Usage
- Policresulen is prescribed for local treatment of vaginal and cervical inflammation, infections, and tissue damage. This includes cervicitis, vaginitis (bacterial, trichomonal, and fungal), cervical erosion, condylomata acuminata, and pressure sores from pessaries. It is also used for haemostasis after cervical biopsies or polyp removal. Occasionally, it is used for oral lesions.
- Pharmacological Classification: Antiseptic, astringent, haemostatic.
- Mechanism of Action: Policresulen exerts its therapeutic effect through a dual mechanism:
- Antimicrobial Effect: It has a broad antimicrobial spectrum against bacteria, fungi, and trichomonas.
- Tissue Denaturation: It selectively coagulates necrotic and pathologically altered tissue, promoting sloughing and stimulating the healing process by fostering re-epithelialization.
Alternate Names
- International Nonproprietary Name (INN): Policresulen
- Other Names: m-cresol sulfonic acid and formaldehyde polymer
- Brand Names: Albothyl, Faktu (in combination with cinchocaine)
How It Works
- Pharmacodynamics: Policresulen’s primary actions are antiseptic, astringent, and haemostatic. It targets and destroys infected or damaged tissue, promoting healing while sparing healthy tissue.
- Pharmacokinetics:
- Absorption: Primarily acts locally with minimal systemic absorption.
- Metabolism: Limited information available.
- Elimination: Primarily eliminated through local shedding of necrotic tissue. Systemic elimination pathways are not well-characterized.
- Mode of Action: The acidic nature of policresulen leads to protein coagulation and necrosis of the affected tissues. It has both antimicrobial and haemostatic effects. There is no known specific receptor binding, enzyme inhibition, or neurotransmitter modulation.
Dosage
Standard Dosage
Adults:
- Vaginal Suppositories: One 90mg suppository inserted deep into the vagina every other day, preferably at bedtime, for up to 9 days.
- Vaginal Solution (36%): Up to 50ml applied to the affected area via a gauze swab, using a speculum, once or twice weekly. For vaginal douches, dilute 1 part concentrate with 3 parts water.
- Ointment (with Cinchocaine): Apply 1-2cm of ointment to the affected anorectal area 3-4 times daily. For rectal application, insert after bowel movement, possibly using an applicator.
Children:
- Not established. Use is generally not recommended for children under 12.
Special Cases:
- Elderly Patients: No specific dose adjustment, but caution advised.
- Patients with Renal Impairment: No specific dose adjustment.
- Patients with Hepatic Dysfunction: No specific dose adjustment.
- Patients with Comorbid Conditions: No specific guidelines, but caution advised.
Clinical Use Cases
- Policresulen is not typically used in settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary application is localized treatment of vaginal/cervical conditions and some oral/anorectal lesions.
Dosage Adjustments
No standard dosage adjustments exist. Clinical judgment is required for individual cases based on the severity of symptoms, the patient’s response to treatment, and the specific condition being treated.
Side Effects
Common Side Effects:
- Local irritation (burning, stinging, itching) at the application site.
- Vaginal dryness.
- Discharge of mucosal tissue fragments.
Rare but Serious Side Effects:
- Allergic reactions (rash, swelling).
Long-Term Effects:
Adverse Drug Reactions (ADR):
- Severe allergic reactions.
Contraindications:
- Hypersensitivity to policresulen or any component of the formulation.
- First trimester of pregnancy (generally avoided).
- Allergy to soya or peanut (for formulations containing soy lecithin).
Drug Interactions:
- Limited information available. Concomitant use of other vaginal medications should be avoided due to the potential for unknown interactions.
Pregnancy and Breastfeeding:
- Pregnancy: Use only if strictly indicated and after careful risk-benefit assessment, especially during the first trimester. Avoid endocervical application during pregnancy.
- Breastfeeding: Avoid use unless the benefit to the mother clearly outweighs the potential risks to the infant. It is unknown if policresulen is excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Antiseptic, astringent, and haemostatic through tissue coagulation and antimicrobial activity.
- Side Effects: Local irritation (burning, stinging), vaginal dryness, allergic reactions.
- Contraindications: Hypersensitivity, first trimester of pregnancy, soya/peanut allergy (in specific formulations).
- Drug Interactions: Limited information. Avoid concomitant use of other vaginal medications.
- Pregnancy & Breastfeeding: Use with caution; assess risk-benefit.
- Dosage: Varies by formulation and indication; see detailed dosage section.
- Monitoring Parameters: Clinical assessment of symptoms, resolution of infection/inflammation, local tolerance.
Popular Combinations:
- Policresulen is sometimes combined with cinchocaine (a local anesthetic) to reduce pain and itching associated with anorectal conditions.
Precautions
- General Precautions: Assess for allergies, and ensure proper application technique to minimize local irritation.
- Specific Populations: See Pregnancy and Breastfeeding, Children dosage sections.
- Lifestyle Considerations: No specific restrictions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Policresulen?
A: The dosage varies depending on the condition being treated and the formulation (suppository, solution, or ointment). Refer to the detailed dosage section above.
Q2: What are the common side effects?
A: The most common side effects are local irritation (burning, stinging) at the application site, vaginal dryness, and discharge of mucosal tissue fragments.
Q3: Can Policresulen be used during pregnancy?
A: It should only be used during pregnancy if strictly indicated and after a careful risk-benefit assessment by a physician. It’s generally avoided during the first trimester, and endocervical application should be avoided throughout pregnancy.
Q4: Is Policresulen safe for breastfeeding mothers?
A: It’s generally advised to avoid using policresulen while breastfeeding unless the benefits outweigh the potential risks to the infant. It is unknown if it’s excreted in breast milk.
Q5: How does Policresulen work?
A: It works by selectively coagulating damaged tissue while exhibiting antimicrobial properties against bacteria, fungi, and trichomonas.
Q6: Are there any drug interactions I should be aware of?
A: Limited information is available on drug interactions. Avoid using other vaginal medications concurrently with policresulen. Consult with a physician regarding potential interactions with other medications you are taking.
Q7: How long should I use Policresulen?
A: Treatment duration varies based on the specific condition and the patient’s response. For vaginal suppositories, treatment typically lasts up to 9 days. Follow your physician’s instructions for treatment duration.
Q8: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember, unless it’s almost time for your next dose. Do not apply a double dose to make up for a missed one.
Q9: What are the contraindications for using Policresulen?
A: Contraindications include hypersensitivity to policresulen or any components of the formulation, the first trimester of pregnancy, and soya/peanut allergy (for certain formulations).
