From Burns to Headaches: Compounding Lidocaine Can Stop the Pain
As anyone who has ever suffered a migraine understands with blinding clarity, the pain from a migraine headache can break over your day like a bow wave, sweeping aside everything except the agony building inside your head. As the pain reaches crescendo, you need something to stop the pain—and fast. For sufferers of intense pains like migraines, burns, post-surgery reactions and more, relief can come in the form of a fast-acting, relatively long-lasting local anesthetic called lidocaine.
First synthesized by Swedish chemist Nils Lofgren in 1943 under the name “xylocaine,” lidocaine is an extremely versatile API that can be compounded to meet patients’ pain management needs in many different treatment settings. Working as an anesthetic by blocking signals within neurons, essentially preventing pain signals being generated in the cell membrane. It is an essential tool for pharmacists looking to meet health care providers’ treatment needs for patients with acute or chronic pain, from dermatological to neuropathic to orofacial.
Compounding Lidocaine for Topical Anesthetic Use — Burns and Other Dermatological Conditions
The treatment, physical pain and emotional fallout from suffering a severe burn can be very difficult for patients. Not only are there physical and potentially emotional rehabilitation steps to go through, victims often suffer high levels of sustained pain. With its fast absorption into the system and strong analgesic qualities, topical lidocaine in even a 5 percent compound has proven extremely effective as topical treatments for both partial- and full-thickness burns.1
In fact, for burns with little to no vascularization and thus no route for systemic treatments to enter the system, a topical anesthetic like a compounded lidocaine medication can be the only possible burn treatment route. Topical anesthetics also see a much lower incidence of infection, crucial for burn recovery patients who often are at higher risk of infection depending on the severity of the burn. In this sensitive environment, pain management can be crucial to maintaining patient stability. In addition to lidocaine compounds, ketoprofen at 2 percent can be compounded for topical use. In severe cases, morphine can also be prescribed.2
Compounded lidocaine also offers clinicians options for patient treatment after cutaneous outpatient procedures such as soft-tissue augmentation or laser surgeries, providing patient comfort with low risk of side effects.3
Compounding Lidocaine for Orofacial and Dental Use
Lidocaine, at 2 percent, is the local anesthetic of choice for dentists and oral surgeons in many countries, in both injected and topical forms. These solutions are cost-effective and can also allow for compounding solutions that are no longer commercially available if those solutions were removed from the market for reasons not related to safety. The most preferred solution is a lidocaine hydrochloride at 2 percent, with epinephrine in the 1:100,000 ratio. For situations requiring more hemostasis or greater depth, lidocaine hydrochloride can be prepared at 1:50,000 of epinephrine.4
Additionally, dental procedures can be terrifying for patients with fear of needles, especially and quite understandably when the patient is anxious at the thought of needles near their mouth. Also known as viscous lidocaine and abbreviated as lidocaine visc, topical pain-reducing compounds with lidocaine can make it possible for patients to remain stable during procedures, making life easier for oral surgeon and patient alike.
Compounding Lidocaine for Neuropathic Pain Treatment and Migraines
Using lidocaine in treatments for migraines and other neuropathic pain is a relatively new application. For many years, migraines were approached as a vascular disorder, resulting in a slew of medications aimed at treating blood circulation issues and other conditions related to restricted vessels. Approaching migraines from the neuropathic pain model of migraine pathophysiology has become more common in recent years, with more and more studies of compounded medications containing APIs like lidocaine in the treatment of neuropathic pain.
So much mystery surrounds the causes and treatments of migraines that it can be discouraging for sufferers of chronic, intense migraines to continually need to try new medications. However, if more traditional remedies have fallen flat for migraine patients, there are several compound medication options, available both over-the-counter and by prescription.
A good compounding pharmacy should be able to offer:
- An OTC capsule dosage with ketoprofen 12.5 mg, riboflavin 100mg and caffeine citrate 100mg. This is a fast-acting pain relief compound, and could be active in patients within 15 minutes.
- Prescription compound lidocaine nasal solution, prepared with between 2.5 and 4.5 percent concentration.
- Combination ergotamine and caffeine capsules/suppositories.
Specifically, lidocaine nasal solution has proven effective in outpatient settings in studies. Pharmacists can also add promethazine or other antiemetics to these compounded medications to lower risk of nausea, a common migraine symptom. These options carry such a low risk of side effects that it can be worthwhile to test these solutions if others aren’t relieving the patient’s migraine pain.5
Is Lidocaine Dangerous? What to Know About Unsupervised Patient Application
Despite its many uses and effectiveness, lidocaine has most often been in the news not for helping migraine sufferers or burn victims, but for being a potentially dangerous pharmaceutical. Often, these stories are about patients overdosing on lidocaine compounds, taking them beyond the prescription, applying too much topical lidocaine over a surface area or period of time, or otherwise not following guidelines that all pharmacists, clinicians, physicians and others should strictly express. As with all medications, compounded or not, lidocaine compounds should be subject to strict internal quality controls. Instances of providers mis-dosing patients or patients misusing compounded lidocaine treatments does not lessen its efficacy and importance to pain treatment.
Lidocaine has been helping providers manage patient pain for decades, and its versatility as an API allows it to be part of compounds used to treat many different patient ailments. For burn victims, migraine sufferers and patients enduring surgery or post-surgery pain, lidocaine can make the difference between a day spent in the grips of severe pain, or being able to live a more quality life.
Pharmaceutica North America is your premier source for quality compounding ingredients like lidocaine for use in treating a wide variety of patient pain, including our Active Prep Kit III with lidocaine, also available as a bulk API. Please contact us to find out how our quality ingredients and custom compounding kits can enhance your pharmacy’s treatment options and patient care.
- “Topical lidocaine in the treatment of partial thickness burns,” Jan/Feb 1989, http://www.ncbi.nlm.nih.gov/pubmed/2921260 ↩
- “A randomised controlled trial to test the analgesic efficacy of topical morphine on minor superficial and partial thickness burns in accident and emergency departments,” June 2007, http://www.ncbi.nlm.nih.gov/pubmed/17513537 ↩
- “Topical Anesthetics for Dermatologic Procedures: A Review,” May 2012, http://www.ncbi.nlm.nih.gov/pubmed/22243434 ↩
- “Local anaesthesia using Articaine and Lidocaine in oral and dental surgery: A comparative meta-analysis,” February 2014, http://www.scirp.org/journal/PaperInformation.aspx?paperID=43231; “Lidocaine Hydrochloride (Local Anesthetic),” accessed August 19, 2015, http://www.drugs.com/monograph/lidocaine-hydrochloride-local-anesthetic.html ↩
- “Compounded Treatments for Migraines,” July 1, 2006, http://www.pharmacytimes.com/publications/issue/2006/2006-07/2006-07-5715 ↩