balsam peru + bismuth oxide + bismuth subgallate + zinc oxide: clinical use

Prescribing considerations

• Exclude clinically important causes of rectal bleeding before recommending treatment.
• Reassess persistent or worsening symptoms rather than continuing empirical self-treatment.
• Consider contact allergy, particularly when symptoms worsen after exposure to Balsam Peru.
• The ointment has broader licensed indications than the suppositories.
• Neither selected formulation is recommended for children.

Contraindications and cautions

• Hypersensitivity to any active ingredient or excipient.
• Use particular caution with known Balsam Peru allergy or previous contact dermatitis from fragranced or balsam-containing products.

Monitoring

• No routine laboratory monitoring is specified.
• Monitor clinical response, bleeding pattern and local tolerability.
• Stop and assess new or worsening rash, burning, erythema, peeling, urticaria or pain.

Clinical pharmacology

The ingredients act locally. Zinc oxide and bismuth compounds protect tissue and provide mild astringent effects; zinc oxide also absorbs moisture and reduces friction. Balsam Peru provides protective and very mild antiseptic activity. No meaningful systemic absorption is described during intended use.

Formulation and product differences

• Ointment supports external application and internal administration through the supplied rectal nozzle; it contains lanolin, castor oil, cocoa butter and a petrolatum base.
• Suppositories are for internal anal use and have a hard-fat base with kaolin, titanium dioxide and medium-chain triglycerides.
• The suppository licence focuses on internal haemorrhoids and related conditions. The ointment licence also includes external haemorrhoids, anal itching, proctitis, fissures and specified postoperative settings.