Comprehensive medication guide to ZTlido including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$40–$150 copay on most commercial plans (Tier 2–3); prior authorization often required. With the Scilex ZTlido Savings Card, eligible commercially insured patients may pay as little as $0 per monthly prescription. Medicare Part D copays vary by plan; manufacturer savings card does not apply to Medicare.
Estimated Cash Pricing
$450–$479 retail for brand ZTlido per 30-patch carton; as low as $320.81 with SingleCare or $360.63 with GoodRx coupons. Eligible commercially insured patients can pay as little as $0/month with the Scilex ZTlido Savings Card.
Medfinder Findability Score
55/100
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ZTlido is the brand name for lidocaine topical system 1.8%, a prescription patch manufactured by Scilex Pharmaceuticals Inc. It received FDA approval in 2018 and is FDA-approved for the relief of pain associated with post-herpetic neuralgia (PHN) — the persistent burning nerve pain that can last months or years after a shingles infection.
Each ZTlido patch is 10 cm × 14 cm and contains 36 mg of lidocaine in a non-aqueous drug-in-adhesive system. Despite containing far less lidocaine than the older Lidoderm (5%) patch (700 mg), ZTlido delivers equivalent total lidocaine exposure due to its more efficient delivery technology. Over 1 million patients have been treated with ZTlido since its launch.
ZTlido is also used off-label for diabetic peripheral neuropathy, neuropathic cancer pain, and other localized neuropathic pain conditions. It is available by prescription only and can be prescribed by any licensed provider — including via telehealth — because it is not a controlled substance.
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ZTlido delivers lidocaine — an amide-class local anesthetic — directly through the skin to the peripheral nerve endings beneath the application site. Lidocaine works by blocking voltage-gated sodium channels in nerve cell membranes. When these channels are blocked, sodium ions cannot rush into the nerve cell, which prevents the formation of action potentials (electrical impulses) that carry pain signals to the brain.
The result is localized analgesia — pain relief precisely at the site of application — without affecting the rest of the body. ZTlido's non-aqueous drug-in-adhesive formulation achieves this with just 36 mg of lidocaine per patch, compared to 700 mg in the older Lidoderm 5% patch, by maximizing how much drug actually penetrates the skin. Used ZTlido patches retain approximately 18 mg of residual lidocaine, compared to 650 mg in used Lidoderm patches, making disposal significantly safer.
ZTlido acts locally and does not repair the underlying nerve damage that causes PHN. Pain relief requires the patch to be worn — once removed and lidocaine levels drop, the sodium channels unblock and pain signaling resumes. This is why ZTlido is applied daily for up to 12 hours.
1.8% — topical system (patch)
36 mg lidocaine per patch; apply up to 3 patches for up to 12 hours per day on intact skin
ZTlido is not listed on the FDA's official Drug Shortage Database as a nationwide shortage, but many patients report difficulty finding it at local pharmacies. As a specialty brand-name product, ZTlido is stocked on-demand at many pharmacies rather than kept in bulk — meaning it may not be available same-day at your nearest pharmacy. The March 2025 FDA approval of a generic lidocaine 1.8% topical system is also creating market transitions that can affect local availability.
Patients are encouraged to call ahead before visiting the pharmacy, try multiple pharmacy chains (CVS, Walgreens, Walmart Pharmacy, specialty pharmacies), or ask the pharmacy to order ZTlido within 1-3 business days. Mail-order pharmacy through your insurance plan often provides more reliable access than retail locations.
medfinder is a paid service that calls pharmacies near you to check ZTlido availability and texts results to your phone — saving you hours of calling. It covers all medications, not just shortage drugs.
Because ZTlido (lidocaine) is not a DEA-scheduled controlled substance, any licensed prescriber with authority to write prescriptions in their state can prescribe it without special DEA certification. This makes it one of the more accessible prescription pain medications for PHN.
