Lidocaine is a local anesthetic that has been used on the skin for decades. It numbs a limited area by blocking the sodium channels that nerve fibers use to send pain and touch signals to the brain. Over-the-counter lidocaine creams and patches are limited to 4%. Above that, lidocaine is a prescription medication, and single-agent strengths from 5% to 30% are prepared by compounding.
Bayview compounds lidocaine as a cream, ointment, gel, or spray, in 30 g and 60 g sizes, to the strength and base your prescriber orders. Lidocaine itself is an FDA-approved drug, but these compounded strengths and bases are not FDA-approved. A valid prescription is required, and only your prescriber can decide whether it is appropriate for you. Bayview compounds this as part of our pain management compounding line.
How does it work?
Lidocaine blocks the voltage-gated sodium channels in nerve fibers, so the nerves under the treated skin stop sending pain and sensation signals (StatPearls, Lidocaine). The effect stays mostly where the medicine is applied; how much reaches the bloodstream depends on the strength, the amount, the size of the area, whether the skin is intact, and whether the area is covered or warmed (StatPearls, Topical Anesthetics). That is why the strength, the area, and the directions all matter.
What is it used for?
Prescribers use topical lidocaine for nerve pain in a limited area, such as the pain that can linger after shingles (postherpetic neuralgia), for which a 5% lidocaine patch is FDA-approved (MedlinePlus, Lidocaine Transdermal Patch). It is also prescribed to numb intact skin before injections, blood draws, and minor procedures, and for localized itch or irritation. Higher strengths are most often applied by the prescriber in the office. Your prescriber decides whether it fits your situation and how it should be used.
Cream, ointment, gel, or spray?
The difference is the base. A cream absorbs and dries, so it suits repeated daily use over a small area. An ointment stays on the skin longer and suits dry or thickened skin. A gel is clear and quick-drying. A spray reaches areas that are painful to touch or awkward to rub. The 30% preparation is made in a film-forming (plasticized) base that sets on the skin and is usually applied in the office before a procedure. Your prescriber selects the form and strength; see the strengths section for what Bayview compounds.
How is it used?
Apply a thin, even layer to clean, intact skin over the area your prescriber specifies, no more often than directed. Use only the amount directed. Do not apply it to broken, blistered, or sunburned skin, do not cover it with plastic wrap or a tight dressing, and do not put heat over it, because these increase how much lidocaine your body absorbs. Wash your hands after applying, keep it away from your eyes and mouth, and remember that numbed skin cannot warn you about heat or injury until the feeling returns. If your prescriber is applying a higher strength in the office, they will time it and remove it.
Side effects & safety
Most effects are mild and local: temporary redness, paleness, mild swelling, itching, or a tingling or burning feeling where it is applied. The serious risk is absorbing too much lidocaine into the bloodstream, which is why the strength, the area, the amount, and the timing all matter.
Who should not use it?
Avoid compounded lidocaine if you are allergic to lidocaine or to related amide anesthetics such as bupivacaine or prilocaine, and do not apply it to broken, infected, or inflamed skin unless your prescriber directs it. Tell your prescriber if you have heart rhythm problems, liver disease, or G6PD deficiency, if you are pregnant or breastfeeding, and about every other medicine you use, including any other product that contains lidocaine or another numbing agent. It is not for use on infants or young children unless a prescriber directs it.
How should it be stored?
Store as directed on your label, at room temperature away from heat and moisture, and keep it out of the reach of children and pets, since even small amounts can be harmful if swallowed. Do not use it after the beyond-use date, and dispose of unused medication as directed.
Why is this compounded?
FDA-approved lidocaine products for the skin come in a narrow set of strengths and forms. When a prescriber wants a different concentration, a specific base, or a form that is not manufactured, the preparation is compounded. As a 503A compounding pharmacy, Bayview prepares each order in small batches under USP standards, pursuant to a prescription for an individual patient. We do not supply lidocaine as clinic or office stock, that is the role of a 503B outsourcing facility, which Bayview is not. Compounded preparations are not FDA-approved. Related preparations include BLT Numbing Cream, Topical Pain Cream, Lidocaine Nasal Spray, and Diclofenac Gel. The full list is in our compounded medications catalog.
Clinical details for prescribers
Regulatory status. Lidocaine is an amide local anesthetic. FDA-approved topical presentations include the 5% patch (postherpetic neuralgia) and lidocaine/prilocaine cream; OTC external analgesics are limited to 4%. Single-agent 5% to 30% creams, ointments, gels, and sprays are compounded and not FDA-approved. Not a controlled substance. Prepared via 503A compounding.
Formulation & directions. Bayview compounds lidocaine 5% and 10% cream or gel, 10% and 15% ointment, 10% topical spray, and 30% cream or plasticized (film-forming) ointment. Dispensed 30 g or 60 g. Typical outpatient directions: apply a thin layer to the affected area up to three times daily, no occlusion. The 30% preparation is generally applied and removed in the office before a procedure.
Safety & counseling:
- Systemic absorption rises with concentration, surface area, application to denuded or inflamed skin, occlusion, and heat. Specify the site, the amount, the frequency, and a maximum daily application; state whether occlusion is permitted.
- Counsel on early signs of local anesthetic systemic toxicity (perioral numbness, metallic taste, tinnitus, dizziness) and on stopping and seeking care.
- Use caution with concurrent class I antiarrhythmics, other lidocaine-containing products, hepatic impairment, and in G6PD deficiency (methemoglobinemia risk).
- Higher strengths are best applied and monitored in-office. The FDA's 2024 warning letters concerned unapproved OTC products marketed for tattoo and cosmetic use at up to 40%; it is a useful reference when patients ask why a prescription is required.
Non-controlled; ship to patient or office per the order form. Licensed to dispense in RI, MA, CT, NY, NJ, NH, and FL. Background: StatPearls, Lidocaine; StatPearls, Topical Anesthetics. Account setup, licensing, and ordering are covered on our for providers page.
This is a prescription compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your prescriber determines whether it is appropriate and sets the formulation and directions.
