Gabapentin | Amitriptyline | Lidocaine Cream

This cream works in more than one way to help calm pain signals in the skin and nearby nerves. Lidocaine is a local numbing medicine that blocks tiny electrical signals in nerves, which can lessen pain and sensitivity; it can start to work within about 15 to 60 minutes and may last a few hours. Amitriptyline, when used on the skin, may help reduce nerve pain by changing how nerve endings send pain messages; it may take several days to a few weeks of regular use to notice the full benefit. Gabapentin, when used topically, is intended to calm overactive nerve signaling in the painful area; benefit may build over days to weeks. Many people notice less burning, shooting pain, or “pins and needles,” but results vary and some people may not respond.

Do not use if you are allergic to gabapentin, amitriptyline, lidocaine, other “-caine” numbing medicines (such as prilocaine or benzocaine), or any ingredient in the cream; serious allergic reactions can occur. Do not apply to broken skin, open wounds, severe rash, or infected areas unless your prescriber tells you to, because more medicine may absorb into your body and raise side effect risk. Do not use if you have ever had a serious heart rhythm problem and your prescriber has told you to avoid amitriptyline, because amitriptyline can affect heart rhythm if enough is absorbed. Do not use in children unless specifically prescribed, because safe use depends on age, body size, and the area being treated. Tell your prescriber before use if you are pregnant, planning pregnancy, or breastfeeding; topical use may still lead to some absorption, and your prescriber will help weigh risks and benefits. Use with extra caution in older adults and in people with severe liver disease, because side effects may be more likely if the medicine builds up in the body.

This medication may interact with other medicines even though it is applied to the skin, especially if used on large areas, used often, or used under tight bandages/occlusion. Serious: Do not use with MAOI antidepressants (such as phenelzine, tranylcypromine, selegiline, or isocarboxazid) unless your prescriber specifically approves; combining with amitriptyline can cause dangerous side effects. Serious: Medicines that can affect heart rhythm (QT prolongation) such as amiodarone, sotalol, dofetilide, some antibiotics (like azithromycin, clarithromycin, levofloxacin), and some antipsychotics (like haloperidol, quetiapine) may add risk when combined with amitriptyline; tell your prescriber if you take any of these. Moderate: Other medicines that cause sleepiness or slow breathing (opioid pain medicines, benzodiazepines like alprazolam/lorazepam, sleep medicines like zolpidem, muscle relaxers like cyclobenzaprine, and antihistamines like diphenhydramine) may increase drowsiness or dizziness if enough amitriptyline or gabapentin is absorbed; avoid alcohol and use caution with driving. Moderate: Other antidepressants (SSRIs/SNRIs like fluoxetine, paroxetine, sertraline, duloxetine, venlafaxine) can raise the chance of side effects; your prescriber may monitor you more closely. Moderate: Other numbing products (lidocaine patches, lidocaine gels/sprays, benzocaine products) can add up and increase the risk of numbness, dizziness, or heart-related side effects; ask your pharmacist before combining. Herbal and supplements: St. John’s wort, valerian, kava, and melatonin may increase drowsiness; use caution. Tell your healthcare provider and pharmacist about all prescription medicines, over-the-counter medicines, and supplements you use.

Most side effects are local (on the skin) and improve after you wash the area or stop using the cream. Very common/common: temporary burning, stinging, itching, redness, dryness, or rash where applied. Common: numbness or tingling beyond the treated area, skin sensitivity, or mild swelling. Uncommon: dizziness, sleepiness, blurred vision, dry mouth, constipation, or trouble urinating (more likely if applied to large areas or used often). Rare but serious (get emergency help): signs of a severe allergic reaction such as hives, swelling of the face/lips/tongue, severe dizziness, or trouble breathing. Rare but serious: fast or irregular heartbeat, fainting, severe confusion, severe weakness, or seizures, which may happen if too much medicine is absorbed (for example, using on large areas, broken skin, or under tight coverings). If you have new or worsening mood changes, severe sleepiness, or you feel unsafe, contact your healthcare provider right away.

Store at room temperature (68-77 degrees F / 20-25 degrees C) unless your pharmacy label tells you differently. Keep away from heat, direct sunlight, and moisture. Do not store in the bathroom or near a kitchen sink. Keep the container tightly closed when not in use and keep out of reach of children and pets. Do not freeze unless directed by the pharmacy. Dispose of expired or unused cream through a pharmacy take-back program when available; if not available, place the cream in a sealed bag with an unwanted material (like coffee grounds or cat litter) and throw it in the household trash, and remove personal information from the label.