Emla

Leaflet accompanying the packaging: information for the user

Warning! Keep the leaflet! Information on the immediate packaging in a foreign language.

EMLA
25 mg/g + 25 mg/g ((2.5+2.5)%), cream
Lidocaine + Prilocaine

You should carefully read the contents of the leaflet before using the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
• If the patient experiences any side effects, including any not listed in this leaflet, they should tell their doctor or pharmacist. See section 4.

Table of contents of the leaflet

• 1. What EMLA is and what it is used for
• 2. Important information before using EMLA
• 3. How to use EMLA
• 4. Possible side effects
• 5. How to store EMLA
• 6. Contents of the packaging and other information

1. What EMLA is and what it is used for

EMLA contains two active substances - lidocaine and prilocaine. They belong to a group of medicines called local anesthetics.
The action of EMLA is to temporarily numb the sensation in the superficial layers of the skin. The cream is applied to the skin before performing certain medical procedures.
This helps to numb the pain in the skin; however, the patient may still feel pressure and touch.

Adults, adolescents, and children

EMLA can be used to anesthetize the skin before:

• injecting a needle into the skin (e.g., when giving an injection or taking a blood sample)
• minor surgical procedures on the skin.

Adults and adolescents

EMLA can also be used:

• to anesthetize the genital area before:
• injections,
• medical procedures such as removing warts. The application of EMLA cream to the genital area should be performed under the supervision of a doctor or nurse.

Adults

EMLA can also be used to anesthetize the skin before:

• debridement or removal of damaged skin on lower limbs with ulcers.

2. Important information before using EMLA

When not to use EMLA:

• 6.

Warnings and precautions

Before starting to use EMLA, you should discuss it with your doctor or pharmacist:

• EMLA should not be used on areas of skin with a rash, cuts, scratches, or other open wounds, except for ulcers on the lower limbs. If the patient has any of these changes, before using the cream, they should contact their doctor or pharmacist,

Due to the possibility of increased absorption from freshly shaved skin, it is essential to follow the recommended dosage, area of application, and time of application on the skin.
One should avoid contact between EMLA and the eyes, as it may cause irritation. If the EMLA cream accidentally gets into the eye, it should be rinsed immediately with lukewarm water or a physiological saline solution (0.9% NaCl solution). One should be careful not to get anything into the eye until sensation returns.
EMLA should not be used on a diseased eardrum.
When EMLA is used in a patient before administering a live vaccine (e.g., tuberculosis vaccine), one should remember to report for a follow-up visit at the time specified by the doctor to assess the effectiveness of the vaccination.

Children and adolescents

In infants and newborns under 3 months of age, a transient, clinically insignificant increase in methemoglobin concentration in the blood (a form of hemoglobin, or blood pigment) is commonly observed within 12 hours after applying EMLA.
The efficacy of EMLA during heel prick blood sampling in newborns or to ensure adequate pain relief during circumcision has not been confirmed in clinical trials.
EMLA should not be used on the mucous membrane of the genital area (e.g., vagina) in children (under 12 years of age) due to insufficient data on the absorption of active substances.
EMLA should not be used in children under 12 months of age who are being treated with other medications that affect blood pigment and may cause methemoglobinemia (e.g., sulfonamides; see also section 2. "EMLA and other medicines").
EMLA should not be used in premature newborns.

EMLA and other medicines

You should inform your doctor or pharmacist about any other medicines you are currently taking or have recently taken or may take. This includes medicines that can be bought without a prescription and herbal medicines. This is important because the ingredients of EMLA can affect the action of some other medicines, and some other medicines may affect the action of EMLA.
In particular, the patient should inform their doctor or pharmacist if they have used or taken any of the following medicines:

• Medicines used to treat infections called sulfonamides and nitrofurantoin.
• Medicines used to treat epilepsy: phenytoin and phenobarbital.
• Other local anesthetics.
• Medicines used to treat irregular heart rhythm, such as amiodarone.
• Cimetidine or beta-adrenergic blockers, which may increase the concentration of lidocaine in the blood. This interaction is not clinically significant in short-term use of EMLA in recommended doses.

