Features
Serious toxicity is unlikely after oral administration of lidocaine due to extensive first pass metabolism, but has been reported after ingestion of large amounts. When ingested the local features are numbness of the mouth, throat and pharynx. Clinical features of toxicity are unlikely if the patient has no local anaesthetic symptoms in the mouth and no other symptoms at presentation, due to low bioavailability. Central Nervous System (CNS) symptoms include increasing restlessness, visual disturbances, agitation, tinnitus, confusion, hallucinations, drowsiness, weakness, shivering, paraesthesia, muscle twitching and can lead to convulsions, which are the major feature of toxicity. Coma and apnoea may develop. Cardiovascular system (CVS) symptoms include transient hypertension and tachycardia followed by arrhythmias. Hypotension may result from depressed myocardial contractility and peripheral vasodilation. Methaemogloginaemia (manifesting as cyanosis and hypoxia). Gastrointestinal (GI) symptoms include nausea and vomiting. Allergic reactions occur rarely and may include urticaria, angioedema, contact dermatitis and pruritis. Acute respiratory distress syndrome (ARDS) has been reported in severe allergic reactions.
Management
If small quantities have been ingested; nil by mouth until oral sensation is returned to normal.
Following ingestion of potentially toxic amounts or in patients with systemic symptoms maintain a clear airway and ensure adequate ventilation. Prolonged resuscitation for cardiac arrest is recommended, continuing for at least 1 hour and only stopped after discussion with a senior clinician. Lidocaine is cardiotoxic and careful assessment of the electrocardiogram (ECG) is required. Perform a 12 lead ECG and measure the QRS duration and QT interval. Repeat 12 lead ECGs are recommended, especially in symptomatic patients. All patients should be observed for at least 4 hours after exposure. If cardiotoxicity is unresponsive to standard care consider the use of a lipid emulsion. Manage any resulting convulsions, hypotension, bradycardia, metabolic acidosis and haemodynamic compromise in the conventional manner. Methaemoglobinaemia can be treated by methylene blue (methylthioninium chloride). Exchange transfusion may be indicated in cases where methaemoglobinaemia is unresponsive or only partially responsive to methylene blue.
36 months
Hypersensitivity to the active substances, anaesthetics of the amide-type or to any of the excipients listed in section 6.1.
None known.
Hydroxyethylmethylcellulose 3000
Polysorbate 20
Nonoxynol 9
Propylene glycol
Menthol
Purified water
Gel
Undesirable effects are listed by MedDRA System Organ Classes. Assessment of undesirable effects is based on the following frequency groupings:
Very common: > 1/10
Common: >1/100 to <1/10
Uncommon: >1/1,000 to <1/100
Rare: >1/10,000 to <1/1,000
Very rare: <1/10,000
Not known: cannot be estimated from the available data
|
System Organ Class |
Undesirable effect and frequency |
|
Immune system disorders |
Not known: Hypersensitivity |
|
Skin and subcutaneous tissues disorders |
Not known: Skin irritation Skin sensitisation |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Not applicable.
For the symptomatic relief of cold sores.
Pharmacotherapeutic group: Anaesthetics for topical use
ATC code: D04AB
Lidocaine hydrochloride is a local anaesthetic of the amide type which is widely used for local application to mucous membranes. It produces surface anaesthesia by diminishing or preventing the conduction of sensory nerve impulses.
Cetrimide is a quaternary ammonium disinfectant. As well as having emulsifying and detergent properties, it is active against gram-positive and some gram-negative organisms.
Zinc sulfate has astringent properties.
Lidocaine hydrochloride is effectively absorbed from mucous membranes.
May 2016
Lypsyl Cold Sore Gel
Alliance Pharmaceuticals Limited
Avonbridge House
Bath Road
Chippenham
Wiltshire
SN15 2BB
United Kingdom
Do not store above 30°C.
Laminated tube consisting of aluminium foil coated internally and externally with low density polyethylene or high density polyethylene.
Pack size: 3g
PL 16853/0146
Pregnancy
The safety of this medicinal product for use in human pregnancy has not been established. The product is, therefore, not recommended during pregnancy.
Breast-feeding
Lidocaine enters the mother's milk, but in such small quantities that there is generally no risk of the child being affected at therapeutic dose levels.
Fertility
No data on human fertility is available.
Lidocaine hydrochloride 2.0% w/w
Zinc sulfate 1.0% w/w
Cetrimide 0.5% w/w
Excipients with known effect:
Each tube contains 0.3g of propylene glycol
For external use only.
Contact with the eyes should be avoided.
Not recommended for children under 12 years.
The excipient propylene glycol may cause skin irritation.
None known.
Posology
Adults and children over 12 years: Apply a small amount to the affected area with your fingertips 3-4 times daily.
Paediatric population
Children under 12 years: Not recommended.
Method of administration: Cutaneous use
No special requirements for disposal. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
23 January 1991.
No known interactions with other drugs.
