What Is ZTlido? Uses, Dosage, and What You Need to Know in 2026

ZTlido is a prescription topical patch that delivers lidocaine — a local anesthetic — directly to painful areas of skin. It's approved specifically for adults with post-herpetic neuralgia (PHN), the chronic nerve pain that persists after a shingles infection. Here's a complete overview of what ZTlido is, how it works, how to use it, and what makes it unique among lidocaine patches.

What Is ZTlido?

ZTlido (pronounced "ZEE-tuh-lye-doe") is the brand name for lidocaine topical system 1.8%, manufactured by Scilex Pharmaceuticals Inc. It received FDA approval in 2018 and is the only FDA-approved lidocaine topical system at the 1.8% concentration.

Despite the lower concentration compared to the older Lidoderm patch (5%), ZTlido delivers the same amount of lidocaine to your bloodstream. This is because ZTlido uses a more efficient delivery technology — a non-aqueous, drug-in-adhesive (DIA) system that maximizes how much lidocaine actually penetrates the skin. Each ZTlido patch contains 36 mg of lidocaine, compared to 700 mg in a Lidoderm patch, yet they achieve equivalent clinical effect.

What Is ZTlido Used For?

ZTlido is FDA-approved for one indication:

Post-herpetic neuralgia (PHN) in adults: The persistent burning, stabbing, or aching nerve pain that can last months or years after a shingles (herpes zoster) infection. PHN most commonly affects the torso, face, or extremities where shingles occurred.

ZTlido is also used off-label (not officially FDA-approved but prescribed by doctors) for:

Diabetic peripheral neuropathy (painful nerve damage from diabetes)

Neuropathic cancer pain (nerve pain related to tumors, surgery, or chemotherapy)

Other types of localized neuropathic or musculoskeletal pain (off-label, coverage varies)

What Does ZTlido Look Like?

Each ZTlido patch is:

Size: 10 cm × 14 cm × 0.08 cm — about the size of a large bandage

Form: Single-layer drug-in-adhesive (DIA) patch on a pliable nonwoven cloth backing

Packaging: 30 topical systems (patches) per carton, each sealed in an individual child-resistant envelope

Can be cut: You can trim ZTlido into smaller sizes with scissors before removing the release liner — useful for smaller or irregularly shaped pain areas

How Do You Use ZTlido? Step-by-Step

Remove the patch from its individual envelope just before applying. Apply immediately after opening.

Identify your most painful area on intact (unbroken) skin.

Remove the release liner and apply the sticky side to your skin. Press firmly for 20 seconds to ensure good contact.

Wear for up to 12 hours, then remove. Do not apply a new patch until the next 24-hour cycle — patches are used once per day.

Wash your hands immediately after applying. Avoid touching your eyes.

Dispose of the used patch by folding it in half (adhesive side inward) and discarding where children and pets cannot access it.

ZTlido Dosage: Key Rules

Maximum patches at once: Up to 3 ZTlido patches simultaneously

Maximum wear time: Up to 12 hours in any 24-hour period

Frequency: Once daily (apply, wear up to 12 hours, remove, wait 12 hours before reapplying)

Skin condition: Apply only to intact (unbroken) skin

What Activities Can I Do While Wearing ZTlido?

Clothing: Wearing clothes over the patch is fine and doesn't affect performance

Moderate exercise: You can bike or walk for up to 30 minutes with the patch on

Water exposure: Short exposure (10-minute shower or 15-minute swim) is okay — gently pat dry afterward

Heat: Do NOT apply heating pads or electric blankets directly to the patch — this dramatically increases lidocaine absorption

Is ZTlido a Controlled Substance?

No. ZTlido contains lidocaine, which is not a DEA-scheduled controlled substance. This means:

Any licensed prescriber can write a ZTlido prescription — no special DEA certification required

ZTlido can be prescribed via telehealth without the restrictions that apply to controlled substances

Refills are not limited by controlled substance laws (though insurance may have refill rules)

Key Facts About ZTlido at a Glance

Generic name: Lidocaine topical system 1.8%

Manufacturer: Scilex Pharmaceuticals Inc.

FDA approval: 2018

Patients treated: Over 1 million since launch

Cash price: ~$450-479 per 30-patch carton (savings card can reduce to $0 for eligible patients)

Controlled substance: No

Having Trouble Finding ZTlido?

ZTlido is a specialty medication and isn't stocked at every pharmacy. If you're having trouble finding it, medfinder calls pharmacies near you to find which ones have it in stock and texts you the results. It's a paid service that saves you the hassle of calling every pharmacy yourself.