Pregnancy, breastfeeding, and fertility

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before using this medicine.
Occasional use of EMLA during pregnancy is not associated with any risk of adverse effects on the fetus.
The active substances of EMLA (lidocaine and prilocaine) are excreted into breast milk. However, the amount that passes into the milk is so small that there is essentially no risk to the breastfed child.
In animal studies, no fertility disorders were found in males or females treated with the active ingredients of EMLA.

Driving and using machines

EMLA has no influence or negligible influence on the ability to drive and use machines when used in recommended doses.

EMLA contains macrogolglycerol hydroxystearate

Macrogolglycerol hydroxystearate may cause skin reactions.

3. How to use EMLA

EMLA should always be used as directed by a doctor, pharmacist, or nurse. If you are unsure, you should consult a doctor, pharmacist, or nurse.

Using EMLA

• The site of application, amount of cream, and time of application depend on the purpose for which it is used.
• The doctor, pharmacist, or nurse will apply the cream to the appropriate area or show the patient how to do it themselves.
• When EMLA is used on the genital area, the doctor or nurse should supervise its use.

EMLA should not be used in the following areas:

• Areas of cuts, scratches, or open wounds, except for ulcers on the lower limbs.
• Areas with skin rash or eczema.
• Eyes or near the eyes.
• Inside the nose, ears, or mouth.
• Rectum.
• Genital area in children.

People who frequently apply or remove the cream from the patient's body should ensure that they effectively avoid contact with the cream to prevent the development of hypersensitivity.
The protective membrane of the tube is pierced with the tube cap.

Application to the skin before minor procedures (such as needle insertion or minor surgical procedures on the skin):

• The cream is applied to the skin in a thick layer. The doctor, pharmacist, or nurse will tell the patient where to apply the cream.
• Then, the layer of cream is covered with a dressing (plastic foil). The dressing is removed immediately before the procedure starts. If the patient applies the cream themselves, they should ensure that they have received dressings from the doctor, pharmacist, or nurse.
• Usually, the dose used in adults and adolescents over 12 years of age is 2 g (grams).
• In adults and adolescents over 12 years of age, the cream should be applied at least 60 minutes before the planned procedure time (except when the cream is to be applied to the genital area). However, the cream should not be applied more than 5 hours before the procedure or earlier.
• In children, the amount of EMLA cream used and the time of application depend on the child's age. The doctor, nurse, or pharmacist will inform the patient how much cream to use and when to apply it.

When applying the EMLA cream, it is very important to follow the following instructions carefully:

• 1. Squeeze out a portion of the cream from the tube to form a mound at the site where it is needed on the skin (e.g., where the needle is to be inserted). Half of the contents of the 5 g tube corresponds to about 2 g of EMLA cream. Do not rub the cream into the skin.

• 2. Peel off the paper layer from the middle window of the non-adhesive side of the dressing (leaving the paper frame).

• 3. Remove the top layer of the adhesive dressing.

• 4. Carefully place the dressing over the mound of cream. Do not spread the cream under the dressing.

• 5. Remove the paper stiffener. Carefully smooth the edges of the dressing. Then, leave the dressing on for at least 60 minutes if the skin is not damaged. The cream should not be left on for more than 60 minutes in children under 3 months of age or more than 30 minutes in children with atopic dermatitis. In the case of application to the genital area or ulcers, shorter application times can be used as described below.

• 6. The doctor or nurse will remove the dressing and remove the cream immediately before the medical procedure (e.g., before inserting the needle).

Using EMLA on larger areas of freshly shaved skin before procedures in outpatient settings (such as hair removal):

Usually, the dose of EMLA used is 1 g of cream per 10 cm² (10 square centimeters) of skin surface, applied for 1 to 5 hours under a dressing. EMLA should not be used on an area of freshly shaved skin larger than 600 cm² (600 square centimeters, e.g., 30 cm x 20 cm). The maximum dose is 60 g.

