Emla, cream for local and external use, 30 g, 1 pc.

Pharmacological properties of the drug Emla

EMLA cream contains lidocaine and prilocaine, amide-type local anesthetics. Due to the penetration of lidocaine and prilocaine into the layers of the epidermis and dermis, skin anesthesia occurs. The degree of anesthesia depends on the time of application and dose. Intact skin When EMLA cream is applied to intact skin for 1–2 hours, anesthesia lasts about 2 hours after removing the occlusive sticker. There were no differences in efficacy (including time to achieve analgesic effect) and safety when applied to intact skin between young and elderly patients. Due to the effect of the cream on the superficial vessels, temporary pallor or redness of the skin area is possible. Vasomotor reactions develop faster (already 30–60 minutes after applying the cream) in patients with widespread neurodermatitis (atopic neurodermatitis), which indicates a faster penetration of the cream through the changed skin. During a puncture biopsy (up to 4 mm in diameter), the use of the cream provides adequate anesthesia of intact skin in 90% of patients 60 minutes after applying the cream when the needle is inserted into the skin to a depth of 2 mm and after 120 minutes - to a depth of 3 mm. The effectiveness of the cream does not depend on the color and pigmentation of the skin (skin types I–IV). The cream can be used for pain relief before vaccination when administering the vaccine subcutaneously or intramuscularly. Genital mucosa The anesthetic effect of the mucous membrane appears earlier, since absorption occurs faster than in cases of application to intact skin. In women, after applying EMLA cream to the mucous membrane of the genital organs, after 5–10 minutes an analgesic effect is achieved that is sufficient for manipulations using 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 when treating trophic ulcers of the lower extremities, the duration of the analgesic effect is about 4 hours. The cream does not have a negative effect on the wound healing process and bacterial flora. Systemic absorption depends on the amount of cream, duration of application, skin thickness (which varies in different areas of the body) and other skin characteristics. Intact skin In adults, after applying 60 g of EMLA cream to 400 cm2 of intact skin on the thigh (1.5 g per 10 cm2) over 3 hours, systemic absorption was 3% for lidocaine and 5% for prilocaine. Absorption occurs slowly. At the above dose, the maximum plasma concentration of lidocaine (average 0.12 mcg/ml) and prilocaine (average 0.07 mcg/ml) was achieved approximately 4 hours after application. The risk of developing toxic symptoms exists only at doses of 5–10 mcg/ml. Trophic ulcers of the lower extremities After applying 5–10 g of EMLA cream to trophic ulcers with an exposure of 30 minutes, the maximum levels of lidocaine and prilocaine in the blood plasma were achieved after 1–2.5 hours (lidocaine concentration in the range of 0.05–0.84 μg/ml , prilocaine - 0.02–0.08 mcg/ml). After repeated application of EMLA cream to trophic ulcers, no significant accumulation of lidocaine, prilocaine or their metabolites in the blood plasma was noted (EMLA cream was applied at a dose of 2–10 g for 30–60 min to an area of ​​62 cm2 15 times a month for 3–7 sessions per week). Genital mucosa The maximum plasma concentration is achieved approximately 35 minutes after applying 10 g of EMLA cream to the vaginal mucosa with an exposure of 10 minutes (the average concentration of lidocaine was 0.18 mcg/ml; prilocaine - 0.15 mcg/ml) .

Cheap analogues of Emla for depilation

The pharmacological market presents cheap Emla substitutes for use in hair removal.

Light Dep

This cream was developed by Russian pharmacists and can replace the medication Emla. It can be used not only for depilation anesthesia, but also as a local anesthetic. The cream contains the following components - prilocaine, lidocaine and tetracaine, which provide the cosmetic product with medicinal properties - pain relief and anesthesia.

The cream can also be used in gynecology and dentistry because it has a vasoconstrictor effect with an anti-allergenic effect.

The cream begins to act 15-20 minutes after application. The action lasts up to 4 hours. The cream, like Emla, is suitable for hair removal of the bikini area (but not mucous membranes).

