hydrocortisone acetate + lidocaine: clinical use

Prescribing considerations

• Exclude malignancy where symptoms could represent another anorectal disorder.
• Avoid excessive rectal application, particularly in infants and children.
• Treat bacterial, viral or fungal infection appropriately if concurrent use is considered.
• Stop treatment if irritation or rectal bleeding develops.
• Consider acute porphyria risk and use only when no safer alternative is available.

Contraindications and cautions

• Hypersensitivity to either active ingredient, an excipient or amide-type local anaesthetics
• Application to atrophic skin
• Untreated bacterial, viral, pathogenic fungal or parasitic infection
• Treatment with a class III anti-arrhythmic outside hospital

Monitoring

• Assess persistent, recurrent or unexplained symptoms and rectal bleeding.
• Monitor for local sensitivity, infection and skin atrophy.
• Watch for neurological or cardiovascular lidocaine toxicity if absorption may be increased.
• For hospitalised patients receiving class III anti-arrhythmics, maintain close surveillance and consider ECG monitoring.

Clinical pharmacology

Lidocaine stabilises neuronal membranes and prevents initiation and conduction of nerve impulses. Hydrocortisone acetate is a mild corticosteroid with local anti-inflammatory and antipruritic activity. Both can be absorbed through mucous membranes and are principally metabolised hepatically and excreted in urine.

Formulation and product differences

• The ointment is suitable for external and intrarectal application and is supplied with an applicator.
• It contains zinc oxide and aluminium acetate; cetyl and stearyl alcohol may cause local contact dermatitis.
• It is normally refrigerated but may be kept below 25°C for up to two months while in use, after which any remainder should be discarded.

Ointment

Route: Cutaneous

Strengths: 5% + 0.275%