Using EMLA on the skin before procedures in hospital settings (e.g., before skin grafting), which require deeper skin anesthesia:

• EMLA can be used in this way in adults and adolescents over 12 years of age.
• Usually, the dose used is 1.5 g to 2 g of cream per 10 cm² (10 square centimeters) of skin surface.
• The cream is applied and covered with a dressing for 2 to 5 hours.

Using EMLA on the skin before removing warts

• EMLA can be used in children and adolescents with atopic dermatitis.
• Usually, the dose used depends on the child's age and is applied for 30 to 60 minutes (30 minutes in patients with atopic dermatitis). The doctor, nurse, or pharmacist will inform the patient how much cream to use.

The patient should be informed how much cream to use.

Using EMLA on the genital area before injecting local anesthetics

• EMLA can be used in this way only in adults and adolescents over 12 years of age.
• Usually, the dose used is 1 g of cream (1 g to 2 g in the case of the genital area in women) per 10 cm² (10 square centimeters) of skin surface.
• The cream is applied and covered with a dressing. The dressing is left on for 15 minutes in men and 60 minutes in women.

on the genital area.

Using EMLA on the genital area before minor surgical procedures on the skin (such as removing warts)

• EMLA can be used in this way only in adults and adolescents over 12 years of age.
• Usually, the dose used is 5 g to 10 g of cream for 10 minutes. No dressing is used. The procedure should be started immediately after.

Using EMLA on ulcers on the lower limbs before debridement or removal of damaged skin

• Usually, the dose used is 1 g to 2 g of cream per 10 cm² (10 square centimeters) of skin surface and no more than 10 g.
• The cream is applied and covered with a tight dressing, e.g., plastic foil. The cream and dressing are applied 30 to 60 minutes before the debridement procedure. The cream should be removed with a cotton swab and the debridement started immediately.
• EMLA can be used before debridement of ulcers on the lower limbs up to 15 times over a period of 1-2 months.
• In the case of using the cream on ulcers on the lower limbs, the EMLA tube should be used as a single-use product: after each use of the cream in the patient, the tube with the remaining amount of cream should be discarded.

Using more EMLA than recommended

If more EMLA than recommended by the doctor, pharmacist, or nurse is used, they should be contacted immediately, even if the patient does not feel any discomfort.
Problems and discomfort that may occur after using too much EMLA are listed below. These discomforts should not occur when using EMLA as directed.

• Feeling of "emptiness" in the head or dizziness.
• Numbness or tingling of the skin around the mouth and tongue.
• Disturbed sense of taste.
• Blurred vision.
• Ringing in the ears.
• There is also a risk of methemoglobinemia (a problem with the concentration of blood pigment). This is more likely if the patient is taking certain other medicines. In the case of this condition, the skin becomes blue-gray due to insufficient oxygen in the blood.

In severe cases of overdose, symptoms such as seizures, decreased blood pressure, decreased breathing rate, respiratory arrest, and abnormal heart rhythm may occur. These problems can be life-threatening.
If you have any further doubts about using this medicine, you should consult a doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, EMLA can cause side effects, although not everybody gets them.
If the patient experiences any of the following side effects, they should contact their doctor or pharmacist. They should tell their doctor about all the discomfort they experience when using EMLA.
In the area where EMLA is used, a mild reaction may occur (pallor or redness of the skin, slight swelling, initial burning or itching sensation). These are common reactions to the cream and anesthetics, which disappear after a short time without the need for any medical intervention.
If the patient experiences any worrying or unusual reactions or effects when using EMLA, they should stop using it and contact their doctor or pharmacist as soon as possible.
Common(may affect up to 1 in 10 people)

• Transient local skin reactions (pallor, redness, swelling) at the site of application when used on the skin, mucous membrane of the genital area, or on ulcers on the lower limbs.
• Initial mild burning, itching, or warmth sensation at the site of application when used on the mucous membrane of the genital area or on ulcers on the lower limbs.

Uncommon(may affect up to 1 in 100 people)

• Initial mild burning, itching, or warmth sensation at the site of application when used on the skin.
• Numbness (tingling) at the site of application when used on the mucous membrane of the genital area.
• Skin irritation at the site of application when used on ulcers on the lower limbs.