Light Dep is water-based, so it does not cause skin rashes or hives. The medication does not pass through the skin barrier and does not enter the blood, so this cosmetic product does not cause systemic side effects.

The cream must be applied in accordance with the manufacturer's recommendations:

• apply a thick layer to the skin using cotton swabs;
• Cover the cream application area with film (to prevent the cream from drying out);
• you can repeat the application of the cream after 30 minutes;
• 10 minutes after re-application, you can wash off the cream and do depilation.

Menovazin

Menovazin contains the following components: menthol, procaine and benzocaine, which provide the drug with an anesthetic, analgesic, cooling and anti-inflammatory effect. Menovazin is produced in alcohol tincture, as well as in cream.

Menovazin is used for the following pathologies:

• neuralgia and myalgia;
• arthralgia and arthritis;
• relief of allergic skin itching;
• psoriasis.

The medication does not affect the patient’s mental and nervous state.

Menovazin should not be used during pregnancy and lactation, because there is no clinical evidence of the safety of the drug during these periods; for the same reason, Menovazin is not prescribed in pediatrics.

The medication is applied externally only. During depilation, to enhance the effect, you can apply the medicine in several layers with a time interval of 10-15 minutes. The therapeutic effect of the medicine lasts for 60-90 minutes from the moment of application.

Use of Emla

Adults:

Trophic ulcers of the lower extremities During surgical treatment (mechanical cleansing) of trophic ulcers, apply 1–2 g of cream per 10 cm2 of surface. The cream is applied in a thick layer to the surface of the ulcer, no more than 10 g of cream per procedure. Cover the surface of the ulcer with an occlusive sticker. Duration of cream application is 30 minutes. The open tube is intended for one-time use; after each procedure, the unused cream is thrown away. When treating ulcers into which tissue penetration of the drug is difficult, the duration of application can be increased to 60 minutes. Surgical treatment of the wound surface should begin no later than 10 minutes after removing the cream. In the treatment of trophic ulcers of the lower extremities, EMLA cream is used up to 15 times over 1–2 months without reducing effectiveness or increasing the incidence of local reactions. Superficial anesthesia of the genital organs Skin of the genital organs Application of local anesthetics before injection:

• men: 1 g per 10 cm2. A thick layer of cream is applied to the skin. Duration of application - 15 minutes;
• women: 1–2 g per 10 cm2. A thick layer of cream is applied to the skin. Duration of application - 60 minutes.

Mucous membrane of the genital organs To remove condylomas or before injection of local anesthetics: 5–10 g of cream, depending on the area of ​​treatment, is applied to the entire surface, including the folds of the mucous membrane. No occlusal adhesive is required. Application duration is 5–10 minutes. The surgical procedure should begin immediately after removing the cream. Children When performing percutaneous injections, removal of molluscum contagiosum and other superficial surgical manipulations: the dose of EMLA cream should not exceed 1 g per 10 cm2 of surface, the cream is applied in a thick layer to the surface of the skin and covered with an occlusive sticker.

Children with atopic dermatitis need to reduce the duration of application to 30 minutes. Recommendations regarding the method of use Pierce the sealed membrane of the tube with a spike located in the upper outer part of the lid. Squeeze out the required amount of cream and apply to the procedure site. When anesthetizing the skin, occlusive stickers are used, included in the kit with the cream (12 pieces, size 6x7 cm).

Similar therapeutic agents

The pharmacological market presents medications for local anesthesia, which are not structural substitutes for Emla, but have the same therapeutic direction with it.

Versatis

Versatis is produced as a therapeutic transdermal system. The main component of the patch is lidocaine.

Versatis is prescribed for the following pathologies:

• myositis;
• neuralgia of various etiologies;
• pain relief in vertebrology.

Not prescribed for TTC therapy for the following reasons:

• hypersensitivity to the drug composition;
• in pediatrics;
• for open wounds on the skin, severe irritation and skin rashes;
• pregnancy and lactation;
• severe pathologies in the relapse stage.

Prescribe with caution to elderly patients.

