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Prilocaine in high doses may cause an increase in the methaemoglobin level particularly in conjunction with methaemoglobin-inducing agents (e.g., sulphonamides).
With large doses of EMLA, consideration should be given to the risk of additional systemic toxicity in patients receiving other local anaesthetics or agents structurally related to local anaesthetics, since the toxic effects are additive.
Specific interaction studies with lidocaine/prilocaine and anti-arrhythmic drugs class III (e.g., amiodarone) have not been performed, but caution is advised (see Precautions).
Drugs that reduce the clearance of lidocaine (e.g., cimetidine or betablockers) may cause potentially toxic plasma concentrations when lidocaine is given in repeated high doses over a long time period. Such interactions should therefore be of no clinical importance following short term treatment with lidocaine (e.g., EMLA cream) at recommended doses.