Primary care physicians (family medicine, internal medicine)
Neurologists
Pain management specialists
Infectious disease physicians
Geriatricians
Nurse practitioners (NPs) and physician assistants (PAs) with full prescribing authority
ZTlido can be prescribed via telehealth platforms without the DEA registration requirements that apply to scheduled medications. This makes it accessible for patients in rural areas or those with mobility limitations. Telehealth platforms including Teladoc, MDLive, and others can connect patients with providers who can evaluate PHN and prescribe ZTlido.
No. ZTlido contains lidocaine, which is not a DEA-scheduled controlled substance. Lidocaine has no abuse potential and is not subject to the prescribing restrictions that apply to Schedule II-V medications.
This has several practical benefits for patients: any licensed prescriber (including primary care physicians, NPs, PAs) can write a ZTlido prescription without special DEA authorization. ZTlido can be prescribed via telehealth without the restrictions that apply to controlled substances. Refill quantities and timing are not limited by DEA scheduling rules, though insurance plans may impose their own refill limitations.
Most side effects of ZTlido are local application site reactions that resolve shortly after removing the patch:
Skin irritation, redness (erythema)
Itching (pruritus) at the patch site
Mild burning sensation or skin dryness
Mild local edema (swelling)
Methemoglobinemia: pale, gray, or blue skin; rapid heartbeat; shortness of breath; lightheadedness
Systemic lidocaine toxicity: numbness around the mouth, dizziness, ringing in the ears, blurred vision, confusion
Severe allergic reaction (anaphylaxis): facial swelling, difficulty breathing, severe hives
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Lidoderm (lidocaine 5% patch)
Generic widely available and much cheaper ($30-80/month); same lidocaine delivery per patch as ZTlido; less efficient delivery technology leaves more residual lidocaine in used patches
Gabapentin (Neurontin)
FDA-approved oral option for PHN; very inexpensive as generic ($10-30/month); systemic mechanism works differently from lidocaine; common side effects include dizziness and sedation
Pregabalin (Lyrica)
FDA-approved oral option for PHN; generic available ($30-80/month); Schedule V controlled substance; more predictable PK than gabapentin
Qutenza (capsaicin 8% patch)
In-clinic application for 60 minutes; effect lasts up to 3 months; different mechanism (TRPV1 desensitization); FDA-approved for PHN
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Other local anesthetic products
majorAdditive lidocaine exposure when combined with other patches, creams, or gels containing local anesthetics. Total lidocaine from all sources must be considered to avoid toxicity.
Class I antiarrhythmics (mexiletine, flecainide)
moderateAdditive cardiac effects possible. Risk is lower with topical ZTlido than IV lidocaine due to low systemic absorption, but monitor in patients on antiarrhythmic therapy.
Oxidizing agents (nitrates, sulfonamides, dapsone)
moderateIncreased risk of methemoglobinemia when used with agents that increase oxidative stress on hemoglobin.
External heat sources
majorNot a drug interaction, but clinically critical: heating pads and electric blankets increase lidocaine absorption by up to 64%. Never apply heat directly to the patch.
ZTlido represents a meaningful advancement in topical lidocaine delivery for post-herpetic neuralgia. Its efficient drug-in-adhesive formulation provides equivalent pain relief to the older Lidoderm 5% patch with just 36 mg of lidocaine, resulting in better adhesion and safer disposal. For PHN patients seeking a non-opioid, localized treatment option, ZTlido is a well-established first-line topical choice supported by AAPM guidelines.
The main challenges with ZTlido are its cost (up to $479 retail) and inconsistent local pharmacy availability. Commercially insured patients should take advantage of the Scilex ZTlido Savings Card (as little as $0/month). For finding it in stock, multiple pharmacies may need to be contacted — calling ahead is essential.
If you're struggling to find ZTlido at your local pharmacy, medfinder is a paid service that calls pharmacies near you to check availability and texts you the results — so you can get the relief you need without spending your day on hold.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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