Usage
This combination medication is primarily prescribed for the treatment of hemorrhoids (piles) and other inflammatory anorectal conditions like anal fissures and proctitis. It’s classified as a haemorrhoidal preparation, encompassing vasoprotective, anti-inflammatory, local anesthetic, and decongestant actions. The medication works by shrinking swollen blood vessels, reducing inflammation, relieving pain and itching, and promoting healing in the affected area.
Alternate Names
While no specific alternate names exist for this exact multi-component formulation, individual components have synonyms. Lidocaine is also known as Lignocaine. Several brand names market this combination, with formulations varying slightly in concentrations. Some examples of brand names include Hemolit, Pilorute, and Ruticool. Formulations are available as creams, ointments, and suppositories.
How It Works
Pharmacodynamics:
- Calcium Dobesilate: A vasoprotective agent that strengthens capillary walls, reduces their permeability, and improves microcirculation. It decreases swelling and inflammation.
- Hydrocortisone: A corticosteroid with anti-inflammatory and antipruritic properties. It reduces swelling, redness, and itching by suppressing the immune response and inhibiting inflammatory mediators.
- Lidocaine: A local anesthetic that blocks nerve signal transmission, reducing pain and itching. It acts by inhibiting voltage-gated sodium channels on nerve cell membranes.
- Phenylephrine: A decongestant that constricts blood vessels, reducing swelling and congestion in the anorectal area.
- Troxerutin: A bioflavonoid and vasoprotective agent. Like Calcium Dobesilate, it helps to strengthen blood vessels and reduce capillary permeability.
- Zinc Oxide: Acts as a skin protectant, mild astringent, and antiseptic, soothing irritation and promoting healing.
Pharmacokinetics: Primarily topical application with minimal systemic absorption. The extent of absorption for each ingredient varies depending on the formulation and application method. Hepatic metabolism is anticipated for the systemically absorbed fraction, with renal excretion of metabolites. Specific pharmacokinetic data for this combined formulation are limited.
Dosage
Standard Dosage
Adults: Apply a thin layer to the clean and dry affected area 2-3 times daily, or as directed by the physician. Use the provided applicator for rectal insertion if using a suppository.
Children: Use in children below 12 years of age is generally not recommended unless specifically prescribed by a doctor. Pediatric dosage adjustments are at the physician’s discretion.
Special Cases:
- Elderly Patients: Use with caution due to potential for increased systemic absorption and drug interactions.
- Patients with Renal Impairment: Dosage adjustment may be needed in cases of severe renal impairment.
- Patients with Hepatic Dysfunction: Exercise caution due to the liver’s role in drug metabolism.
- Patients with Comorbid Conditions: Caution is advisable in patients with diabetes, hypertension, heart disease, or glaucoma.
Side Effects
Common Side Effects:
- Burning or stinging sensation at the application site
- Itching
- Redness
- Irritation
- Dryness
Rare but Serious Side Effects:
- Allergic reactions (rash, hives, angioedema)
- Worsening of inflammation
- Rectal bleeding
Contraindications
- Hypersensitivity to any component of the medication
- Bacterial, viral, or fungal infections in the anorectal area
- Tuberculosis or syphilis affecting the anal region
Drug Interactions
- Anticoagulants (warfarin, heparin)
- Antiplatelet medications (aspirin, clopidogrel)
- Other topical preparations in the anal area (avoid concomitant use)
Pregnancy and Breastfeeding
Consult a doctor before using this medication during pregnancy or breastfeeding. The safety of its use in these conditions has not been fully established. It is generally advised to avoid use during the first trimester of pregnancy. Lidocaine may be excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: See “How it works” above.
- Side Effects: Burning, itching, redness, irritation, dryness, rarely allergic reactions.
- Contraindications: Hypersensitivity, anorectal infections.
- Drug Interactions: Anticoagulants, antiplatelet agents.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: Apply thinly to the affected area 2-3 times daily.
- Monitoring Parameters: Observe for signs of allergic reactions, worsening of inflammation, or bleeding.
Popular Combinations
This combination medication itself represents a combination of active pharmaceutical ingredients. It is generally not combined with other medications for topical application.
Precautions
- Avoid contact with eyes, nose, and mouth.
- Avoid use on broken or infected skin.
- Prolonged use of topical corticosteroids like hydrocortisone can cause skin discoloration.
- Patients with pre-existing conditions should consult a physician before use.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Dobesilate + Hydrocortisone + Lidocaine + Phenylephrine + Troxerutin + Zinc Oxide?
A: Apply a thin layer to the affected area 2-3 times daily.
Q2: Can I use this cream during pregnancy?
A: Consult your doctor before using it during pregnancy, especially during the first trimester.
Q3: Is it safe to breastfeed while using this cream?
A: Consult your doctor. Lidocaine may be excreted in breast milk.
Q4: Can I use this cream for other skin problems like eczema?
A: No, it is specifically formulated for anorectal conditions.
Q5: What should I do if I accidentally ingest the cream?
A: Seek immediate medical attention.
Q6: Can I apply the cream internally using my finger?
A: No, use the applicator provided with the product or as directed by the physician. Wash your hands before and after application.
Q7: What should I do if my symptoms don’t improve after a week of use?
A: Consult your doctor.
Q8: Can I stop using the cream as soon as my symptoms improve?
A: No, complete the course of treatment as prescribed by your doctor.
Q9: Can this cream cause a burning sensation?
A: Mild burning or stinging is a common side effect and usually subsides quickly. If it persists or worsens, consult your doctor.
Q10: Are there any drug interactions I should be aware of?
A: Inform your doctor about all other medications you are using, especially anticoagulants and antiplatelet drugs.
