Topical Anesthetic Selector
Find Your Best Topical Anesthetic
Select your needs to find the most appropriate numbing cream for your procedure.
When a minor skin procedure or a painful stitch is on the agenda, a quick‑acting numbing cream can be a game‑changer. Prilox cream is one of the most talked‑about options in Australia, but how does it really stack up against other topical anesthetics? This guide breaks down the chemistry, performance, cost and safety of Prilox and its main competitors so you can pick the right product for the job.
Key Takeaways
- Prilox combines lidocaine (5%) and prilocaine (5%) for fast onset (3‑5min) and moderate depth (2‑4mm).
- EMLA (2.5% lidocaine+2.5% prilocaine) offers longer lasting anesthesia but takes 60‑90min to work.
- Benzocaine (10-20%) provides rapid surface relief but shallow penetration and higher allergy risk.
- Oraqix, a lidocaine‑tetracaine gel, is designed for dental procedures and delivers numbness for up to 2hours.
- Cost, application time and contraindications are the biggest factors when choosing a numbing cream.
What Is Prilox Cream?
Prilox Cream is a topical anesthetic formulation containing 5% lidocaine and 5% prilocaine. First approved in Australia in 2008, it is marketed for minor skin procedures, venipuncture, tattooing and minor burns. The cream is packaged in a 30g tube, designed to be applied in a thin layer and covered with an occlusive dressing for optimal absorption.
Key attributes:
- Onset: 3‑5minutes when covered.
- Duration: 30‑60minutes of effective anesthesia.
- Depth of penetration: approximately 2‑4mm, sufficient for superficial skin work.
- Side‑effects: mild erythema, rare systemic toxicity at recommended doses.
How Prilox Works
Both lidocaine and prilocaine block voltage‑gated sodium channels in peripheral nerves, preventing the initiation and propagation of pain signals. The combination creates a synergistic effect: lidocaine provides quick onset, while prilocaine extends the duration. Because the two agents are present at equal concentration, the risk of methemoglobinemia remains low-unlike high‑dose prilocaine alone.
Major Alternatives
Below are the most common topical anesthetics that patients and clinicians consider alongside Prilox.
EMLA Cream
EMLA contains 2.5% lidocaine and 2.5% prilocaine. It’s the classic reference product used in hospitals worldwide. The lower concentrations mean a longer time to reach peak effect-usually 60‑90minutes-but it can anesthetize deeper tissue (up to 5mm) and lasts up to 2hours.
Benzocaine
Usually sold as 10% or 20% gels or sprays, benzocaine is an ester‑type anesthetic. It works very fast (1‑2minutes) but stays on the surface, providing only 1‑2mm depth. Allergic reactions are more common, especially in people with a history of asthma or eczema.
Oraqix
Oraqix is a dental gel that mixes 5% lidocaine with 5% tetracaine. Applied directly to the gums, it produces a numbing effect in 5‑10minutes that can last up to 120minutes, making it ideal for longer dental procedures.
Tetracaine
Often combined with lidocaine in specialty gels, tetracaine is a potent, long‑acting anesthetic. Its onset is slower than lidocaine alone, but it provides deep tissue anesthesia (up to 5‑6mm) and is useful for procedures requiring extended numbness.
Xylocaine
Xylocaine is the brand name for pure lidocaine. Topical formulations (e.g., 4% lidocaine patches) are used for localized neuropathic pain. While it offers fast onset, the depth is limited to about 2mm and the duration is short (30‑45minutes).
Lidoderm Patch
Lidoderm is a transdermal patch delivering 5% lidocaine over 12hours. It’s meant for chronic pain rather than procedural anesthesia, but it illustrates how lidocaine can be formulated for prolonged release.
Direct Comparison Table
| Attribute | Prilox Cream | EMLA Cream | Benzocaine (10%) | Oraqix (Lidocaine+Tetracaine) | Xylocaine (4% Lidocaine) |
|---|---|---|---|---|---|
| Active Ingredients | 5% Lidocaine / 5% Prilocaine | 2.5% Lidocaine / 2.5% Prilocaine | 10% Benzocaine | 5% Lidocaine / 5% Tetracaine | 4% Lidocaine |
| Onset (covered) | 3‑5min | 60‑90min | 1‑2min | 5‑10min | 5‑10min |
| Duration | 30‑60min | 90‑120min | 15‑30min | 60‑120min | 30‑45min |
| Depth of Anesthesia | 2‑4mm | 4‑5mm | 1‑2mm | 3‑5mm | ≈2mm |
| Typical Cost (AU$) | ~$15 per 30g tube | ~$25 per 30g tube | ~$8 per 30g tube | ~$30 per sachet (single use) | ~$12 per patch set |
| Common Uses | Minor skin procedures, tattoos, venipuncture | Surgical skin prep, IV cannulation | Oral ulcers, minor burns | Dental extractions, periodontal surgery | Post‑herpetic neuralgia, localized pain |
| Key Contra‑indications | Severe cardiac disease, allergy to amide anesthetics | Pregnancy (first trimester), methemoglobinemia risk | Allergy to esters, asthma | Open wounds, allergic reaction to tetracaine | Severe liver disease, hypersensitivity |
How to Choose the Right Product
Pick a numbing cream based on three practical questions:
- How much time do I have before the procedure? If you only have a few minutes, benzocaine or Prilox are the only options that work fast enough. For longer prep windows, EMLA or Oraqix give deeper, longer anesthesia.
