Usage
This combination medication is primarily prescribed for the treatment of hemorrhoids (piles) and anal fissures. It is classified as a topical anesthetic, anti-inflammatory, and vasoconstrictor agent. The mechanism of action involves a synergistic effect of its components: Calcium Dobesilate improves vascular tone and reduces capillary permeability; Hydrocortisone provides anti-inflammatory and antipruritic effects; Lidocaine acts as a local anesthetic; and Zinc oxide promotes wound healing and acts as a mild antiseptic.
Alternate Names
While no specific international nonproprietary name (INN) exists for this exact combination, the individual components have their respective INNs. Several brand names exist depending on the manufacturer and region. Some examples include Dobesil-H, Smuth Cream, Dobelate Heal Cream, and Anasure cream.
How It Works
Pharmacodynamics: Calcium Dobesilate enhances vascular tone, reduces capillary fragility and permeability, thus decreasing swelling and inflammation. Hydrocortisone, a corticosteroid, suppresses the inflammatory response and reduces itching. Lidocaine blocks nerve conduction, providing local anesthesia. Zinc oxide promotes wound healing and has antiseptic properties.
Pharmacokinetics: This combination is applied topically. Absorption of the individual components through the skin varies. Lidocaine is absorbed relatively quickly, while hydrocortisone absorption is limited. Calcium Dobesilate and zinc oxide have minimal systemic absorption. Metabolism and elimination pathways for each component are similar to their individual profiles when administered separately. Lidocaine is primarily metabolized in the liver and excreted by the kidneys. Hydrocortisone undergoes hepatic metabolism. Information on the metabolism of calcium dobesilate and zinc oxide, when applied topically, is limited.
Dosage
Standard Dosage
Adults: A thin layer of the cream is applied to the clean, dry affected area two to three times daily or as directed by the physician. Application into the anal canal may be facilitated by the provided applicator.
Children: Use in children under 12 years of age is generally not recommended unless specifically directed by a physician.
Special Cases: Dosage adjustments may be required in elderly patients, individuals with renal or hepatic impairment, and those with comorbid conditions. These adjustments should be made under the guidance of a physician based on the individual’s specific circumstances.
Clinical Use Cases
The primary clinical use cases are for the topical treatment of hemorrhoids and anal fissures. Use in other clinical settings like intubation, surgical procedures, or within the ICU is not indicated for this specific drug combination.
Dosage Adjustments
Dosage modifications should be made under careful medical supervision considering patient-specific factors, including renal/hepatic function, metabolic disorders, or other relevant medical conditions.
Side Effects
Common Side Effects
Burning or stinging sensation at the application site, itching, redness, irritation, dryness, or peeling of the skin.
Rare but Serious Side Effects
Allergic reactions (rash, hives, swelling), worsening of inflammation.
Long-Term Effects
With prolonged use, skin thinning may occur due to the hydrocortisone component.
Adverse Drug Reactions (ADR)
Severe allergic reactions requiring immediate medical attention are rare but possible.
Contraindications
Hypersensitivity to any of the components, existing rectal or anal infections.
Drug Interactions
Potential interactions may exist with anticoagulants, antiplatelet medications, and other topical agents. Consult a physician regarding concurrent use of other medications. Alcohol interaction is unknown.
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. Safety in these conditions has not been fully established.
Drug Profile Summary
- Mechanism of Action: Combined anesthetic, anti-inflammatory, vasoconstrictive, and wound-healing effects.
- Side Effects: Burning, itching, redness, irritation at the application site. Rarely, allergic reactions.
- Contraindications: Hypersensitivity, rectal/anal infections.
- Drug Interactions: Potential with anticoagulants, antiplatelet drugs.
- Pregnancy & Breastfeeding: Consult physician before use.
- Dosage: Apply thinly to affected area 2-3 times daily.
- Monitoring Parameters: Observe for local skin reactions and symptom improvement.
Popular Combinations
This specific combination is typically formulated as a single product. Individual components may be found in other combination drugs for different indications.
Precautions
- General Precautions: Evaluate for allergies and pre-existing skin conditions before use.
- Specific Populations: Use cautiously in pregnant/breastfeeding individuals and children. Consult a physician.
- Lifestyle Considerations: Avoid excessive alcohol consumption, which may worsen skin conditions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Dobesilate + Hydrocortisone + Lidocaine + Zinc cream?
A: Apply a thin layer to the affected area 2-3 times a day, or as directed by your physician.
Q2: Can I use this cream if I am pregnant or breastfeeding?
A: Consult your doctor before using this cream if you are pregnant or breastfeeding, as safety in these conditions hasn’t been fully established.
Q3: What are the common side effects of this cream?
A: Common side effects include burning, stinging, itching, redness, and irritation at the application site.
Q4: How long can I use this cream?
A: Use this cream for the duration prescribed by your doctor. If symptoms persist or worsen after 1-2 weeks, consult your doctor.
Q5: Can I use this cream for other skin conditions like eczema or dermatitis?
A: While some components may be used in other skin conditions, this specific combination is primarily indicated for hemorrhoids and anal fissures. Consult your doctor for appropriate treatment of other skin conditions.
Q6: What should I do if I accidentally swallow the cream?
A: Seek immediate medical attention.
Q7: Can I cover the treated area with a bandage?
A: Avoid covering the treated area with a bandage unless specifically advised by your doctor.
Q8: What if I miss a dose?
A: Apply the missed dose as soon as you remember, unless it is almost time for the next application. Do not apply extra cream to make up for the missed dose.
Q9: Can I use this cream if I have diabetes or high blood pressure?
A: Inform your doctor about all pre-existing medical conditions before using this medication, including diabetes and hypertension.
Q10: Does this cream interact with any other medications I might be taking?
A: Inform your doctor about all other medications you are using, including over-the-counter drugs and supplements, to avoid potential drug interactions. It may interact with anticoagulants or antiplatelet medications.
