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Local anaesthetic + vasoconstrictor Pregnancy: Contraindicated - lidocaine and phenylephrine topical solution should not be administered to those who are pregnant or breast-feeding.

Lidocaine with phenylephrine

A combination local anaesthetic preparation pairing lidocaine, an amide-type local anaesthetic, with phenylephrine, an alpha-adrenergic vasoconstrictor, used to provide local anaesthesia with reduced bleeding and prolonged effect.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Each spray delivers a dose volume of 130 microlitres, equivalent to 6.5 mg lidocaine hydrochloride and 0.65 mg phenylephrine hydrochloride. Adults and children over 12 years: up to a maximum of 8 sprays in total.
Route: Topical solution, delivered as a spray by pump dispenser
Frequency: Sprays applied to the application site up to the stated total maximum; no repeat interval is stated in the SPC
Max: Up to a maximum of 8 sprays in total
Prime the pump dispenser by activating the pump 3 times before use. Each bottle contains 2.5 ml of solution, equivalent to 125 mg lidocaine hydrochloride and 12.5 mg phenylephrine hydrochloride. Children below 12 years of age: not recommended. Use with caution in patients with traumatised mucosa and/or sepsis in the region of the proposed application. Oral topical anaesthesia may interfere with swallowing, and numbness of the tongue or buccal mucosa may increase the danger of biting trauma. Check that sympathomimetic-containing preparations are not simultaneously administered by several routes (e.g. orally and topically - nasal, aural, eye preparations). Source product: Lidocaine Hydrochloride 5% w/v and Phenylephrine Hydrochloride 0.5% w/v Topical Solution (UK SPC).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to lidocaine hydrochloride, to local anaesthetics of the amide type, to phenylephrine hydrochloride, or to any of the excipients
  • Pregnancy and breast-feeding
  • Hypovolaemia, hypertension, acute ischaemic heart disease and complete heart block
  • Thyrotoxicosis, glaucoma or urinary retention
  • Patients receiving other sympathomimetic drugs
  • Patients taking monoamine oxidase inhibitors, or within 2 weeks of their use

Side effects

  • May interfere with swallowing; numbness of the tongue or buccal mucosa may increase the danger of biting trauma
  • Lidocaine CNS toxicity: restlessness, excitement, nervousness, dizziness, tinnitus, blurred vision, muscle twitching/tremors and convulsions; numbness of the tongue and perioral region as an early sign; may be followed by drowsiness, respiratory failure and coma
  • Lidocaine cardiovascular toxicity: myocardial depression and peripheral vasodilatation with hypotension and bradycardia; arrhythmias and cardiac arrest may occur
  • Methaemoglobinaemia (reported with some local anaesthetics)
  • Phenylephrine sympathomimetic effects: hypertension (vasoconstriction may be severe enough to cause gangrene if infiltrated into digits), reflex bradycardia or tachycardia, arrhythmias, anginal pain, palpitations, cardiac arrest, flushing, dizziness and fainting
  • Phenylephrine central effects: fear, anxiety, nervousness, restlessness, tremors, insomnia, confusion, irritability, psychotic states, epileptiform convulsions; reduced appetite, nausea and vomiting

Interactions

  • Monoamine oxidase inhibitors: irreversible MAOIs may increase the effect of phenylephrine, resulting in a dangerous hypertensive crisis - do not use in patients taking irreversible MAOIs or within three weeks of their discontinuation
  • Antihypertensives (e.g. beta-adrenergic blocking agents): effects may be reversed by phenylephrine, with possible fatal reactions; caution with guanethidine, reserpine, digitalis and methyldopa
  • Propranolol: increased risk of myocardial depression and increased risk of lidocaine toxicity
  • Antiarrhythmics (e.g. tocainide): toxic effects are additive - use lidocaine with caution
  • Quinupristin/dalfopristin: increased risk of ventricular arrhythmias - concomitant use should be avoided
  • Diuretics: effects of lidocaine antagonised by hypokalaemia with acetazolamide, loop diuretics and thiazides

Clinical monograph

How it works

Lidocaine blocks voltage-gated sodium channels in nerve membranes to prevent impulse conduction, while phenylephrine causes local vasoconstriction that slows systemic absorption of the anaesthetic and reduces local bleeding.

Prescribing in practice

  • Avoid injection of vasoconstrictor-containing solutions into or near end-arterial sites such as digits, nose, ears, penis or skin flaps, where vasoconstriction can cause ischaemic necrosis.
  • Always aspirate before injecting to avoid inadvertent intravascular administration, and respect the recommended maximum total dose to prevent systemic lidocaine toxicity.
  • Use with caution in patients with cardiovascular disease, hyperthyroidism or those taking drugs that potentiate sympathomimetics.

Monitoring

Monitor for early signs of systemic local anaesthetic toxicity such as perioral tingling, tinnitus, agitation or cardiovascular instability, and observe for excessive sympathomimetic effects.

Counselling the patient

  • Numbness will wear off gradually; protect the anaesthetised area from heat, biting or injury until sensation returns.
  • Report dizziness, palpitations, ringing in the ears or a metallic taste during the procedure immediately.

Evidence & guidelines

Lidocaine with a vasoconstrictor is a long-established standard for infiltration and dental anaesthesia, with use guided by SPC and recognised local anaesthetic safety guidance on maximum doses and toxicity management.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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