasma concentrations of lidocaine (mean 0.12 µg/ml) and prilocaine (mean 0.07 µg/ml) were reached approximately 4 hours after application of the cream. The risk of toxic symptoms only exists at a plasma concentration of 5-10 µg/ml. The maximum plasma concentration of lidocaine and prilocaine when applying EMLA cream to intact skin in both young and elderly patients is very low and well below the possible toxic level.

Trophic ulcers of the lower extremities:

The time to reach the maximum concentration of lidocaine (0.05-0.84 µg/ml) and prilocaine (0.02-0.08 µg/ml) in blood plasma is 1-2.5 hours from the moment the drug is applied to the ulcerative surface (5 - 10 g of cream for 30 minutes).

With repeated application of the cream to the ulcerative surface, there was no accumulation in the blood plasma of prilocaine, lidocaine or their metabolites. 2-10 g of EMLA cream were applied to the ulcer surface up to 62 cm2 for 30-60 minutes from 3 to 7 times a week (15 times during a month).

The mucosa of the genital organs:

The time to reach the maximum concentration of lidocaine and prilocaine in the blood plasma (on average 0.18 μg / ml and 0.15 μg / ml, respectively) is approximately 35 minutes from the moment the drug is applied to the vaginal mucosa (10 g of cream for 10 minutes).

Indications for use:

Superficial anesthesia of the skin during punctures and catheterization of blood vessels and superficial surgical interventions;
- superficial anesthesia of trophic ulcers of the lower extremities during surgical treatment (mechanical cleaning), for example, to remove fibrin, pus and necrotic tissues;
- superficial anesthesia of the genital mucosa before painful manipulations and for pain relief before injections of local anesthetics.

Important! Get to know the treatment

Dosage and administration:

adults
Superficial anesthesia of intact skin.

Indication	Dosage and method of application	Application time
When inserting a needle, for example, during vascular catheterization and when taking blood samples	half a 5 g tube (approximately 2 g) per 10 cm 2 apply a thick layer to the skin and cover with an occlusive dressing	1 hour, maximum 5 hours
For minor surgical procedures, such as scraping molluscum contagiosum		1 hour, maximum 5 hours
For superficial procedures over large areas, such as split-flap skin sampling	1.5-2 g / 10 cm 2 apply a thick layer on the skin and cover with an occlusive dressing	2 hours, maximum 5 hours

Superficial anesthesia of trophic ulcers of the lower extremities:
During surgical treatment (mechanical cleaning) of trophic ulcers of the lower extremities: a single dose of about 1-2 g / 10 cm2; apply the cream in a thick layer on the ulcerative surface, no more than 10 g of cream per procedure. Apply an occlusive dressing. Application time: at least 30 min.
The opened tube of cream is intended for single use, the tube with the remains of the cream should be discarded after use in one patient.
In the case of treatment of ulcers, in the tissues of which the penetration of the drug is difficult, the duration of the application can be increased to 60 minutes. Mechanical cleaning must begin no later than 10 minutes after removing the cream.
During manipulations on ulcers of the lower extremities, EMLA cream was used up to 15 times within 1-2 months without reducing the effectiveness and increasing the frequency of local reactions.
Superficial anesthesia of the genital organs:
Genital skin:
Pain relief before local anesthetic injections:
Men: 1 g/10 cm2. Apply the cream in a thick layer on the skin. Application time: 15 min.
Women: 1-2 g/10 cm2. Apply the cream in a thick layer on the skin. Application time: 60 min.
Superficial anesthesia of the genital mucosa:
When removing genital warts and for pain relief before injections of local anesthetics: approximately 5-10 g of cream, depending on the area of ​​the treated surface. The cream should be applied to the entire mucosal surface, including the folds of the mucosa. An occlusive dressing is not required. Application time: 5-10 min. Carry out the procedure immediately after removing the cream.
Children
Pain relief for needle insertion, molluscum contagiosum scraping, and other minor superficial surgical procedures.
Apply the cream in a thick layer on the skin and cover with an occlusive dressing. The dose should correspond to the treated surface and should not exceed 1 g of cream per 10 cm2

	Application area	Application duration
	maximum 10 cm 2 (total 1 g of cream) (maximum daily dose)	1 hour (important: no more than 1 hour)
	maximum 20 cm 2 (total 2 g of cream)
	maximum 100 cm (total 10 g of cream)	1 hour, maximum 5 hours
	maximum 200 cm (total 20 g of cream)	1 hour, maximum 5 hours

Increasing the application time reduces anesthesia. In children with widespread neurodermatitis (atonic dermatitis), the application time should be reduced to 30 minutes. Apply the cream in a thick layer on the skin and cover with an occlusive dressing.
Recommendations for applying the drug
1. Pierce the protective membrane of the aluminum tube using the screw cap, squeeze out a sufficient amount of cream from the tube and apply to the site of the proposed procedure. When anesthesia of the skin, it is possible to use occlusal stickers (attached to the package 5x 5 g)
2.
o Take one of the occlusal stickers and remove its central part
o Separate the paper liner from the paper edging on the back of the dressing
When anaesthetizing a leg ulcer, use an occlusive PVC dressing.
3. Cover the applied cream with a bandage so that the layer of cream under it is thick and does not squeeze out from under the bandage. Gently smooth the edges of the dressing to avoid cream leakage.
4. If using the occlusal sticker supplied with the package, remove the paper frame. The time of application of the drug can be recorded directly on the dressing.
5. After the recommended time, remove the bandage and cream residue from the surface.

