Dear HoG: ElaMax Cream

Horizons in Hemophilia, June 2009

Dear HoG:

I don't want my child to suffer when he gets stuck to receive factor, so I have been using Ela-Max cream, an over the counter numbing medicine, before we begin to stick. I have read conflicting things on the Internet about this cream, and wonder how much to use, and is it safe for my child?

--Concerned Parent

Dear Concerned Parent:

You are right to be concerned and ask questions about the safety of any medication or product you or your family uses. Ela-Max numbing cream is sometimes used on an area where you plan to stick a vein to help prevent any pain. Even young children who are afraid of being stuck may choose not to use Ela-Max cream once they learn that they feel better and the pain of a bleed stops when they get factor.  Since they have to wait at least 30 minutes before the cream takes effect and they have more time to dread the infusion, they just prefer to get the infusion over with without using the Ela-Max.

Ela-Max cream contains 4% Lidocaine, and some people are severely allergic to Lidocaine and can have enough swelling in the airway after exposure to stop breathing, as well as having lower blood pressure leading to shock and death. Skin numbing cream can cause the skin to be more easily burned or injured due to less sensation to that area.

You should only use enough cream to help numb the area you plan to stick, since excessive amounts can cause more serious reactions. Doctors advise that you should never use more Ela-Max than the size of the palm of the hand of the person you are applying it to in approximately ¼ inch layer. Covering the cream with plastic wrap increases the absorption rate and numbing effect. Babies and very young children are especially at risk for toxicity if too much Ela-Max cream is used. Ela-Max also causes the veins to constrict or get smaller in babies and young children, so it can be harder to get a needle into their already small veins for a factor infusion.

You should never use Ela-Max cream on broken or inflamed skin, and never apply near the face or ears. If you have concerns about the use of Ela-Max, you can discuss it with your Hemophilia Treatment Center doctor or nurse coordinator to weigh the benefits and risks associated with the use of this product. Talk to your HoG outreach nurse about diversion techniques and other ideas to help people with the fear of being stuck.