balsam peru + bismuth oxide + zinc oxide: clinical use

Prescribing considerations

• Confirm that rectal bleeding, blood in the stool, persistent pain or altered bowel symptoms do not require investigation.
• Review the diagnosis if symptoms persist or worsen.
• Not recommended for children.
• Suspected adverse reactions can be reported through the UK Yellow Card Scheme.

Contraindications and cautions

• Hypersensitivity to Balsam Peru, bismuth oxide, zinc oxide or any excipient.
• Use caution with previous fragrance or Balsam Peru contact allergy because sensitisation and systemic contact dermatitis have been reported.

Monitoring

• No routine laboratory monitoring is specified.
• Monitor for local irritation, hypersensitivity or contact dermatitis.
• Reassess persistent or worsening symptoms and rectal bleeding.

Clinical pharmacology

A locally acting C05AX combination. Bismuth oxide and zinc oxide have protective and mildly astringent effects; zinc oxide also absorbs moisture and reduces friction. Balsam Peru provides protective and very mild antiseptic actions. Systemic absorption is expected to be minimal.

Formulation and product differences

• Buff-coloured vanishing cream for external application or internal administration with the supplied nozzle.
• Does not contain hydrocortisone, local anaesthetic or bismuth subgallate.
• Can lubricate suppository administration.
• Excipients include propylene glycol, liquid paraffin, polysorbate, sorbitan stearate and methyl and propyl parahydroxybenzoates.