Application Features:

Patients with glucose-6-phosphate dehydrogenase deficiency or hereditary or idiopathic methemoglobinemia are more susceptible to drug-dependent.

The effectiveness of the cream in newborns during the procedure for taking blood samples from the heel has not been established.

Care should be taken when applying EMLA cream near the eyes, as the drug causes eye irritation. Also, the loss of protective reflexes can make it possible to irritate and damage the cornea. If the cream gets into the eyes, rinse immediately with water or saline or protect the eyes until protective reflexes are restored.

Care must be taken when applying the drug to the skin with widespread neurodermatitis (atopic dermatitis); application time should be reduced (15-30 minutes).

In children under 3 months of age, the safety and efficacy of EMLA cream was determined after a single dose application. In these children, after application of the cream, a temporary increase in the levels of methemoglobin in the blood lasting up to 13 hours was often observed. However, the observed increase in blood levels of methemoglobin probably has no clinical significance.

Patients taking anti-arrhythmic drugs class III(for example, amiodarone), should be under constant supervision and ECG control, tk. possible effect on cardiac activity.

Do not apply EMLA cream to a damaged eardrum or in other cases where the cream may penetrate into the middle ear. Do not apply cream to open wounds.

Due to the lack of data on the absorption of the drug, it is not recommended to apply the cream to the genital mucosa in children.

Lidocaine and prilocaine in concentrations above 0.5 - 2% have bactericidal and antiviral properties. In this regard, it is recommended that special care be taken when applying the cream before subcutaneous administration of a live vaccine (eg BCG).

Side effects:

Adverse reactions caused by the use of local anesthetics occur in less than 1/1000 patients.

There are isolated reports of cases of local reactions in the area of ​​application of the drug, such as hemorrhagic rash or petechial hemorrhages, especially after prolonged application in children with atopic dermatitis or molluscum. Irritation of the cornea due to accidental contact of the cream with the eyes.

Interaction with other drugs:

Influence on the ability to drive vehicles and work with machinery. There was no decrease in response when using EMLA cream.

Contraindications:

Hypersensitivity to amidio-type local anesthetics or any other component of the drug;
- premature newborns born at a gestational age of less than 37 weeks.
-Pregnancy and lactation

Pregnancy. In the course of animal studies, no direct or indirect negative effects of the drug on pregnancy, intrauterine development of the fetus, on the birth process or postnatal development were revealed. In animals and humans, lidocaine and prilocaine cross the placental barrier and can be absorbed into fetal tissues. It should be taken into account that lidocaine and prilocaine have been used in a large number pregnant women and women of childbearing age. No specific reproductive disorders have been reported, such as an increase in the incidence of malformations or other direct or indirect adverse effects on the fetus. However, caution should be exercised when using the cream in pregnant women.

Lactation. Lidocaine and prilocaine are excreted in breast milk in amounts that do not pose a risk to the child when using the drug at therapeutic doses.

Overdose:

Subject to the recommended dosage regimen, the development of signs of systemic toxicity is unlikely. Symptoms are likely to be the same as with other local anesthetics, such as central nervous system (CNS) stimulation and, in severe cases, CNS and cardiac depression.

In rare cases, children have developed clinically significant methemoglobinemia.

Prilocaine in high doses can cause an increase in methemoglobin levels.

Topical application of 125 mg of prilocaine for 5 hours caused the development of moderate methemoglobinemia in 3 patients. month old baby. Surface application of lidocaine at a dose of 8.6-17.2 mg/kg caused serious intoxication in newborns.

Severe neurological symptoms (convulsions, depression of the central nervous system) require symptomatic treatment, including the appointment of anticonvulsants and, if necessary,. In the case of the development of methemoglobinemia, the antidote is methylthionium.

Due to the slow systemic absorption of the drug, patients should be monitored for several hours after the start of intoxication treatment.

Interaction with other medicinal products and other forms of interaction

In patients receiving drugs that induce the development of methemoglobinemia (for example, drugs containing a sulfo group), EMLA cream may increase the concentration of methemoglobin in the blood.

When treating with other local anesthetics and drugs structurally similar to them (including tocainide), the risk of increased systemic effects when using high doses of EMLA cream should be taken into account.

Special studies evaluating the interaction of lidocaine / prilocaine with class III antiarrhythmic drugs have not been conducted, care should be taken when co-administering drugs. Pharmaceutical interaction: not found.

Storage conditions:

Shelf life - 3 years. Do not use after the expiry date stated on the packaging. List B. Store at temperatures below 30 ° C, out of the reach of children. Do not freeze.

Leave conditions:

On prescription

Package:

5 g in an aluminum tube, sealed with an aluminum membrane and closed with a screw cap. 5 tubes with occlusal stickers and instructions for use in a cardboard box.

30 g in an aluminum tube, sealed with an aluminum membrane and closed with a screw cap. 1 tube with instructions for use in a cardboard box.