The application must be done on clean and dry skin. If you need to cover a small area of ​​the epidermis with a patch, then the patch can be cut into pieces. The patch is applied for 12 hours. For effective therapy, after removing one patch, immediately apply another one to this place.

Among the side effects, patients note redness at the site of installation of the application, an increase in local temperature at the treatment site, as well as skin rashes and itching. Very rarely, urticaria and angioedema may occur.

Nefluan

Nefluan is a medication that is used in urology, gynecology and proctology. The medication is prepared in the form of a gel with lidocaine, fluocinolone and neomycin. The drug has the following effects on the body:

• anesthetic and antibacterial;
• anti-inflammatory.

Medicine is prescribed in this case:

• diagnostics of the bladder and urinary organs - catheterization, colposcopy, cystoscopy, rectoscopy;
• treatment of inflammation of the genitourinary organs – urethritis, vulvitis, cystitis;
• diagnosis and treatment of hemorrhoids;
• treatment of anusitis, rectal fissures;
• treatment of fistulas and trophic ulcers on the skin and soft tissues.

When conducting diagnostics and instrumental treatment of the urethra, it is necessary to squeeze the contents of the tube (10 g) into the urethra and install the clamp for 10 minutes. After this, lubricate the instrument that will be inserted into the urethral canal in one layer. After a therapeutic procedure or diagnosis, you need to reapply the gel.

To treat inflammation, you need to inject the gel into the urethral canal 2-3 times a day for 5-15 days, and to treat hemorrhoids, the gel is injected into the anus for 10-20 days.

The following medications are not prescribed:

• in childhood and old age;
• if you are allergic to the ingredients in the composition.

Side effects manifest themselves in the form of allergic reactions on the skin - urticaria, burning and itching at the injection site, rash and skin hyperemia.

Instillagel

Instillagel is a local combined anesthetic with lidocaine and chlorhexidine. The drug also has anti-inflammatory and antimicrobial effects. The medication acts on gram-positive and gram-negative microorganisms, as well as dermatophytes and yeast fungi.

Medication is prescribed in the following situations:

• endoscopic diagnostics;
• instrumental examination of urological and gynecological organs;
• catheter replacement;
• diagnosing rectal pathologies.

The medication is not prescribed if you are allergic to the components in the composition, for children under 2 years of age, or in the 1st trimester of pregnancy. During lactation, you need to interrupt feeding the newborn for 12-24 hours after using the medicine. Standard dosages - 1 dose into the urethral canal or into the uterine cavity.

Negative actions can manifest themselves locally or systemically:

• systemic manifestations - heart rhythm disturbances - bradycardia, blood pressure fluctuations, convulsions in different locations and anaphylactic shock;
• local manifestations - skin allergies (dermatitis, hyperemia and rash), as well as burning at the site of application of the gel.

Cathegel with lidocaine

Catedzhel is a combined medication (lidocaine + chlorhexidine) for local use in urology. In addition to the anesthetic effect, the drug prevents the development of infection of the urethral organ along the ascending pathways to the bladder and kidneys. Catedzhel is prescribed for instillation of the urethra and instrumental diagnosis of urological pathologies.

Emla substitute is not used for the following reasons:

• bradycardia;
• allergy to ingredients in the medicine;
• childhood.

It is not prohibited to use the medication in the treatment of pregnant and lactating women.

For urethral instillation, it is necessary to carry out a number of preparatory measures before the procedure:

• after emptying the urethra, it must be disinfected;
• it is necessary to remove the tip on the package and inject the contents of the syringe into the urethra;
• squeezing out the gel is carried out using a corrugated syringe, which after the procedure must be kept compressed, and only then removed from the urethra.

Diagnostics can be carried out 10 minutes after the introduction of the gel. Side effects occur very rarely and are not systemic. Negative symptoms may include skin allergies, as well as discomfort and burning in the urethra.

Side effects of Emla

True adverse reactions caused by the use of local anesthetics occur with a frequency of 1/1000 patients.

Isolated cases of local reactions at the site of application of the cream, such as hemorrhagic rashes or petechiae, have been reported, especially after prolonged application in children with atopic dermatitis or warts. If the drug accidentally gets into the eyes, corneal irritation may occur.