Rare(may affect up to 1 in 1000 people)

• Allergic reactions, which in rare cases can lead to anaphylactic shock (skin rash, swelling, fever, difficulty breathing, and fainting) when used on the skin, mucous membrane of the genital area, or on ulcers on the lower limbs.
• Methemoglobinemia (blood disorder) when used on the skin.
• Mild pinpoint bleeding (petechiae) at the site of application (especially in children with eczema after longer application time) when used on the skin.
• Irritation of the eyes if they accidentally come into contact with the EMLA cream during its application on the skin.

Additional side effects in children

Methemoglobinemia, a blood disorder, which is more commonly observed in children, often in association with overdose in newborns and infants from 0 to 12 months of age.

Reporting side effects

If side effects occur, including any not listed in the leaflet, the patient should tell their doctor or pharmacist. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: +48 22 49 21 301, fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl.
By reporting side effects, more information can be collected on the safety of the medicine.

5. How to store EMLA

Keep the medicine out of the sight and reach of children.
Do not freeze. Keep the tube tightly closed.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month.
Medicines should not be disposed of via wastewater or household waste. You should ask your pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

6. Contents of the packaging and other information

What EMLA contains

• The active substances of EMLA are: lidocaine and prilocaine. 1 g of cream contains: 25 mg of lidocaine and 25 mg of prilocaine.
• EMLA also contains: carbomers, macrogolglycerol hydroxystearate, sodium hydroxide, and purified water.

What EMLA looks like and what the packaging contains

White, homogeneous cream.
EMLA is packaged in an aluminum tube with a membrane coated with a protective lacquer based on epoxy resin with a polypropylene cap and a piercing device, in a cardboard box.
EMLA is available in the following packaging:
1 tube containing 5 g of cream and 2 dressings
1 tube containing 5 g of cream and 3 dressings
5 tubes containing 5 g of cream and 10 dressings
5 tubes containing 5 g of cream and 12 dressings.
For more detailed information, you should contact the marketing authorization holder or parallel importer.

Marketing authorization holder in Greece, the country of export:

Aspen Pharma Trading Limited
3016 Lake Drive
Citywest Business Campus
Dublin 24, Ireland

Manufacturer:

Recipharm Karlskoga AB
Bjorkbornsvagen 5
SE-691 33 Karlskoga
Sweden
AstraZeneca AB
Astraallén, Gärtunaporten (B674:5)
S-151 85 Södertälje
Sweden
AstraZeneca UK Limited
Silk Road Business Park
Macclesfield
Cheshire
SK10 2NA
United Kingdom
AstraZeneca GmbH
Tinsdaler Weg 183
DE-22880 Wedel
Germany

Parallel importer:

InPharm Sp. z o.o.
ul. Strumykowa 28/11
03-138 Warsaw

Repackaged by:

InPharm Sp. z o.o. Services sp. k.
ul. Chełmżyńska 249
04-458 Warsaw
Marketing authorization number in Greece, the country of export:54941/21-10-2003
40466/15-09-2009
78819/16/22-03-17
Parallel import authorization number:553/12

This medicinal product is authorized in the Member States of the European Economic Area under the following names:

Austria
Emla 5% - Creme
Belgium
Emla 25mg/25mg crème
Cyprus
Emla Cream 5%
Czech Republic
Emla krém 5%
Denmark
Emla
Finland
EMLA
France
EMLA 5 POUR CENT, crème
Germany
EMLA
Greece
EMLA
Iceland
Emla
Ireland
EMLA 5% w/w Cream
Italy
EMLA
Latvia
Emla 5 % krēms
Luxembourg
Emla 25mg/25mg crème
Malta
EMLA 5% w/w Cream
Norway
Emla
Poland
EMLA
Portugal
Emla
Spain
EMLA 25 mg/g + 25 mg/g crema
Sweden
EMLA
Netherlands
Emla
United Kingdom
Emla Cream 5%
Date of approval of the leaflet: 04.10.2022
[Information about the trademark]