Home ›› Drugs ›› Emla Cream – The Strongest Numbing Cream Over The Counter
Emla Cream

Emla Cream – The Strongest Numbing Cream Over The Counter

Emla Cream is an over the counter topical cream. It’s used to produce a strong local pain insensitivity. It is used whenever the skin is injured, for example, in the insertion of catheters in veins, in blood collection and surgical procedures on the skin surface.

Furthermore, This potent pain cream protects against pain when dead tissue has to be removed during wound cleansing of leg ulcers (ulcus cruris).

For minor surgeries on the mucosal surface of the genitals, Emla cream provides pain resistance and is also used to make punctures bearable for deeper tissue anesthesia.


Emla Cream contains the two active ingredients lidocaine and prilocaine.

The following non-active ingredients are included in the drug:

  • Carbomer 974P
  • purified water
  • sodium hydroxide
  • Poly (oxyethylene) -54 hydrogenated castor oil

Main Uses

  • Local anesthesia of the skin prior to waxing, piercings, insertion of venous catheters, prior to blood sampling and surgical procedures on the skin surface.
  • Local pain relief before tattooing sessions and removal of dead tissue in ulcers of the legs (ulcus cruris).
  • Local anesthesia of the mucosa in the pubic area during hair removing and minor surgical procedures on the mucosal surface.
  • Pain suppression with deep injection of local anesthetic into the mucous membranes of the pubic area.
  • Premature Ejaculation in men  to last longer in bed. It’s an off-label use for numbing genitals to have a longer sexual intercourse.


A thick layer of cream is applied to the areas of the skin to be treated under airtight patches. The minimum exposure time is one hour; the longest possible five hours. Then the numbing effect subsides. Before removal of mollusc warts in children with atopic dermatitis, an exposure time of 30 minutes is recommended.

In infants between three and eleven months, the cream should not remain on the skin for more than four hours, in newborns and infants for up to two months, not more than one hour. Once the maximum dosage has been applied to newborns and infants up to three months, further treatment should be given at least eight hours apart.

Before the procedure at the anesthetized place the usual disinfection measures are to be considered and the dressing and the cream are to be removed from the skin. After removing the bandage and the cream, the local anesthetic is at least one more hour.

For skin anesthesia, also for piercing a vein, adolescents from 12 years and adults wear about 1.5 grams of cream on 10 square centimeters of skin. In children from one to eleven years, the dosage is one gram per 10 square centimeters of skin. Infants up to twelve months of age receive about 0.5 grams on 5 square centimeters of skin.

For larger-scale surgical procedures on the skin surface during a hospital stay, for example in skin transplants, about 1.5 to 2 grams of cream are applied to 10 square centimeters of skin.

For wound cleansing of a leg ulcer, a thick layer of cream is applied to the surface to be cleaned and covered with an
airtight patch of suitable size. It uses about 1 to 2 grams of cream / 10 square centimeters of skin and up to a maximum of 10 grams of cream. The exposure time is 30 to 60 minutes.

When applied to the pubic mucosa, approximately 5 to 10 grams of cream are applied to the affected area of ​​the mucosa in adolescents aged 12 years and above for surgical removal of genital warts and prior to injection of local anesthetic. The exposure time is 5 to 10 minutes.

If the cervix is ​​scraped off (cervical curettage), apply 10 grams of cream to the lateral vaginal vault. The exposure time is 10 minutes.

For topical anesthesia prior to injection of anesthetic into the skin of the pubic area, a thick layer of cream is applied to the area of ​​the skin to be treated (approximately 1 gram of cream / 10 square centimeters) and sealed airtight. The exposure time is 15 minutes under an airtight dressing. For women, 1 to 2 grams of cream / 10 square centimeters are used and the duration of exposure to an airtight bandage is 60 minutes.

Side Effects

Depending on the place of application, differences in the type and frequency of side effects arise:

On uninjured skin

Common side effects:
Transient local reactions in the treated skin area, such as paleness, redness and swelling.

Uncommon Side Effects:
Skin reactions (initial mild burning sensation, itching or sensation of warmth in the treated area of ​​the skin).

Rare side effects:
single local bruises or subcutaneous hemorrhages in the treated skin area (especially after prolonged treatment of children with atopic dermatitis or mollusc warts), methaemoglobinaemia , corneal irritation after accidental eye contact, allergic reactions (in severe cases to shock ).