Emla cream: composition and mechanism of action on the skin

Why does a person experience pain? In general, this feeling performs a kind of protective function in the body. When the skin is injured or otherwise damaged, the nerve endings immediately send an impulse to the brain about it. Thus, the biological meaning of pain is that it instantly mobilizes the body for self-preservation.

The epilation process is always accompanied by painful sensations

However, pain becomes a serious obstacle during some beauty procedures, in particular during hair removal or depilation, when hairs are removed, damaging the hair follicle, or pulled out along with the root. In this case, Emla cream is often used, which blocks the nerve endings, as a result of which the brain does not receive any alarm signals.

The drug contains the anesthetic components lidocaine and prilocaine. Lidocaine exhibits its analgesic properties much faster than prilocaine, but its duration of action is shorter than that of the second anesthetic.

The combination of these two components in Emla provides, although not instantaneous, a relatively quick and fairly long-lasting effect, which allows epilation or depilation over large areas of the skin.

Research shows that Emla is a highly effective drug. 91% of women noted complete pain relief after applying the cream. The remaining 9% experienced minor pain. This could be due to the use of an insufficient amount of the drug, or the exposure time was incorrectly chosen .

Another reason for inadequate anesthesia may be a physiological feature of the skin: the thicker the skin, the longer it takes the drug to reach the nerve endings. Therefore, in this case, the application time of Emla should be increased so that the components of the drug can penetrate the skin layers as deeply as possible.

Special instructions for the use of Emla

Patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia are more likely to develop drug-dependent methemoglobinemia. EMLA cream should be used with caution on the skin in the eye area, since the drug irritates the mucous membrane of the eyes. In addition, loss of protective reflexes due to anesthetic contact with the cornea can lead to irritation and damage to the cornea. If EMLA cream gets into your eyes, they should be immediately rinsed with water or saline (sodium chloride solution) and protected until sensitivity of the cornea is restored. In patients with atopic dermatitis, the cream should be used with caution, and the duration of application should be reduced to 15–30 minutes. The effectiveness of using the cream in newborns when taking blood from the heel has not been established. The safety and effectiveness of the drug in children under 3 months of age have been studied only using a single dose. In such children, after applying the cream, a temporary increase in the level of methemoglobin in the blood is often observed, lasting up to 13 hours. However, this fact is probably not clinically significant. The cream should not be applied to a damaged eardrum and should not be used in situations where the drug may penetrate into the middle ear cavity. The cream should not be applied to open wounds. The drug should not be applied to the genital mucosa in children due to insufficient data regarding absorption. At concentrations exceeding 0.5–2.0%, lidocaine and prilocaine exhibit bactericidal and antiviral properties. Therefore, if the drug is used during vaccination (intradermal administration of a live vaccine, for example BCG), careful monitoring of the results of vaccination is necessary. EMLA cream should not be used in children aged 0 to 12 months receiving concomitant therapy with drugs that induce methemoglobinemia due to the lack of sufficient clinical experience with its use. It is necessary to monitor patients receiving antiarrhythmic drugs belonging to class III (for example, amiodarone), taking into account the results of the ECG in such patients, since lidocaine and class III antiarrhythmic drugs have additive effects. Pregnancy and lactation period Data regarding treatment of pregnant women with EMLA cream are insufficient. The results of studies conducted on animals do not contain sufficiently complete and reliable information regarding the effect on pregnancy, embryonic/fetal development, childbirth and development after birth. Lidocaine and prilocaine penetrate the placental barrier and can be absorbed by fetal tissues. There were no reports of reproductive disturbances, such as an increased incidence of malformations or direct or indirect effects on the fetus. However, when using the drug during pregnancy, it is necessary to weigh the benefit/risk ratio. Lidocaine and, probably, prilocaine pass into breast milk, but in such small quantities that the effect of therapeutic doses of the drug on the child is unlikely. Does not affect the ability to drive vehicles and operate machinery.

Substitutes in other dosage forms

Substitutes for Emla can be medications that are prepared in the form of solutions for external use and as injections.

