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Key takeaways
Lidocaine is widely used for local anesthesia. Alternatives include Marcaine, Xylocaine with epinephrine, Nesacaine, Altacaine, and Benzodent.
Alternatives to lidocaine include both amide and ester-class local anesthetics. Options vary in application method, duration of action, and potential for allergic reactions.
Among the top alternatives, Marcaine offers longer-lasting anesthesia, Xylocaine with epinephrine reduces bleeding, Nesacaine serves as an ester alternative for those allergic to amides, and Altacaine and Benzodent provide options for eye and oral pain relief.
Natural substances and discussing options with a healthcare provider are important steps for those considering switching from lidocaine to a more suitable local anesthetic solution.
Just because lidocaine is the most commonly used local anesthetic for sedation approved by the Food and Drug Administration (FDA), it does not mean that lidocaine is the right choice for everyone. While its forte provides local pain relief by numbing the region where it is applied or injected, other options exist. Those alternatives may offer a longer action duration or help avoid an allergic reaction. What they lack is the diversity of formulations that lidocaine is available. To help better sift through the options to find a fitting substitute for lidocaine, we will present detailed comparisons to take any ideas to a healthcare provider for medical advice.
What can I take in place of lidocaine?
Local anesthetics or pain relievers come from one of two major classes. Lidocaine headlines the amide group of local anesthetic agents. They produce analgesia by blocking sodium channels within nerve cells. Lidocaine can be injected in a subcutaneous fashion (under the skin), infiltrated into the skin, applied as a topical gel or patch, or swished in the mouth. Intravenous lidocaine is a treatment for certain heart rhythm problems. Although not nearly as adaptable to different routes of application, other amide anesthetics include mepivacaine, prilocaine, ropivacaine, and bupivacaine.
The second local anesthetic class is the ester family, headlined by Novacaine (procaine), the infamous injectable numbing agent used by dentists historically. Tetracaine, chloroprocaine, and benzocaine are other esters.
Compare Lidocaine (Xylocaine) alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Xylocaine (lidocaine) 1% solution | Local or regional anesthesia, heart arrhythmia | Procedure-dependent dose infiltrated into tissue locally for procedures, variable antiarrhythmic dosing | Xylocaine 1% solution coupons |
| Xylocaine (lidocaine) 1% preservative-free solution | Local or regional anesthesia, heart arrhythmia | Procedure-dependent dose infiltrated into tissue locally for procedures, variable antiarrhythmic dosing | Xylocaine 1% preservative-free solution |
| Xylocaine (lidocaine) 1% with epinephrine solution | Local or regional anesthesia | Weight-based 20 to 500 mg infiltrated into tissue locally | Xylocaine 1% with epinephrine solution coupons |
| Lidocaine 5% patch | Post-herpetic neuralgia | Apply one patch to the affected area for up to 12 hours per day as needed | Lidocaine 5% patch coupons |
| Lidocaine 2% viscous solution | Oral, pharyngeal, or nasal anesthesia | 1 to 5 mL applied every 3 hours as needed | Lidocaine 2% viscous solution coupons |
| Lidocaine 3% cream | Painful skin conditions | Apply 2 to 3 times daily as needed | Lidocaine 3% cream coupons |
| Marcaine (bupivacaine) 0.25% solution | Local or regional anesthesia | Procedure-dependent dose infiltrated into tissue locally for procedures | Marcaine 0.25% solution coupons |
| Marcaine (bupivacaine) 0.25% with epinephrine | Local or regional anesthesia | Procedure-dependent dose infiltrated into tissue locally for procedures | Marcaine 0.25% with epinephrine solution |
| Altacaine (tetracaine) ophthalmic | Ophthalmic anesthesia | 1 drop into the affected eye as needed | Altacaine coupons |
| Lidocaine 2.5% with prilocaine 2.5% cream | Local anesthesia | 2 grams applied to area 1 hour before procedure | Lidocaine 2.5% with prilocaine 2.5% cream coupons |
| Naropin (ropivacaine) 0.5% solution | Local or regional anesthesia | Procedure-dependent dose infiltrated into tissue locally for procedures | Naropin solution coupons |
| Nesacaine (chloroprocaine) 1% solution | Local or regional anesthesia | Procedure-dependent dose infiltrated into tissue locally for procedure | Nesacaine coupons |
| Benzodent (benzocaine oropharyngeal) 20% topical cream | Local anesthesia | Applied to the affected area of mouth four times daily as needed | Benzodent coupons |
Other alternatives to lidocaine
Top 5 lidocaine alternatives
The following are some of the most common alternatives to lidocaine.
