balsam peru + benzyl benzoate + bismuth oxide + bismuth subgallate + hydrocortisone acetate + zinc oxide: clinical use

Prescribing considerations

• Confirm the diagnosis in persistent or recurrent anorectal symptoms.
• Investigate rectal bleeding or blood in the stool before treatment.
• Minimise prolonged or excessive exposure because rectal hydrocortisone can be absorbed systemically.
• Review concurrent corticosteroids and CYP3A inhibitors.
• Not recommended for people under 18.

Contraindications and cautions

• Hypersensitivity to any active ingredient or excipient
• Tuberculous, fungal or most viral lesions, including herpes simplex, vaccinia and varicella
• Pregnancy or breastfeeding under the selected product licences

Monitoring

• Clinical response, worsening or recurrence
• Rectal bleeding or evidence of another diagnosis
• Local sensitisation, infection or skin atrophy
• Systemic corticosteroid effects where exposure or interaction risk is increased
• Blurred vision or other visual disturbance

Clinical pharmacology

Hydrocortisone acetate provides local anti-inflammatory activity. Zinc oxide and bismuth salts protect raw surfaces and are mildly astringent. Balsam Peru is protective and mildly antiseptic; benzyl benzoate supports solubilisation and preservation. Rectal hydrocortisone absorption can occur, while the other ingredients principally act locally.

Formulation and product differences

• Suppositories are for internal haemorrhoids and contain a hard-fat base with light kaolin.
• Ointment treats internal or external symptoms and includes a rectal nozzle and anhydrous lanolin.
• The suppository is listed as a pharmacy medicine; the selected ointment is prescription-only.