As a practice, we are committed to ensuring that we prescribe effective and safe treatments. We are currently reviewing patients who receive regular prescriptions for Lidocaine 5% Medicated Plasters (Ralvo 700mg plasters/Versatis 700mg plasters).

Lidocaine plasters are only licensed for the short-term treatment of pain that occurs following a shingles infection. They are used “off license” to treat other types of pain (often on a recommendation from hospital). The long-term safety of the plasters when used for unlicensed uses has not been evaluated.

 We are writing to you with a view to reducing and discontinuing your use of these plasters. Continued use can cause changes in the nerve endings meaning the plasters cease to have any benefit and patients often do not notice any difference in their pain control after stopping the plasters.
You have been using Lidocaine plasters for a while now and we recommend that you check whether they are still providing benefit. To do this
• Please try leaving the plaster off for a day and assess whether this makes any difference to your pain.
• Please leave a period of 36 hours before applying a new plaster.
• If there hasn’t been a significant difference in the level of pain, you can stop using the plaster.
• If you feel that your pain worsens during the trial, we would like to offer you a review – please make a routine telephone appointment by calling the practice at 8am to        book a review of this medication.
In the meantime if you receive this item on repeat prescription, we have removed it from your repeat list.


Reasons for using Lidocaine plasters
Medical evidence shows that Lidocaine plasters can be effective for the relief of nerve pain that can occur after a shingles infection. This is the only licensed use for Lidocaine plasters. They are however often used for other types of pain such as muscle pain, joint pain and back pain. There is no good evidence to suggest that Lidocaine plasters are effective for these types of pain and this use is not routinely recommended. To be considered effective, Lidocaine should improve your pain by 30 to 50%. As a general rule when using Lidocaine plasters, please ensure that you don’t wear a plaster for any longer than 12 hours. You must remove the old plaster and take a break of at least 12 hours before applying a new plaster.

Taking a break
It is recommended that people using Lidocaine plasters take a break in treatment (a “plaster-free day”) to see whether the plaster is continuing to be effective. Even when Lidocaine has had a good effect in the past, changes in the nerve endings mean that the plaster can often be stopped after a period of time without the pain returning.

Why stop?
It is often possible to stop using Lidocaine plasters after a period of time because either:
• Lidocaine is not helpful for your type of pain e.g. muscle and joint pain
• The pain has improved e.g. due to the healing of an injury
• The action of Lidocaine has a long lasting effect

Can I step treatment down?
Even if you don’t stop using Lidocaine plasters completely, you can try to increase the period of time when you don’t wear the plaster. For example, you can increase the number of hours or days where you don’t apply a plaster. If you have been advised to use more than one plaster at a time, you can try to reduce the number of plasters needed to cover the painful area. (The maximum number of plasters which can be worn at one time is three. Only use more than one plaster at a time if advised to do so by your doctor or pharmacist.)

So, what should I do now? 
• Choose a day to not wear a plaster for a full 36 hours
• Think about whether the pain is noticeably worse during this time
• If there hasn’t been much change in the level of pain you can stop using the plaster
• If the pain returns, you can go back to using the plaster as before or try to step down by using fewer plasters at a time or increasing the period of time when the plaster is not worn
• If you start using the plaster again, please contact the practice to discuss and then repeat the “plaster-free” day every 4 weeks. Most people find that they can reduce and stop the plasters in time.