Document Detail

Penile absorption of EMLA cream in piglets: implications for use of EMLA in neonatal circumcision.
MedLine Citation:
PMID:  8835088     Owner:  NLM     Status:  MEDLINE    
EMLA (eutectic mixture of lidocaine and prilocaine) cream is currently not recommended for use in infants < 1 month of age because of the potential risk of methemoglobinemia as a result of the o-toluidine metabolite of prilocaine. We studied bioavailability and changes in methemoglobin levels following topical penile exposure to 1 g of EMLA cream for 1 hour in piglets. Lidocaine, prilocaine, and o-toluidine concentrations were measured simultaneously using a high-performance liquid chromatography method. The systemic bioavailability of EMLA was low: 4.0 +/- (SD) 4.7% for lidocaine (range 0-13.6; n = 8) and 7.2 +/- 5.7% for prilocaine (range 0-14.5; n = 8). The ratio between exposure to o-toluidine with EMLA versus intravenous administration (i.e., AUCEMLA/AUCIV; see text) was also low: 4.2 +/- 9.3% (range 0-28.6; n = 9). The mean maximum methemoglobin value after intravenous administration was 1.23 +/- 0.64% (range 0.5-3.0; n = 12) and after penile application 0.99 +/- 0.36% (range 0.5-2.0; n = 12). The methemoglobin value was elevated significantly above baseline after intravenous administration (p = 0.03), but not after penile application of EMLA. These findings suggest that penile administration of 1 g of EMLA may be safe for neonatal circumcision, but further study is required.
M Gazarian; A Taddio; J Klein; G Kent; G Koren
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Biology of the neonate     Volume:  68     ISSN:  0006-3126     ISO Abbreviation:  Biol. Neonate     Publication Date:  1995  
Date Detail:
Created Date:  1996-12-17     Completed Date:  1996-12-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0247551     Medline TA:  Biol Neonate     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  334-41     Citation Subset:  IM    
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ont., Canada.
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MeSH Terms
Anesthetics, Local / pharmacokinetics
Animals, Newborn / metabolism*
Circumcision, Male*
Cross-Over Studies
Drug Combinations
Injections, Intravenous
Lidocaine / pharmacokinetics*
Methemoglobinemia / blood
Ointments / pharmacokinetics
Penis / metabolism*
Prilocaine / pharmacokinetics*
Toluidines / metabolism
Reg. No./Substance:
0/Anesthetics, Local; 0/Drug Combinations; 0/EMLA; 0/Ointments; 0/Toluidines; 137-58-6/Lidocaine; 721-50-6/Prilocaine; 95-53-4/2-toluidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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