EMLA Cream Side Effects – A Full List

A review reported that topical anesthetics, such as lidocaine-prilocaine, commonly cause localized erythema (in up to 43% of users), edema, and temporary skin pallor. While these reactions are typically mild, they highlight the need for cautious use—especially in sensitive individuals or when applied to large surface areas.

EMLA cream, a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine, is widely used in medical and cosmetic procedures for its effective numbing action. However, even with proper use, users may experience side effects that range from skin reactions to more serious but rare systemic issues. These risks emphasize the importance of following safe-use guidelines, including dosing limits and avoiding prolonged exposure.

This article provides a comprehensive overview of EMLA cream side effects, helping users and healthcare providers better understand what to expect—and how to use the cream safely and effectively.

Key Takeaways

• Most side effects are mild and localized, such as redness, swelling, or temporary stinging, and typically resolve within a few hours.
• If dosing guidelines are exceeded, rare but serious systemic reactions, including methemoglobinemia or central nervous system effects, may occur.
• Proper use is essential—apply only on intact skin, avoid large surface areas, and adhere to time limits to minimize risks.
• High-risk groups like infants under 3 months or individuals with G6PD deficiency require special caution and medical supervision.
• Patient education and monitoring after application help detect side effects early and ensure a safe, effective experience with EMLA cream.

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Local Skin Reactions and Their Management

Most side effects associated with EMLA cream are localized to the application area. These reactions are typically mild, temporary, and resolve on their own. Common local side effects include:

• Redness (erythema)
• Paleness or blanching
• Mild swelling (edema)
• Stinging or burning sensation
• Itchiness or irritation

These symptoms generally disappear within a few hours after removal. To relieve minor discomfort, patients can apply a cold compress to the affected area. If irritation persists or worsens, discontinue use and consult a healthcare professional.

Systemic Side Effects and Risk Factors

Although rare, systemic side effects may occur if EMLA cream is used improperly—such as on large surface areas, under occlusion for extended periods, or at higher-than-recommended doses. The active ingredients, lidocaine and prilocaine, can be absorbed into the bloodstream and affect the central nervous system or cardiovascular system. Possible symptoms include:

• Dizziness or lightheadedness
• Nausea or drowsiness
• Confusion or restlessness
• Irregular heartbeat
• Seizures (in cases of extreme overdose)

These adverse effects are most commonly linked to misuse or excessive application. It’s critical to follow clinical guidance regarding EMLA cream dosage to avoid complications.

Rare Adverse Events and Monitoring Protocols

A serious but uncommon risk is methemoglobinemia, a condition that reduces the blood’s oxygen-carrying capacity. It is primarily associated with the prilocaine component and can be life-threatening if not treated promptly. Those at elevated risk include:

• Infants under 3 months
• Individuals with G6PD deficiency
• Patients with congenital or idiopathic methemoglobinemia

Early warning signs may include blue-tinged skin (cyanosis), fatigue, rapid heartbeat, and difficulty breathing. If these symptoms appear, immediate medical intervention is necessary.

Mechanisms Underlying Side Effects

The side effects of EMLA are rooted in its pharmacological action. The cream’s eutectic mixture of lidocaine and prilocaine works by blocking sodium channels in nerve endings, thus preventing pain transmission. However, if the medication enters the bloodstream, its effect may extend beyond the local application site.

• Local reactions are often the result of mild inflammation or irritation caused by the anesthetics.
• Systemic effects, though rare, are due to broader nerve or cardiac interactions when excessive absorption occurs.

Patient Education and Post-Application Monitoring

Patient education plays a key role in preventing side effects and ensuring optimal results. Healthcare providers should review proper application instructions, especially for first-time users.

Key points to emphasize:

• Do not exceed the prescribed amount
• Avoid use on irritated or broken skin
• Always follow the recommended timing
• Use occlusive dressings only when advised
• Store the cream in a cool, dry place

Patients—particularly children or first-time users—should be monitored for 30 minutes post-application for any signs of sensitivity or adverse effects. Proper instruction can significantly improve both safety and comfort.

Conclusion

EMLA cream remains a trusted and effective topical anesthetic when used appropriately. While most side effects are mild and temporary, it is essential to be informed about rarer systemic issues like methemoglobinemia. Adhering to recommended guidelines and maintaining close communication between provider and patient ensures both safety and efficacy.

FAQs

1. What are the most common EMLA cream side effects?

 The most frequently reported side effects include redness, blanching, swelling, and a mild stinging sensation at the application site. These are usually short-lived and require no treatment.

2. Can EMLA cream cause an allergic reaction?

Although rare, some people may experience an allergic reaction to EMLA. Symptoms include rash, itching, swelling, or difficulty breathing. If these symptoms occur, immediate discontinuation and medical attention are advised.

3. Is methemoglobinemia a profound side effect of EMLA?

Yes, methemoglobinemia is a rare but potentially serious side effect, particularly in infants and people with certain blood conditions. 

4. What should I do if I experience a side effect after applying EMLA?

Stop using the cream and wash the area thoroughly. For mild irritation, apply a cold compress. Seek medical advice if symptoms persist or if you notice signs of a systemic reaction such as dizziness or bluish skin.

5. How can I minimize the risk of side effects when using EMLA cream?

Follow dosing guidelines carefully, avoid applying to large areas or for prolonged periods, and consult a healthcare provider if unsure about proper use.

6. Are there any long-term side effects of EMLA cream?

Long-term side effects are extremely rare but may include persistent skin discoloration or sensitivity at the application site.

References

Lidocaine / prilocaine topical side effects: common, severe, long term. Drugs.com. https://www.drugs.com/sfx/lidocaine-prilocaine-topical-side-effects.html

Tran AN, Koo JY. Risk of systemic toxicity with topical lidocaine/prilocaine: a review. J Drugs Dermatol. 2014;13(9):1118-1122.

Chowdhary S, Bukoye B, Bhansali AM, et al. Risk of topical anesthetic-induced methemoglobinemia: a 10-year retrospective case-control study. JAMA Intern Med. 2013;173(9):771-776. doi:10.1001/jamainternmed.2013.75