Relador Shortage: What Providers and Prescribers Need to Know in 2026

The shortage of lidocaine-containing medications has created significant challenges for providers across dermatology, surgery, emergency medicine, anesthesiology, and primary care. Relador (lidocaine 2.5%/prilocaine 2.5% topical cream, Accelis Pharma) is among the formulations patients are struggling to fill. This guide provides an evidence-based clinical overview for prescribers navigating this shortage in 2026.

Current Shortage Landscape: What Formulations Are Affected?

As of 2026, the ASHP maintains active shortage listings for multiple lidocaine products:

Injectable lidocaine HCl (0.5%, 1%, 2%): Most severely impacted. Pfizer has 0.5% 50 mL vials and 2% emergency Ansyr syringes on back order; Abboject LifeShield syringes were discontinued mid-2025. Eugia US discontinued multiple ampule presentations in H1 2026. Fresenius Kabi and Eugia US are partially available.

Lidocaine viscous 2% oral solution: On ASHP shortage with Hikma on allocation as of December 2025 (listing originally created April 2023).

Relador / lidocaine-prilocaine 2.5%/2.5% topical cream: Not separately listed on the FDA shortage database, but API-level supply constraints affect all lidocaine formulations. Localized retail pharmacy stockouts are reported. Branded Relador Pak kits are less routinely stocked than generic cream.

Pharmacology Review: Lidocaine-Prilocaine Mechanism and Clinical Use

Lidocaine and prilocaine are both amide-type local anesthetics. They stabilize neuronal membranes by inhibiting voltage-gated sodium channels, preventing action potential generation and propagation. The eutectic mixture in lidocaine-prilocaine cream has a lower melting point than either component alone, resulting in a liquid state at body temperature that penetrates intact skin more effectively than individual components.

Standard application protocol: Apply 2.5 g/10 cm² under an occlusive dressing 45–60 minutes before superficial procedures (e.g., split-skin grafts). For deeper tissue anesthesia (e.g., split-skin grafting), 2 hours is recommended. Maximum application area is weight-based in children; consult prescribing information for pediatric dosing tables.

Clinical Substitution Options: A Provider's Reference

When Relador is unavailable, consider these evidence-based substitutions:

Generic lidocaine-prilocaine 2.5%/2.5% cream: FDA AB-rated equivalent. The most direct substitution. Write the prescription generically as 'lidocaine 2.5%/prilocaine 2.5% topical cream' with DAW code 0 to allow generic dispensing. More available and far less expensive than brand Relador Pak.

EMLA cream (AstraZeneca): The reference listed drug for lidocaine-prilocaine; may be available where Relador Pak is not. Identical formulation and clinical performance.

LMX 4 (lidocaine 4% cream, OTC): Appropriate for minor procedures — needle insertions, IV placement, superficial biopsies. Available without prescription. Efficacy data for skin anesthesia support use for procedures requiring superficial dermal penetration. Apply 30–60 minutes before procedure.

Compounded lidocaine-prilocaine cream: A licensed compounding pharmacy (PCAB-accredited preferred) can prepare the cream when commercial supply is unavailable. Requires a prescription specifying a compounded preparation. Not FDA-approved but may be appropriate when commercial alternatives are exhausted.

Benzocaine 20% gel: Appropriate for mucous membrane anesthesia only (dental, ENT, endoscopy prep). Not a substitute for skin anesthesia. Methemoglobinemia risk — use minimum effective amount.

Methemoglobinemia Risk: A Key Safety Consideration

Prilocaine carries a higher methemoglobin-forming potential than lidocaine. When counseling patients on Relador or its equivalents, or when considering substitutions, be aware of the following risk factors for clinically significant methemoglobinemia:

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Congenital or idiopathic methemoglobinemia

Cardiac or pulmonary compromise

Infants under 6 months of age

Concurrent use of methemoglobin-inducing agents: dapsone, sulfasalazine, nitrofurantoin, phenobarbital, phenytoin, nitroglycerin

For at-risk patients, lidocaine 4% cream (without prilocaine) may be preferable as it eliminates the methemoglobin-forming component.

Communicating With Patients About the Shortage

Patients are often frustrated and confused when they can't fill a prescription. A proactive approach improves satisfaction and reduces no-shows from patients who couldn't get their medication:

Write prescriptions generically (lidocaine 2.5%/prilocaine 2.5% cream) rather than brand-specifically — this gives pharmacists more flexibility to substitute equivalent generic stock

Consider sending patients to use medfinder.com, a paid service that contacts pharmacies on their behalf to find which ones currently have the medication in stock

Advise patients to start their pharmacy search 5–7 days before any scheduled procedure

Have a pre-approved substitution plan (e.g., LMX 4 OTC or compounded cream) documented in your notes so patients know their options without needing a callback

Practice Management During a Topical Anesthetic Shortage

For practices that administer topical anesthetics in-office:

Source supplies through multiple distributors (Cardinal Health, McKesson, Cencora/AmerisourceBergen) — alternative manufacturers like Sintetica and Avenacy have verified inventory through these channels

Establish a relationship with a reliable compounding pharmacy for backup supply

Maintain a minimum reserve supply appropriate for your procedure volume — but avoid panic hoarding, which worsens shortage conditions for other practices

For more guidance on supporting your patients, see our provider's guide to helping patients find Relador in stock. medfinder also has a dedicated provider portal to help refer patients to the right pharmacies.