Research ArticlesSystemic Absorption of Topical Lidocaine in Normal Volunteers, Patients with Post-Herpetic Neuralgia, and Patients with Acute Herpes Zoster
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INTRODUCTION
Herpes zoster is a commonly occurring disease that can result in significant chronic neuropathic pain. Approximately 10–20% of people will suffer from herpes zoster during their lifetime.1,2 Treatment with narcotics, tricyclic antidepressants, and anticonvulsant drugs alleviate pain, but side effects often limit their use, especially in elderly patients. Rowbotham et al. demonstrated the efficacy of topical lidocaine as a potentially more tolerable alternative to systemically administered
METHODS
Three studies were conducted and normal volunteers, PHN patients, and AHZ patients were studied separately. Written informed consent was obtained from all patients and volunteers. Studies were approved by the USCF Committee on Human Research and followed Good Clinical Practice guidelines.
Normal Volunteers
The absolute doses of lidocaine absorbed after topical application of patches or gel to the torso, application of gel to the forehead, and application of patches to the torso on 3 consecutive days in normal volunteers are summarized in Table 1. The bioavailability for a single dose and repeated doses was similar at 3%. Thus, repeated application of patches on 3 consecutive days resulted in systemic absorption of 188 mg of lidocaine compared with 63 mg when patches were applied for a single 12-h
DISCUSSION
The results of this study confirm previous reports that topically applied lidocaine produces minimal systemic exposure.3,4 A small percentage of the administered dose is absorbed into systemic circulation regardless of the formulation. The mean absolute dose absorbed into systemic circulation was 63.6 mg (0.9 mg/kg) after patch administration in normal volunteers, which is similar to the loading dose of lidocaine recommended for ventricular arrhythmias (i.e., 1 mg/kg). However, the rate of
Acknowledgements
This research was supported by a gift from Hind Health Care, Inc. We thank Karl Beutner for assistance in conducting the study, Lisa Yu for performance of the lidocaine and MEGX assays, Gunnard Modin for assistance in statistical analysis, and Kaye Welch and Paula Tarr for assistance in manuscript preparation.
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