page96
is lacking.
Lidocaine ointment
(section 15.2)
is used
before emptying the bowel
to relieve pain associated
with
anal fissure
. Alternative local anaesthetics include
tetracaine,
cinchocaine (dibucaine),
and pramocaine
(pramoxine),
but
they are more irritant.
Local
anaes-
thetic ointments can be absorbed through the rectal
mucosa
therefore
excessive
application
should
be
avoided,
particularly in infants and children.
Prepara-
tions containing local
anaesthetics should be used for
short periods only (no longer than a few days) since they
may cause sensitisation of the anal skin.
1.7.2
Compound haemorrhoidal
preparations with
corticosteroids
Corticosteroids are often combined with local
anaes-
thetics and soothing agents in preparations for haemorr-
hoids.
They are suitable for occasional
short-term use
after
exclusion of
infections,
such as herpes simplex;
prolonged use can cause atrophy of
the anal
skin.
See
section 13.4 for general
comments on topical
corticos-
teroids and section 1.7.1 for comment on local
anaes-
thetics.
Children
Haemorrhoids in children are rare.
Treat-
ment
is usually symptomatic and the use of
a locally
applied cream is appropriate for short periods; however,
local
anaesthetics can cause stinging initially and this
may aggravate the child’s fear of defaecation.
Anugesic-HC
c
(Pfizer) A
Cream
, benzyl benzoate 1.2%, bismuth oxide 0.875%,
hydrocortisone acetate 0.5%,
Peru balsam 1.85%,
pramocaine hydrochloride 1%, zinc oxide 12.35%. Net
price 30 g (with rectal nozzle) = £3.71
Dose
apply night and morning and after a bowel movement; do
not use for longer than 7 days;
CHILD not recommended
Suppositories
, buff, benzyl benzoate 33 mg, bismuth
oxide 24 mg,
bismuth subgallate 59 mg,
hydrocorti-
sone acetate 5 mg,
Peru balsam 49 mg,
pramocaine
hydrochloride 27 mg,
zinc oxide 296 mg,
net price 12
= £2.69
Dose
insert 1 suppository night and morning and after a bowel
movement;
do not use for longer than 7 days;
CHILD not recom-
mended
Anusol-HC
c
(McNeil) A
Ointment
,
benzyl benzoate 1.25%,
bismuth oxide
0.875%,
bismuth subgallate 2.25%,
hydrocortisone
acetate 0.25%,
Peru balsam 1.875%,
zinc oxide
10.75%.
Net price 30 g (with rectal nozzle) = £3.29
Dose
apply night and morning and after a bowel movement; do
not use for longer than 7 days;
CHILD not recommended
Note
A proprietary brand (
Anusol Plus HC
c
ointment) is on sale
to the public
Suppositories
, benzyl benzoate 33 mg, bismuth oxide
24 mg,
bismuth subgallate 59 mg,
hydrocortisone
acetate 10 mg, Peru balsam 49 mg, zinc oxide 296 mg.
Net price 12 = £2.31
Dose
insert 1 suppository night and morning and after a bowel
movement;
do not use for longer than 7 days;
CHILD not recom-
mended
Note
A proprietary brand (
Anusol Plus HC
c
suppositories) is on
sale to the public
Perinal
c
(Dermal)
Spray application
,
hydrocortisone 0.2%,
lidocaine
hydrochloride 1%. Net price 30-mL pack = £6.11
Dose
ADULT and CHILD over 14 years, spray once over the
affected area up to 3 times daily; do not use for longer than 7 days
without medical advice; CHILD under 14 years on medical advice
only
Proctofoam HC
c
(Meda) A
Foam
in aerosol pack,
hydrocortisone acetate 1%,
pramocaine hydrochloride 1%.
Net price 21.2-g pack
(approx.
40 applications) with applicator = £5.06
Dose
haemorrhoids and proctitis, 1 applicatorful (4–6 mg
hydrocortisone acetate, 4–6 mg pramocaine hydrochloride) by
rectum 2–3 times daily and after each bowel movement (max.
4
times daily);
do not use for longer than 7 days;
CHILD not
recommended
Proctosedyl
c
(Sanofi-Aventis) A
Ointment
,
cinchocaine (dibucaine) hydrochloride
0.5%,
hydrocortisone 0.5%.
Net price 30 g = £10.34
(with cannula)
Dose
apply morning and night and after a bowel movement,
externally or by rectum;
do not use for longer than 7 days
Suppositories
,
cinchocaine (dibucaine) hydro-
chloride 5 mg,
hydrocortisone 5 mg.
Net price 12 =
£4.66
Dose
insert 1 suppository night and morning and after a bowel
movement;
do not use for longer than 7 days
Scheriproct
c
(Bayer Schering) A
Ointment
,
cinchocaine (dibucaine) hydrochloride
0.5%, prednisolone hexanoate 0.19%. Net price 30 g =
£2.94
Dose
apply twice daily for 5–7 days (3–4 times daily on 1st day if
necessary),
then once daily for a few days after symptoms have
cleared
Suppositories
,
cinchocaine (dibucaine) hydro-
chloride 1 mg,
prednisolone hexanoate 1.3 mg.
Net
price 12 = £1.38
Dose
insert 1 suppository daily after a bowel movement, for 5–7
days (in severe cases initially 2–3 times daily)
Ultraproct
c
(Meadow) A
Ointment
,
cinchocaine (dibucaine) hydrochloride
0.5%,
fluocortolone caproate 0.095%,
fluocortolone
pivalate 0.092%,
net price 30 g (with rectal nozzle) =
£4.57
Dose
apply twice daily for 5–7 days (3–4 times daily on 1st day if
necessary),
then once daily for a few days after symptoms have
cleared
Suppositories
,
cinchocaine (dibucaine) hydro-
chloride 1 mg,
fluocortolone caproate 630 micr-
ograms,
fluocortolone pivalate 610 micrograms, net
price 12 = £2.15
Dose
insert 1 suppository daily after a bowel movement, for 5–7
days (in severe cases initially 2–3 times daily) then 1 suppository
every other day for 1 week
Uniroid-HC
c
(Chemidex) A
Ointment
,
cinchocaine (dibucaine) hydrochloride
0.5%,
hydrocortisone 0.5%.
Net price 30 g (with
applicator) = £4.23
Dose
ADULT and CHILD over 12 years, apply twice daily and after
a bowel movement, externally or by rectum; do not use for longer
than 7 days; CHILD under 12 years on medical
advice only
Suppositories
,
cinchocaine (dibucaine) hydro-
chloride 5 mg,
hydrocortisone 5 mg.
Net price 12 =
£1.91
Dose
ADULT and CHILD over 12 years, insert 1 suppository twice
daily and after a bowel movement;
do not use for longer than 7
days
76
1.7.2 Compound haemorrhoidal preparations with corticosteroids
BNF 61
1
Gastro-intestinal system