cinchocaine hydrochloride + prednisolone hexanoate: clinical use

Prescribing considerations

• Confirm that symptoms are consistent with haemorrhoids or pruritus ani; investigate persistent, recurrent or atypical symptoms and unexplained bleeding.
• Exclude or appropriately treat local infection before prescribing.
• Avoid occlusion over the perineum and extensive exposure because systemic corticosteroid absorption and adrenal suppression are possible.
• Consider latex-barrier failure and CYP3A-inhibitor interactions.

Contraindications and cautions

• Hypersensitivity to either active ingredient, another local anaesthetic or a formulation component
• Viral infection in the treatment area
• Untreated primary bacterial or fungal infection
• Secondary skin infection without appropriate anti-infective therapy

Monitoring

• Review persistent or worsening symptoms and rectal bleeding.
• Check for local allergic reactions, skin atrophy and features of systemic corticosteroid exposure where absorption risk is increased.
• Assess blurred vision or other visual disturbance and consider ophthalmology referral.
• If concurrent strong CYP3A inhibition is unavoidable, monitor for systemic corticosteroid adverse effects.

Clinical pharmacology

Prednisolone hexanoate suppresses local inflammatory vascular and cellular responses. Cinchocaine produces local anaesthesia of anorectal mucosa. Absorbed prednisolone hexanoate is rapidly hydrolysed to prednisolone, which is mainly inactivated by the liver.

Formulation and product differences

• The ointment can be used externally or rectally and is supplied with an applicator. Its castor-oil derivatives may cause skin reactions and impair latex products.
• Suppositories are intended for internal rectal symptoms, contain hard fat that may impair latex products, and require refrigerated storage.
• Softened suppositories can be firmed in cold water before unwrapping.