- How deep does the anesthesia need to be? Superficial skin work (e.g., superficial tattoo lines) needs 1‑2mm depth - benzocaine or lidocaine patches suffice. Deeper skin excisions benefit from Prilox, EMLA or tetracaine‑based gels.
- Are there any health concerns? Patients with a history of methemoglobinemia should avoid high‑dose prilocaine (EMLA) and prefer lidocaine‑only products. Allergic individuals should steer clear of ester‑type agents like benzocaine.
Cost matters too. In most Australian pharmacies Prilox offers the best price‑performance ratio for quick procedures, while EMLA is pricier but worth it for surgeries that demand deeper anesthesia.
Practical Tips & Common Pitfalls
- Always apply a thin, even layer and cover with an occlusive dressing (plastic wrap or waterproof bandage). Without covering, the cream may not reach its full potency.
- Do not exceed the recommended surface area (generally 10cm²). Over‑application increases the risk of systemic absorption and side effects.
- Wait the full onset time before starting the procedure. Cutting it short leads to incomplete numbness and a painful experience.
- Store creams at room temperature, away from direct sunlight. Heat can degrade the active ingredients.
- If you notice ringing in the ears, dizziness, or a metallic taste, wash the area immediately and seek medical advice - these can be signs of systemic toxicity.
Frequently Asked Questions
Can I use Prilox on children?
Prilox is approved for patients aged 12years and older. For younger children, EMLA is usually preferred because the lower concentration reduces the risk of systemic effects.
How long before I can remove the dressing?
Leave the dressing on for at least the recommended onset time (3‑5min for Prilox, 60‑90min for EMLA). After the numbness sets in, you can gently wipe off any excess cream and remove the dressing.
Is there a risk of allergic reaction?
Allergic reactions are rare but can occur, especially with ester‑type agents like benzocaine. Look for redness, swelling, or hives. Discontinue use immediately and consult a pharmacist or doctor.
Can I combine Prilox with a local injection?
Yes, many clinicians apply Prilox first, then give a sub‑cutaneous injection. The cream reduces needle‑pain, and the injection adds deeper anesthesia if needed.
What should I do if the numbness wears off too quickly?
Consider extending the coverage time by re‑applying a fresh layer (if the total dose stays within the package limit) or switch to a longer‑acting product like EMLA for future procedures.
By weighing onset speed, depth of anesthesia, safety profile and cost, you can choose the topical anesthetic that fits your specific need. Whether you settle on Prilox for a quick tattoo or opt for Oraqix for a dental extraction, the right numbing cream makes uncomfortable procedures a lot more tolerable.
Julien Martin
Reading through the comparison, it’s clear that the pharmacokinetic profile of Prilox hinges on the synergistic interaction between lidocaine and prilocaine, each at 5% w/w, which accelerates the onset to roughly 3‑5 minutes while maintaining a moderate depth of 2‑4 mm.
By contrast, EMLA’s lower concentration (2.5%/2.5%) necessitates a protracted absorption phase of 60‑90 minutes, yet it achieves a deeper penetration of up to 5 mm, making it more suitable for procedures that demand extensive dermal anesthesia.
Benzocaine, an ester, offers the fastest onset (1‑2 minutes) but its superficial depth (1‑2 mm) and higher allergenic potential limit its utility to very minor surface applications.
Oraqix, with a lidocaine‑tetracaine matrix, balances a moderate onset (5‑10 minutes) with a prolonged duration (up to 120 minutes) and a depth of 3‑5 mm, which is why it dominates dental procedural protocols.
Xylocaine (4% lidocaine) provides a lidocaine‑only formula, circumventing methemoglobinemia risk but sacrificing depth, remaining around 2 mm.
When evaluating cost, Prilox emerges as the most cost‑effective option (~$15 for a 30 g tube) relative to EMLA (~$25) and Oraqix (~$30), especially when the clinical need aligns with its rapid onset and moderate depth.
From a safety standpoint, the equal ratio of lidocaine to prilocaine in Prilox mitigates methemoglobinemia risk, a concern that is more pronounced with high‑dose prilocaine formulations such as EMLA.
Patients with cardiac comorbidities should still exercise caution, as amide anesthetics can influence conduction pathways, though the risk is substantially lower than with higher concentrations.
Lolita Rosa
Prilox is just a marketing gimmick, isn’t it?