Usage
Lidocaine + Metronidazole + Sucralfate is a combination medication primarily prescribed for the treatment of anorectal disorders. These include:
- Anal fissures: Small tears in the lining of the anus.
- Fistulas: Abnormal connections or passages near the anus.
- Hemorrhoids (piles): Swollen and inflamed veins in the rectum and anus.
- Bedsores: Sores on the skin appearing on areas of the body under pressure
- Post-anorectal surgery: Preventing infections and promoting healing.
Pharmacological Classifications:
- Lidocaine: Local anesthetic, amide type.
- Metronidazole: Antibiotic, nitroimidazole.
- Sucralfate: Gastrointestinal protectant. Also used topically as a protectant.
Alternate Names
This combination medication may be referred to as:
- Lignocaine + Metronidazole + Sucralfate
- Sucralfate + Metronidazole + Lidocaine
Brand Names:
Brand names may vary depending on the region and manufacturer. Some examples based on the source include:
- Sucral Ano cream
- Crema Ano cream
- Ano metrogyl cream
- Cremagel Ano
How It Works
Pharmacodynamics:
- Lidocaine: Blocks voltage-gated sodium channels in neuronal membranes, inhibiting nerve impulse transmission and producing local anesthesia. This action reduces pain in the anorectal area.
- Metronidazole: Disrupts DNA synthesis and structure in susceptible anaerobic bacteria and protozoa, leading to their death. This action prevents and treats infections in the affected area.
- Sucralfate: Forms a protective barrier on the mucosal surface of the anorectal area, protecting it from further irritation by gastric acid, bile salts, and digestive enzymes. Additionally, it stimulates prostaglandin synthesis, promotes local blood flow, and facilitates tissue repair and healing.
Pharmacokinetics:
- Lidocaine: When applied topically, lidocaine is absorbed through the skin and mucous membranes but generally has low systemic absorption in the case of anorectal application. It is metabolized in the liver by CYP enzymes and excreted renally.
- Metronidazole: Topical application leads to limited systemic absorption. After absorption, it is metabolized in the liver and excreted primarily in the urine.
- Sucralfate: It is minimally absorbed from the gastrointestinal tract when applied topically so it has negligible systemic effects. The small amount that is absorbed is excreted mainly through the kidneys.
Dosage
Standard Dosage
Adults:
Apply a small amount of the cream/ointment/gel to the clean and dry affected area of the anus, typically two to four times a day or as directed by the physician. Specific brand instructions should always be followed. The provided sources lack information on dosing frequency and maximum daily doses for this specific drug combination.
Children:
Safety and efficacy have not been established in children under 12 years old. The sources suggest using with caution in children and adolescents below 18. Consult with a pediatrician or a specialist for appropriate guidance.
Special Cases:
- Elderly Patients: Exercise caution due to potential age-related changes in organ function.
- Patients with Renal Impairment: As topical administration leads to limited systemic absorption, dose adjustment is usually not required. However, caution is advised.
- Patients with Hepatic Dysfunction: Due to limited systemic absorption, dose adjustment is usually not required. However, caution is advised, especially for long term use.
- Patients with Comorbid Conditions: Assess patient-specific factors, such as diabetes or blood disorders, before prescribing.
Clinical Use Cases
The dosage in clinical settings for indications other than anal fissures, fistulae, and hemorrhoids is not specified in the sources provided. However, it has been indicated for pressure sores (bed sores).
Dosage Adjustments
Dosage adjustments are typically not necessary due to the low systemic absorption of topical application. However, patient-specific factors should be considered.
Side Effects
Common Side Effects:
- Burning or stinging sensation at the application site
- Itching or irritation
- Redness or rash
- Dry mouth
- Unusual or metallic taste in the mouth
- Diarrhea
Rare but Serious Side Effects:
- Allergic reactions (hives, swelling, difficulty breathing)
- Seizures
- Peripheral neuropathy (numbness, tingling, pain in hands and feet)
- Blood disorders (anemia, thrombocytopenia)
- Liver damage (jaundice, nausea, vomiting, abdominal pain)
Long-Term Effects:
Limited data are available on the long-term effects of this combination medication.
