My Hospital computer would not permit an image pertinent to this post to be downloaded without admin privileges, so here is a photo of Quinoa.

Pearl: Lidoderm 4% patches are available over the counter. Lidoderm 5% patches are prescription only.

Background: There are decent data that for certain indications (post-herpetic neuralgia, neuropathic pain) that topical analgesic are as efficacious as systemic medications, but with reduced systemic side effects due to low systemic absorption. The problem, in the US, is that these options (i.e. lidoderm 5% patches, ketoprofen gel) are either very expensive (the former) or not available in the U.S. (the latter). For a fun romp through the meadows of topical analgesia guided by our own Nick Genes, including a review of some of the evidence to which I allude, click here.

Tip: One simple work-around is to recommend lidoderm 4% patches rather than 5%. Though we do not have a head-to-head comparison of the two, one could reasonably expect a similar effect. While lidoderm 5% patches can cost hundreds of dollars and are often not covered by insurance, lidoderm 4% patches are available OTC from many pharmacies (Walgreens and RiteAid had them on their website, CVS did not and the 97th st pharmacist had never heard of them, Amazon sells them in bulk). Naturally, for some patients finding the correct patch in the sea of medications at a pharmacy may prove an added barrier to treatment, but it is at least an option. If you are really counting on the OTC patch as your treatment strategy, however, consider calling the pharmacy to ensure it is in stock.

Credit goes to Angela Chen and Nick Genes for suggesting this post. Have something you want to know but don’t want to look up? Email me and maybe it will become a Pearl!