1. Marcaine (bupivacaine Hcl)
Marcaine and its generic version, bupivacaine, are options to consider if looking for an injectable local anesthetic that outlasts lidocaine. While lidocaine provides moderate anesthesia duration, Marcaine is considered one of the longest-lasting agents. A nerve block injection of Marcaine can result in up to 15 hours of anesthesia, depending on location.
Of note, adverse reactions could be longer lasting too. Both lidocaine and bupivacaine can cause local burning, and more alarmingly, they can cause systemic toxicity if too much is absorbed. Those risks include seizures, heart arrhythmias, vomiting, tremors, low blood pressure, and conditions called local anesthetic systemic toxicity (LAST) and methemoglobinemia, both of which can be fatal.
2. Xylocaine with epinephrine (lidocaine-epinephrine)
Adding epinephrine (a vasoconstrictor) to injectable lidocaine hydrochloride solutions or other local anesthetics can prolong the analgesic effect and reduce the bleeding at the procedure site. The downside to Xylocaine with epinephrine is that one may experience side effects such as more of an uncomfortable burning session when the injection is first given. This is a result of it being more acidic than regular Xylocaine.
3. Nesacaine
Allergic reactions to the local anesthetic class of medication are not common. Signs of an allergic reaction differ from potential side effects. Local dermatitis from the injection or vasovagal reactions to the procedure may look like an allergic reaction but do not have a dangerous allergic cause. If hypersensitivity reactions with symptoms such as urticaria (hives) or anaphylactic reactions after receiving lidocaine occur, seeing an allergist for skin testing is important. The plan often involves trying an ester local anesthetic such as Nesacaine instead to avoid cross-reactivity.
4. Altacaine (tetracaine Hcl)
Xylocaine is the brand-name version of locally injectable lidocaine, but other products package lidocaine in mouthwash, patch, and cream forms. Among the versatile formulations of lidocaine on the market is a lidocaine-based eye gel Akten. Altacaine eye drops provide an alternative to Akten from the ester category. It can be useful for short-term relief of eye pain.
5. Benzodent
Another niche for local anesthesia is pain relief from mouth conditions. Benzodent is a topical cream that may be easier to apply to mouth sores than viscous lidocaine. Commonly reported side effects often resolve as the body adjusts to the medication. While relatively inexpensive, presenting a SingleCare discount card to a pharmacist may help get Benzodent, Xylocaine, or any topical anesthetics at a lower cost.
Natural alternatives to lidocaine
Considering a natural pain relief option as an alternative to lidocaine is not so crazy. The local anesthetic family is closely related to cocaine, a derivative of the coca plant. Cocaine is an ester anesthetic, having structural similarities to Novocaine and Benzodent. More than just interesting, this bit of trivia about cocaine is a great example of how natural substances can have the potential for serious adverse effects.
With that said, more mundane plants, roots, and herbs have substances with local anesthetic properties, as reviewed in a comprehensive article on the subject. The review article lists several essential oils, including thyme, lavender, and nutmeg, as having substances that can act on nerve fibers to reduce pain signals. Unfortunately, dosing guidelines and full safety reviews are lacking. Likewise, despite their defined roles in the medical treatment of other conditions, magnesium, and vitamin B12 supplements have promising but still unclear potential for pain management.
How to switch to a lidocaine alternative
Having brushed up on different lidocaine forms and alternatives, one can be prepared to sit with a healthcare provider. A conversation about lidocaine concerns and what other interest options should be had. After reviewing a list of prescription drugs, over-the-counter medications, and supplements to avoid drug interactions, the healthcare provider can provide additional drug information to help determine which alternative makes the most sense. Another possibility is that one may walk away with a better understanding of why lidocaine is still a good choice.