Naropin

Naropin is prepared in an injection solution with ropivacaine. The drug has not only anesthetic properties, but also analgesic ones. In large dosages, Naropin acts as an anesthetic during simple operations, and in low dosages the medication can be used to relieve spasms and muscle pain.

Emla's analogue is prescribed as a local anesthetic in the following cases:

• C-section;
• epidural manipulations;
• conductor application;
• infiltration anesthesia;
• pain relief during childbirth, as well as in the postoperative period.

Naropin is not used in therapy for the following reasons:

• allergic reactions to the medicinal composition;
• age up to 12 years;
• lactation period.

Naropin is prescribed by a doctor based on the pathology and the degree of its progression, as well as the individuality of the patient’s body. It is prohibited to use Naropin on your own.

To relieve pain, dosages are lower than when using the medication in surgery.

Adverse reactions of the body to taking Naropin can develop in all organs and systems. The intensity of negative reactions depends on the dosage of the medication:

• at high dosages, side effects may occur in the central nervous system and myocardium - neuropathy, paresthesia and dizziness, as well as pressure fluctuations and heart rhythm disturbances - bradycardia and tachycardia, arrhythmia and angina pectoris;
• the gastrointestinal tract reacts with dyspepsia and nausea;
• general reactions - skin allergies, shortness of breath and angioedema, urinary retention.

Lidocaine

Lidocaine is used as a local anesthetic. The effectiveness of this medication is due to the main component lidocaine, which blocks sodium channels and the passage of painful impulses along nerve fibers. The drug works at the level of brain receptors.

Lidocaine is used in dentistry, otolaryngology, ophthalmology and surgery for the following types of anesthesia:

• terminal and conductor;
• infiltration.

Lidocaine is also used as a solvent for antibacterial medications of the pharmacological group of cephalosporins.

Lidocaine is not prescribed in the following cases:

• allergy to components;
• cardiomyopathy;
• severe cardiac pathologies;
• severe vascular pathologies;
• cerebral and myocardial ischemia;
• hypertension and diabetes mellitus;
• hyperthyroidism and migraine;
• prostatitis;
• glaucoma;
• nephropathy.

Lidocaine is also not used in the treatment of lactating and pregnant women and patients younger than 6 years.

Dosages for intramuscular administration – 1-2 ml per administration procedure. Depending on the operation, the dosage can be increased to 10 ml. Terminal anesthesia - apply the solution to the required surface. The effect of the anesthetic is no more than 30 minutes. Conductive anesthesia procedure – 5-10 ml;

For anesthesia in the eyes, you need to instill a solution of 2 drops into each eye three times with a time interval of 30 seconds. Frequency of procedures per day – 3-4 times

In other cases, when prescribing, the doctor himself determines the required dosages.

Side effects:

• swelling of the skin and urticaria;
• headache, insomnia, dizziness and paresis;
• loss of consciousness;
• numbness of lips and tongue;
• increased irritability and depression;
• hallucination and euphoria;
• vertigo;
• nystagmus, conjunctivitis and blindness;
• myocardial rhythm disturbance;
• dyspepsia;
• thrombophlebitis.

Ultracaine D-S

Ultracaine D-S is a local anesthetic based on articaine, which blocks sodium channels and the transmission of painful impulses along the fibers of the nervous system. Another active ingredient is epinephrine.

The main purpose of Ultracain is conduction and infiltration anesthesia. The medication is most often used in dentistry. The drug is safe for infiltration anesthesia in pediatric (from 4 years of age) and adolescent dentistry.

The drug is safe in the treatment of patients with systemic and moderate cardiac disorders. Pain relief occurs within 1-3 minutes from the moment of administration. The most effective anesthesia period is 20 minutes.

The medication is not prescribed for the following pathologies:

• severe bradycardia;
• atrioventricular block 2-3 degrees;
• heart failure in severe decompensated form;
• malignant hypertension;
• megaloblastic anemia;
• hypoxia;
• allergy to the composition of the medicine.

Also not used during pregnancy and lactation, and in children under 4 years of age.

