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5 Articles in this Series
Exercise Improves Chronic Pain Biomarkers
New Lidocaine Patch for Postherpetic Neuralgia
OPERA Study: Patients Satisfied With Topical Analgesics
Pharmacist-Led Chronic Pain Service
Reaching Clinical Targets for PTSD Patients With Fibromyalgia

New Lidocaine Patch for Postherpetic Neuralgia

Lidocaine is a local anesthetic commonly used to relieve pain associated with postherpetic neuralgia (PHN). For a number of years, the standard 5% lidocaine patch has been considered sufficient for providing relief, though not totally blocking, PHN pain. However, a new formulation, ZTlido, may be an improved treatment of choice.

SCILEX Pharmaceuticals recently developed a next-
generation proprietary patch that features more advanced construction whilst replicating the same infusion of lidocaine analgesia provided by older patches.

ZTlido is a single-layered anhydrous patch featuring proprietary technology that offers advantages over the multi-layered hydrogel patches, noted the poster presenters.1 Containing only 36 mg of lidocaine per patch, compared to the 700 mg found in the multi-layered hydrogel system, ZTlido 1.8% patches use a specialized construction that makes them thinner, more adhesive and more flexible, with a rate-controlling membrane designed for more effective lidocaine delivery.

ZTlido patches are also more efficient, leaving behind less residual drugs left in the patch after use, which “may reduce toxicity from unintentional exposure following removal of the patch,” according to the investigators led by Jeffrey Gudin, MD, Director of Pain Management and Palliative Care at Englewood Hospital and Medical Center, in Englewood, NJ.

A comparative pharmokinetic (PK) study test was used to weigh the equivalence in efficacy and safety between generic 5% lidocaine patch and the new ZTlido 1.8% patch. Using stress tests of heat and exercise to evaluate the new technology’s efficacy, ZTlido patches showed strong results in their adhesion and lidocaine delivery.

Forty-one patients were randomized to receive the 5% lidocaine and ZTlido 1.8% patches.2 Adhesion was scored from a 0 to 4 scale, where 0 represented essentially no lifting off of the skin and 4 represented the patch completely falling off of the skin. ZTlido patches appeared twice as adhesive as their generic counterparts, scoring an average adhesion score of 1.1, compared to the 2.2 of standard 5% lidocaine patches (SD 1.4 and 1.5, respectively).

“The superior adhesion may result in improved patient compliance as the patch is less prone to inadvertent detachment and will require less reinforcement during the 12-hour treatment period,” the study stated. This may also be explained by the fact that ZTlido patches are lighter and thinner than their counterparts, weighing 2 g compared to 14 g, with a width 0.0315 inches compared to 0.0675 in., respectively.

ZTlido’s dermal safety profile is also comparable to standard 5 % lidocaine patches, showing no evidence of photosensitization, phototoxicity, sensitization, or significant dermal irritation.

Granted, mean cumulative irritation was higher with ZTlido patches compared to 5% lidocaine patches, the observed irritation was not considered clinically significant, the study authors stated. There were a limited number of treatment-related adverse events, ranging from mild to moderate and severe. No serious adverse events were reported.


  1. Gudin F, Argoff C, Nalamachu S. 1.8% lidocaine patch (ZTlido): review of a new formulation. Postgrad Med. 2015;Early Online:44.
  2. Gudin F, Backonja M, Nalamachu S. A review of the clinical data on ZTlido (lidocaine 1.8%). Postgrad Med. 2015;Early Online:45.
Next summary: OPERA Study: Patients Satisfied With Topical Analgesics
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