On the pubic area

Common side effects:
Transient local reactions (eg paleness, reddening and swelling), skin reactions (initially usually mild burning sensation,
itching or sensation of warmth in the treated skin area).

Uncommon side effects:
local sensation (tingling)

Rare side effects:
allergic reactions (in severe cases to shock).

Wound cleansing in leg

ulcers Common side effects:
Transient local reactions (paleness, redness or swelling), skin reactions (initially usually mild burning sensation, itching or sensation of warmth in the treated skin area).

Uncommon Side Effects:
Skin irritation at the site of use.

Rare side effects:
allergic reactions (in severe cases to shock).

Drug Interactions

Together with the combination form sulfonamides ( antibiotics group), nitroglycerin (against angina pectoris), the gastric agent metoclopramide , the antiepileptic drug phenytoin and the leprosy agent dapsone reinforced an altered form of red blood pigment (methemoglobin). Methaemoglobin can no longer bind oxygen, therefore, concomitant use should be avoided. This is especially true for infants up to twelve months.

Because some foods also form methemoglobin (for example, nitrites and nitrates in pickling salt), they should also not be used with the combination.

If the combination is used in high dosage (simultaneous treatment of several skin areas) together with lidocaine and / or prilocaine in another application form, their toxic effects in the body can be increased. The same applies to other means of local anesthesia or chemically related substances such as the antiarrhythmic tocainide and mexiletine.

Special studies on interactions of lidocaine with Class III antiarrhythmic drugs (eg amiodarone ) have not been performed, but medical attention should be taken.

Substances that inhibit the secretion of lidocaine (such as the gastric agent cimetidine or beta-blockers ) may result in toxic concentrations of the drug. This is especially true if lidocaine is repeatedly used in high doses over a longer period of time. Because the application on the skin but only small doses and short-term, such interactions are unlikely to occur.


Emla Cream should not be used in cases of hypersensitivity to lidocaine and prilocaine.

In addition, the use in the ear canal or inner ear is prohibited because damage to the inner ear can not be ruled out with certainty.

Only after careful consideration of the benefit and risk by the physician and under his control may the combination be used

  • open wounds except for the preparation of the cleaning of a leg ulcer, because too little is known about the absorption of the active ingredients in the body
  • Patients with congenital or later red blood cell malformations ( methaemoglobinaemia ) or patients with deficiency of the enzyme glucose-6-phosphate dehydrogenase, as the use of the combination increases the risk of methaemoglobin formation
  • severe hepatic impairment because it delays the elimination of the drug
  • Patients with atopic dermatitis (atopic dermatitis), as a shorter exposure time may be sufficient due to the previously damaged skin
  • Use in the environment of the eye, as eye irritation may occur and the absence of protective eyelids may damage the cornea
  • Administration of live vaccines, as the combination may reduce their effect.

Pregnancy & Lactation

Although the use of the cream on the skin is very low for absorption in the body, it should be used with care in pregnant women.

Lidocaine and, most likely, prilocaine also pass into breast milk. However, in normal use on the skin, this is done in such small amounts that the risk of side effects in the breast-fed child is considered very low. However, contact of the infant with the treated skin should be avoided.


  • In appropriate dosage, the combination can also be applied to the skin of newborns and infants. However, a use on the skin or mucous membrane of the pubic region in children may be made only from twelve years.
  • The drug can, before vaccinations with life vaccines applied to the injection site, endangering the vaccination success.
  • If the eyes are in contact with the drug, the eye must be immediately rinsed with plenty of lukewarm water or isotonic saline and then protected until sensation or vision is restored.
  • The drug must not be frozen.
  • The adjuvant poly (oxyethylene) -54-hydrogenated castor oil contained in the drug can cause skin irritation.
  • Medicines can cause allergic reactions. Signs of this may include: rash, runny nose, itching, mucosal swelling, itching and redness of the eyes, narrowing of the airways (asthma). In rare cases allergic shock with unconsciousness may occur. If you notice signs of an allergic reaction, inform a doctor immediately.

Overall Rating

Ease of Use
Action Duration
Side Effects Tolerability


It's a very popular anesthetic cream with amazing results.

User Rating: 4.7 ( 1 votes)

One Unbiased Opinion

  1. Chris Lee

    This cream stuns as hoped.

    I use it before sessions of permanent hair removal with IPL in the most sensitive areas.

    On legs, it doesn’t much effect – probably due to skin thickness compared to armpits and genital areas.

Leave a Reply

Your email address will not be published. Required fields are marked *


error: Content is protected !!