Adverse Drug Reactions (ADR):
Severe allergic reactions, liver damage, seizures, peripheral neuropathy, and blood disorders are potential ADRs requiring immediate medical attention.
Contraindications
- Hypersensitivity to lidocaine, metronidazole, sucralfate, or any component of the formulation.
- Deep wounds or puncture injuries in the application area.
- Active sexually transmitted infections in the application area.
- Pregnancy (unless considered necessary by a doctor).
- Breastfeeding (use with caution).
Drug Interactions
- Lidocaine: May interact with other local anesthetics (bupivacaine, ropivacaine), Class I antiarrhythmics (mexiletine, tocainide), beta-blockers (propranolol, metoprolol), and cimetidine.
- Metronidazole: Avoid alcohol consumption due to the risk of a disulfiram-like reaction (flushing, nausea, vomiting). May interact with anticoagulants (warfarin), cimetidine, lithium and disulfiram.
- Sucralfate: May interact with certain antibiotics (fluoroquinolones, tetracyclines), digoxin, ketoconazole, levothyroxine, phenytoin, and warfarin.
Pregnancy and Breastfeeding
- Pregnancy: Contraindicated unless absolutely necessary. Consult a doctor before use during pregnancy.
- Breastfeeding: Use with caution. Consult a doctor before use while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Lidocaine provides local anesthesia; metronidazole combats bacterial infections; sucralfate protects and promotes healing.
- Side Effects: Common: burning, itching, irritation. Rare but Serious: allergic reactions, seizures, neuropathy.
- Contraindications: Hypersensitivity, deep wounds, active STIs in the application area, pregnancy (generally), breastfeeding (use with caution).
- Drug Interactions: Lidocaine with other local anesthetics or certain antiarrhythmics; metronidazole with alcohol; sucralfate with certain antibiotics or other medications affecting absorption.
- Pregnancy & Breastfeeding: Generally avoided.
- Dosage: Apply to the affected area 2-4 times/day.
- Monitoring Parameters: Observe for signs of allergic reactions, skin irritation, or other adverse effects.
Popular Combinations
The provided sources do not refer to the combination with other drugs.
Precautions
- Avoid contact with eyes, nose, and mouth.
- Wash hands before and after application.
- Do not use on broken or irritated skin.
- Do not use inside the rectum.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lidocaine + Metronidazole + Sucralfate?
A: Apply a small amount to the clean, dry affected area 2-4 times daily or as directed by the physician.
Q2: Can I use this medication if I am pregnant or breastfeeding?
A: It’s generally contraindicated during pregnancy and should be used with caution while breastfeeding. Consult your doctor.
Q3: What are the common side effects?
A: Burning, itching, stinging, redness, rash, unusual taste in the mouth, headache, and diarrhea are common side effects.
Q4: Are there any serious side effects I should be aware of?
A: Although rare, serious side effects include allergic reactions, liver damage, seizures, peripheral neuropathy, and blood disorders. Seek immediate medical attention if any of these occur.
Q5: Can I drink alcohol while using this medication?
A: Avoid alcohol while using this medication, especially if it contains metronidazole, as it can cause a disulfiram-like reaction.
Q6: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q7: Can I use this medication on broken skin?
A: No, avoid applying this medication to broken or irritated skin. Consult your doctor for appropriate treatment options.
Q8: How should I store this medication?
A: Store it at room temperature away from direct sunlight and moisture. Keep it out of reach of children.
Q9: What are the key drug interactions?
A: It may interact with certain antiarrhythmic drugs (mexiletine, tocainide), cimetidine, beta blockers (propranolol, metoprolol), alcohol (metronidazole) and other medications affecting absorption (sucralfate).
Q10: Who should not use Sucralfate, Lidocaine, and Metronidazole cream?
A: It should not be used by people allergic to its ingredients. Additionally, it should be used with caution for pregnant women, breastfeeding women, individuals with liver disease, lung disease, kidney disease or neurological disorders, as well as for elderly and children.
