Usage
This combination medication is primarily prescribed for symptomatic relief of anorectal disorders, such as hemorrhoids (piles) and anal fissures. It may also offer relief for other anorectal conditions like proctitis and pruritus ani. It combines agents with different mechanisms for comprehensive symptom management.
Its pharmacological classifications include:
- Vasoprotective: Calcium dobesilate
- Corticosteroid: Hydrocortisone
- Local anesthetic: Lidocaine
- Decongestant: Phenylephrine
- Astringent/Antiseptic: Zinc oxide
This combination reduces inflammation, relieves pain and itching, and promotes healing in the affected area.
Alternate Names
There are no widely recognized alternate names for this specific combination product. Individual components have alternate names (Lidocaine/Lignocaine), but the combination is typically referred to by its constituent drugs. Some brand names include Anofresh Gold Cream and Pilorute Cream.
How It Works
Pharmacodynamics:
- Calcium Dobesilate: Improves microcirculation by decreasing capillary permeability and increasing venous tone. Exhibits anti-inflammatory and anti-edema properties.
- Hydrocortisone: Exerts anti-inflammatory, antipruritic (anti-itch), and vasoconstrictive actions, reducing swelling, redness, and itching.
- Lidocaine: Blocks nerve signals, thus reducing pain and discomfort.
- Phenylephrine: Constricts blood vessels, helping shrink hemorrhoidal tissue.
- Zinc Oxide: Acts as a skin protectant, mild antiseptic, and astringent.
Pharmacokinetics:
This medication is primarily for topical application. Absorption, metabolism, and elimination data for this specific combination are not readily available. Information regarding individual components can be consulted.
Mode of Action: The components work synergistically to alleviate symptoms. Calcium dobesilate strengthens capillaries and improves blood flow. Hydrocortisone reduces inflammation. Lidocaine provides local anesthesia. Phenylephrine acts as a decongestant, and zinc oxide protects the skin.
Dosage
This medication is primarily for topical application. The dosage varies depending on the formulation (cream, ointment, suppository), severity of symptoms, and individual patient factors. Always follow prescribed instructions.
Standard Dosage
Adults:
Apply a thin layer to the clean, dry affected area 2–4 times daily, or as directed by a physician. Insert one suppository rectally, usually 1–2 times daily, if using a suppository form.
Children:
Not recommended for children under 12 years of age unless prescribed by a doctor.
Special Cases:
- Elderly Patients: Use with caution due to potential increased systemic absorption of hydrocortisone.
- Patients with Renal Impairment: Use with caution. Monitor for systemic side effects of hydrocortisone and lidocaine.
- Patients with Hepatic Dysfunction: Use with caution. Monitor for systemic side effects of hydrocortisone and lidocaine.
- Patients with Comorbid Conditions (e.g., diabetes, hypertension): Caution is advised. Dosage adjustments may be necessary.
Clinical Use Cases
This combination isn’t typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, the ICU, or emergency situations. It is primarily used for topical treatment of anorectal conditions in outpatient settings.
Dosage Adjustments
Adjustments may be necessary based on individual patient response and tolerance. Start with the lowest effective dose and titrate upward as needed. Consider renal/hepatic function and comorbid conditions.
Side Effects
Common Side Effects:
Burning or stinging sensation at the application site, itching, redness, dryness.
Rare but Serious Side Effects:
Allergic reactions (rash, hives, angioedema), worsening of infection, skin thinning or discoloration with prolonged hydrocortisone use.
Long-Term Effects:
Potential skin thinning or discoloration with prolonged hydrocortisone use.
Adverse Drug Reactions (ADR):
Severe allergic reactions requiring urgent medical attention.
Contraindications
Hypersensitivity to any component; existing rectal or anal infections; bacterial, fungal, or viral infections in the anorectal area.
Drug Interactions
May interact with other local anesthetics, corticosteroids, vasoconstrictors, anticoagulants (e.g., warfarin, heparin), and antiplatelet medications (e.g., aspirin, clopidogrel).
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: Improves microcirculation, reduces inflammation, provides local anesthesia, and protects the skin.
- Side Effects: Burning, itching, redness, dryness (common); allergic reactions, skin thinning (rare).
- Contraindications: Hypersensitivity, anorectal infections.
- Drug Interactions: Other anesthetics, corticosteroids, vasoconstrictors, anticoagulants, antiplatelet drugs.
- Pregnancy & Breastfeeding: Use with caution. Consult a doctor.
- Dosage: Topical application 2–4 times daily; suppositories 1–2 times daily. Adjust based on patient response.
- Monitoring Parameters: Observe for local skin reactions and signs of infection.
Popular Combinations
This formulation itself is a popular combination. Individual ingredients are often combined with other drugs for various indications, but discussing these is beyond the scope of this profile.
Precautions
- Pre-screening for allergies and relevant medical conditions is essential.
- Pregnant Women: Use only if clearly necessary.
- Breastfeeding Mothers: Use with caution.
- Children & Elderly: Not generally recommended for children under 12. Use with caution in the elderly.
- Lifestyle Considerations: Maintain a high-fiber diet, adequate hydration, and regular exercise.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for this combination?
A: Adults: Apply a thin layer 2-4 times daily or as directed. Suppositories: 1-2 times daily. Adjust for children and special populations as needed. Consult a doctor.
Q2: What conditions does this combination treat?
A: Primarily hemorrhoids and anal fissures. May also provide relief for other anorectal conditions.
Q3: Are there any serious side effects?
A: Rarely, allergic reactions or skin thinning can occur. Seek immediate medical attention for severe reactions.
Q4: Can I use this medication if I am pregnant or breastfeeding?
A: Consult your doctor before use during pregnancy or breastfeeding.
Q5: What should I do if my symptoms do not improve?
A: Consult your doctor if symptoms persist or worsen after 2-4 weeks.
Q6: Can this medication interact with other drugs I am taking?
A: Yes, potential interactions exist. Inform your doctor about all other medications, including OTC drugs and supplements.
A: Clean and dry the affected area before applying a thin layer. Wash hands thoroughly before and after application.
Q8: What are the long-term effects of using this medication?
A: Prolonged hydrocortisone use can potentially lead to skin thinning or discoloration.
Q9: Are there any dietary or lifestyle recommendations while using this medication?
A: Maintain a high-fiber diet, drink plenty of fluids, and engage in regular physical activity to prevent constipation and promote healing.
