Usage
- This combination medication is prescribed for the treatment of anorectal disorders, including hemorrhoids (piles), anal fissures, and anal pruritus (itching). It is also used in pre- and post-operative care for anorectal examinations and proctologic surgery.
- Pharmacological Classification: This is a combination product encompassing multiple classifications:
- Anti-inflammatory (Hydrocortisone)
- Local anesthetic (Lidocaine)
- Skin protectant (Allantoin, Zinc Oxide)
- Astringent (Zinc Oxide)
- Mechanism of Action: The components work synergistically to provide comprehensive relief:
- Allantoin promotes cell proliferation and tissue regeneration, aiding wound healing.
- Hydrocortisone suppresses inflammation by inhibiting prostaglandin and leukotriene production.
- Lidocaine blocks nerve signals, providing local anesthesia and relieving pain.
- Zinc oxide forms a protective barrier, reducing irritation and promoting healing, while also exhibiting mild astringent and antiseptic properties.
Alternate Names
- While no specific alternate names exist for the combination as a whole, the individual components may have synonyms (e.g., lignocaine for lidocaine).
- Brand Names: Examples include Anaproct, Pileum, Anomex, Corect, PYL-X, and Shield. Availability may vary regionally.
How It Works
- Pharmacodynamics: The combined effects result in decreased inflammation, pain relief, reduced itching, and accelerated healing in the anorectal area.
- Pharmacokinetics:
- Lidocaine is absorbed systemically following topical application to mucous membranes. It is metabolized in the liver and excreted renally.
- Hydrocortisone can also be absorbed systemically, especially with prolonged or extensive use.
- Allantoin and zinc oxide primarily exert their effects locally with minimal systemic absorption.
- Mode of Action: See “Mechanism of Action” under “Usage.”
- Receptor binding, enzyme inhibition, or neurotransmitter modulation: Hydrocortisone binds to glucocorticoid receptors. Lidocaine blocks sodium channels in nerve fibers.
Dosage
Standard Dosage
Adults: Apply ointment or insert suppository two to three times daily, typically after bowel movements. Treatment duration should generally not exceed 7 days unless under medical supervision.
Children: Use in children under 12 is generally not recommended. Consult a pediatrician if necessary.
Special Cases:
- Elderly Patients: Use with caution and monitor for systemic corticosteroid side effects, especially with prolonged use.
- Patients with Renal Impairment: Caution advised, especially with prolonged use.
- Patients with Hepatic Dysfunction: Lidocaine is metabolized hepatically; dosage adjustment may be necessary.
- Patients with Comorbid Conditions: Caution in patients with conditions that may be exacerbated by corticosteroids (e.g., hypertension, diabetes, glaucoma, osteoporosis).
Clinical Use Cases
- Dosage for intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is generally the same as the standard dosage. The clinical context might necessitate more frequent application. However, prolonged use should still be avoided unless under strict medical supervision.
Dosage Adjustments
- Adjust based on patient response and tolerance. Consider renal/hepatic function and comorbid conditions.
Side Effects
Common Side Effects
- Burning, itching, irritation, dryness, and redness at the application site.
Rare but Serious Side Effects
- Allergic reactions (rash, hives, difficulty breathing, swelling of the face).
- Adrenal insufficiency (with prolonged use).
- Skin atrophy (with prolonged use of hydrocortisone).
Long-Term Effects
- Skin thinning and discoloration (with prolonged hydrocortisone use).
Adverse Drug Reactions (ADR)
- Anaphylaxis (rare but serious).
Contraindications
- Hypersensitivity to any component.
- Untreated bacterial, viral, or fungal infections in the anorectal area.
- Tubercular, fungal, or viral lesions (e.g., herpes simplex, varicella, vaccinia).
Drug Interactions
- Class III antiarrhythmics (e.g., amiodarone).
- Drugs metabolized by liver enzymes (CYP450).
- Medications that may enhance the effects of hydrocortisone (e.g., other corticosteroids).
Pregnancy and Breastfeeding
- Use with caution; consult a physician. Not generally recommended unless the potential benefits clearly outweigh the risks.
Drug Profile Summary
See sections above.
Popular Combinations
This medication is itself a combination product and is not typically combined with other drugs.
Precautions
- Avoid prolonged use (generally not exceeding 7 days) unless medically necessary.
- Monitor for local skin reactions and systemic corticosteroid effects (with prolonged use).
- Use with caution in specific populations (see “Dosage - Special Cases”).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Allantoin + Hydrocortisone + Lidocaine + Zinc Oxide?
A: See “Dosage” section above.
Q2: Can this medication be used during pregnancy or breastfeeding?
A: Use with caution; consult a physician. It’s generally not recommended unless the benefits outweigh the risks.
Q3: What are the common side effects?
A: Common side effects include local reactions such as burning, itching, irritation, and redness at the application site.
Q4: Are there any serious side effects?
A: Rare but serious side effects include allergic reactions and, with prolonged use, adrenal insufficiency and skin atrophy.
Q5: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue with your regular schedule.
Q6: How long can I use this medication?
A: Generally, not exceeding 7 days unless under medical supervision.
Q7: What are the contraindications for this medication?
A: Hypersensitivity, untreated anorectal infections, and certain skin lesions are contraindications.
Q8: Can this medication interact with other medications?
A: Yes, interactions are possible with Class III antiarrhythmics, drugs metabolized by the liver, and other corticosteroids.
Q9: What are the monitoring parameters?
A: Monitor for local skin reactions and, with prolonged use, systemic corticosteroid effects.
Q10: Is it safe to use this medication if I have kidney or liver problems?
A: Use with caution in patients with renal or hepatic impairment, especially with prolonged use. Consult a physician.