For adult patients: maximum dosage 4-6 mg/kg body weight. The total dosage should not exceed 400 mg. When used in dentistry, it is necessary to inject 1-1.7 ml of solution into the area of ​​the diseased tooth.

Negative effects:

• increase and decrease in blood pressure index;
• bradycardia;
• arrhythmia;
• stupor;
• tremor of the limbs;
• loss of consciousness;
• nervousness;
• feeling of anxiety;
• drowsiness;
• angioedema;
• allergy;
• skin itching and rash;
• at the site of injection of the solution - redness and swelling of the skin;
• hyperemia;
• severe nausea;
• dyspepsia;
• vomit.

Emla drug interactions

EMLA cream may increase the formation of methemoglobin in patients receiving treatment with methemoglobin-inducing drugs (eg, sulfonamides). When using EMLA cream in high doses in patients receiving local anesthetics or drugs structurally similar to local anesthetics, such as tocainide, the risk of systemic additive effects must be considered. Specific studies of the interaction of the drug with local anesthetics and antiarrhythmic drugs belonging to class III have not been conducted, so caution is recommended when using them together.

Reviews on the use of Emla analogues

Reviews about Emla are more positive both from specialized specialists and from patients. The only drawback that patients note is the very high cost of the drug:

1. Taranenko Yu.V., urologist: “For inflammation of the bladder and urethral infections, I prescribe Emla to reduce pain during diagnosis or when installing a catheter to remove urine and administering medications. This is the most effective medication in its pharmaceutical group. The cost of Emla is not suitable for everyone, so I recommend using Instillagel or Lidocaine in solution.”
2. Yulia, 38 years old: “I was prescribed Emla before a cystoscopy diagnosis. Emla is a truly effective medication, because I felt absolutely no pain or discomfort from this painful procedure. The price, of course, is steep, but the effect is good.”

Emla is the most effective local anesthetic that has very low toxicity. But this medication has a drawback - a high price, so the doctor can choose cheaper analogues for diagnosis and therapy.

Emla drug overdose, symptoms and treatment

If the recommended dosage regimen is followed, the development of systemic toxicity is unlikely. The probable symptoms of intoxication are the same as with the use of other local anesthetics: at the beginning, stimulation of the central nervous system, in severe cases, depression of the central nervous system and cardiac activity. Cases of clinically significant methemoglobinemia have been very rarely reported in children, as prilocaine in high doses can increase methemoglobin levels. Superficial application of 125 mg of prilocaine for 5 hours caused the development of moderate methemoglobinemia in a three-month-old child. Topical application of 8.6–17.2 mg/kg lidocaine led to the development of severe intoxication in infants. Severe neurological symptoms (convulsions, central nervous system depression) require symptomatic treatment: the use of mechanical ventilation and anticonvulsants. The antidote for methemoglobinemia is methylthionine. Due to the slow systemic absorption of the drug, the patient's condition must be monitored for several hours after the symptoms of intoxication have resolved.

Advantages and disadvantages

Consumers appreciated Emla and noted its following advantages:

• effective skin pain relief before epilation/depilation;
• Possibility of use in the intimate area;
• no odor;
• good consistency of the product, which does not allow the cream to spread after application;
• easy and convenient use;
• a small list of contraindications;
• the ability to purchase tubes individually, which saves money.

However, consumers also discovered disadvantages:

• the need to wait until the components of the drug begin to act;
• the likelihood of side effects;
• high price of the drug.

Precautionary measures

To ensure that the hair removal or depilation process is painless and that no side effects occur after using Emla, certain precautions must be observed.

When applying an anesthetic to the skin of the face, you need to ensure that the cream does not get on the mucous membrane of the eyes, since Emla causes irritation of the cornea. If accidental contact with the drug does occur, the eyes should be thoroughly rinsed with running water.

The use of cream for anesthesia of the upper lip should also be careful, since getting the product into the oral cavity is undesirable.

To avoid any unpleasant moments when using Emla before hair removal or depilation, experts advise studying the instructions for the drug and strictly following the instructions.