Usage
Lidocaine + Zinc Carnosine is primarily prescribed for the treatment of painful mouth ulcers (aphthous stomatitis). It combines the local anesthetic action of lidocaine with the potential mucosal protective and wound-healing effects of zinc carnosine. It can also be used as a zinc supplement. Other uses include treatment of gastric ulcers, pain, itching, sunburn, burns, premature ejaculation, and erectile dysfunction.
It can be categorized as a combination drug with local anesthetic and nutritional supplement properties.
Lidocaine works by blocking sodium channels, inhibiting nerve impulse transmission and reducing pain. Zinc carnosine’s mechanism is not fully understood but is thought to involve antioxidant, anti-inflammatory, and growth-promoting effects on the mucosal lining.
Alternate Names
Polaprezinc, PepZin GI™
How It Works
Pharmacodynamics: Lidocaine blocks voltage-gated sodium channels, thus preventing pain signal transmission. Zinc carnosine stabilizes and protects the gastric and intestinal mucosal lining, promoting ulcer healing. This may involve antioxidant, anti-inflammatory, and growth factor-stimulating effects. It also enhances gastric lining integrity.
Pharmacokinetics: Lidocaine is absorbed through mucous membranes; systemic absorption from topical oral application is minimal but can increase with application to damaged skin. It is metabolized in the liver and excreted renally. Zinc carnosine’s pharmacokinetics after topical oral administration are not well-characterized. However, when taken orally it slowly dissociates in the gastrointestinal tract, the zinc is poorly absorbed, being primarily eliminated in feces. Carnosine is further metabolized to L-histidine which is primarily used in the production of proteins.
Dosage
Standard Dosage
Adults:
A pea-sized amount of gel applied directly to the mouth ulcer 3-4 times daily. Avoid eating or drinking for at least 30 minutes post-application. As a zinc supplement, 75 mg three times daily or 150 mg twice daily is used. For other conditions, such as gastric ulcers or taste impairment, 75-150 mg of Zinc Carnosine can be taken twice or thrice a day.
Children: Use in children should be under the guidance of a healthcare professional.
Special Cases:
- Elderly Patients: 100 mg Zinc Carnosine daily is recommended due to potentially reduced digestive function.
- Patients with Renal Impairment: Caution is advised in severe renal impairment due to the systemic absorption of lidocaine.
- Patients with Hepatic Dysfunction: Caution advised in severe hepatic impairment due to potential for reduced lidocaine metabolism. Medical supervision is needed.
Clinical Use Cases
Lidocaine, when used intravenously, is given at 1.5 mg/kg 3 minutes before intubation. For suctioning intubated patients, endotracheal lidocaine can be administered at 5-6 mg/kg. Specific dosage for Lidocaine + Zinc Carnosine is not established for clinical situations like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Adjustments are based on patient response, tolerability, renal/hepatic function, and age.
Side Effects
Common Side Effects
Burning or stinging at the application site (transient). Nausea, indigestion, and stomach pain can also occur.
Rare but Serious Side Effects
Allergic reactions (rash, hives, itching, swelling). Depression and convulsions have been reported.
Long-Term Effects
No significant long-term effects are known with topical use.
Adverse Drug Reactions (ADR)
Severe allergic reactions (anaphylaxis).
Contraindications
Hypersensitivity to lidocaine, zinc, or carnosine. Severe liver or kidney disease. Burns, eczema, heart failure, atrial fibrillation and atrial flutter. Drug allergies.
Drug Interactions
Other local anesthetics (additive effects), drugs that prolong the QT interval (increased risk of arrhythmias), medications affecting liver enzymes (altered lidocaine metabolism). Amiodarone and codeine. Corticosteroids (such as prednisone and dexamethasone). Medications affecting blood coagulation (like warfarin and heparin). Other local anesthetics (including bupivacaine and ropivacaine) may interact with lidocaine. Alcohol may interact. Interaction with medications for diabetes may cause blood sugar to drop too low.
Pregnancy and Breastfeeding
Consult with a physician before using during these stages. The safety of Lidocaine + Zinc Carnosine during pregnancy hasn’t been established. Lidocaine is present in breast milk, generally considered safe. However, zinc carnosine’s impact on infants isn’t well studied. Breastfeeding is probably safe if prescribed.
Drug Profile Summary
- Mechanism of Action: Lidocaine blocks sodium channels, reducing pain. Zinc carnosine protects and heals the mucosal lining, possibly via antioxidant and anti-inflammatory effects.
- Side Effects: Burning/stinging at the application site, allergic reactions, nausea, indigestion, stomach cramps.
- Contraindications: Hypersensitivity, severe liver/kidney disease.
- Drug Interactions: Other local anesthetics, QT-prolonging drugs, liver enzyme modifiers. Alcohol, medications affecting blood coagulation, corticosteroids.
- Pregnancy & Breastfeeding: Consult a doctor.
- Dosage: Topical: Pea-sized amount 3-4 times/day. Oral: 75-150 mg two or three times a day. Elderly: 100 mg/day. Adjustments needed for hepatic/renal impairment.
- Monitoring Parameters: Liver and kidney function tests, blood sugar levels for diabetic patients.
Popular Combinations
No specific popular drug combinations.
Precautions
General precautions include pre-screening for allergies and organ dysfunction. Caution for pregnant/breastfeeding women, children, and elderly. Lifestyle considerations: Discuss alcohol use with patients.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lidocaine + Zinc Carnosine?
A: For mouth ulcers, apply a pea-sized amount of gel 3-4 times daily. As a zinc supplement, 75 mg three times daily or 150 mg twice daily has been used. For other conditions, consult dosage guidelines based on the specific situation.
Q2: Can Lidocaine + Zinc Carnosine be used during pregnancy or breastfeeding?
A: Consult a physician before using during pregnancy or breastfeeding. Safety hasn’t been definitively established.
Q3: What are the common side effects of Lidocaine + Zinc Carnosine?
A: Common side effects include a transient burning or stinging sensation at the application site. Nausea, indigestion, and stomach pain can also occur.
Q4: Are there any drug interactions I should be aware of?
A: Yes, Lidocaine + Zinc Carnosine may interact with other local anesthetics, drugs that prolong the QT interval, medications affecting liver enzymes, and possibly alcohol.
Q5: How does Zinc Carnosine contribute to the healing of mouth ulcers?
A: Zinc carnosine’s mechanism is not fully understood, but it is thought to stabilize and protect the mucosal lining, promoting ulcer healing through antioxidant, anti-inflammatory, and possibly growth-promoting effects.
Q6: Can Lidocaine + Zinc Carnosine be used in children?
A: Use in children should be under the guidance of a healthcare professional.
Q7: What are the contraindications for Lidocaine + Zinc Carnosine?
A: Contraindications include hypersensitivity to lidocaine, zinc, or carnosine, and severe liver or kidney disease.
Q8: Are there any precautions for elderly patients?
A: A lower dose of 100 mg Zinc Carnosine is recommended in the elderly due to reduced digestive function.
Q9: How should Lidocaine + Zinc Carnosine gel be applied?
A: Apply a pea-sized amount directly to the mouth ulcer. Avoid eating or drinking for at least 30 minutes after application.
