Hydrocortisone Rectal

1. Introduction

Hydrocortisone rectal foam is a topical corticosteroid formulation used to treat inflammation and swelling in the rectum and lower bowel. It works by suppressing local inflammatory responses, reducing swelling, itching, and discomfort associated with rectal and lower intestinal conditions.

2. Indications

  • Approved Indications:
    • Ulcerative proctitis (inflammation of the rectum).
    • Haemorrhoids (severe cases with associated inflammation).
    • Other inflammatory rectal conditions (as prescribed).

3. Dosage

  • Adults and Adolescents (≥12 years):
    • Apply one metered dose of foam (90 mg hydrocortisone) into the rectum twice daily for 2–3 weeks, followed by once daily as symptoms improve.
    • Treatment duration typically ranges from 2 to 6 weeks, depending on severity.
  • Children (<12 years):
    • Not recommended unless specifically prescribed by a healthcare provider.

4. Administration

  1. Shake the canister well before use.
  2. Attach the applicator to the canister.
  3. Gently insert the applicator tip into the rectum while lying down or squatting.
  4. Press the canister to release one dose of foam into the rectum.
  5. Remove the applicator, wash it with warm soapy water, and store it for future use.
  6. Avoid using the foam immediately before a bowel movement for optimal absorption.

5. Forms Available

  • Rectal Foam: 10% hydrocortisone (90 mg per dose).

6. Side Effects

6.1. Common Side Effects

  • Local irritation or discomfort.
  • Rectal pain or itching.

6.2. Less Common Side Effects

  • Abdominal bloating.
  • Mild diarrhoea or increased bowel movements.

6.3. Rare but Serious Side Effects

  • Systemic absorption leading to adrenal suppression (prolonged use).
  • Severe rectal bleeding or infection.

7. Warnings

  • Systemic Absorption: Prolonged use may lead to systemic corticosteroid effects, especially in patients with other conditions requiring corticosteroids.
  • Infections: Do not use if rectal or perianal infections are present.

8. Precautions

  • Use cautiously in patients with a history of:
    • Adrenal insufficiency.
    • Gastrointestinal perforation or fistulas.
    • Rectal or perianal infections.
  • Discontinue use and consult a doctor if symptoms worsen or rectal bleeding persists.

9. Interactions

  • Drug-Drug Interactions:
    • Oral corticosteroids: Increased risk of systemic side effects.
    • NSAIDs: Increased risk of gastrointestinal irritation or bleeding.
  • Drug-Food Interactions:
    • No significant interactions.

10. Monitoring Parameters

  • Improvement in symptoms such as swelling, pain, or bleeding.
  • Signs of local irritation or infection.
  • Monitor adrenal function with prolonged use.

11. Use in Children

  • Not typically recommended in children under 12 years due to limited safety data. Use only under specialist advice.

12. Use in Pregnancy

  • Category C: Use only if the potential benefit outweighs the risk. Consult your doctor before use during pregnancy.

13. Use in Elderly

  • Safe for use in elderly patients, but monitor for local side effects and systemic absorption.

14. Use in Kidney Disease

  • Safe for use as systemic absorption is minimal.

15. Use in Liver Disease

  • Use cautiously in severe liver impairment due to the potential for systemic absorption.

16. Patient Counselling Points

  • Use the foam as prescribed, typically after a bowel movement for maximum effect.
  • Shake the canister well before use and follow the application steps carefully.
  • Wash the applicator thoroughly after each use.
  • Do not exceed the prescribed duration to avoid potential side effects like skin thinning or systemic absorption.
  • Report persistent symptoms, worsening inflammation, or unusual rectal bleeding to your healthcare provider.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
ColifoamMeda Pharmaceuticals$30–50 (14 applications)
Generic HydrocortisoneVarious manufacturers$20–40 (14 applications)

18. FAQs (15 Questions)

  1. What is hydrocortisone rectal foam used for?
    It is used to treat inflammation and swelling in conditions like ulcerative proctitis and haemorrhoids.
  2. How does hydrocortisone rectal foam work?
    It reduces inflammation by suppressing the release of inflammatory mediators in the rectal area.
  3. How often should hydrocortisone rectal foam be used?
    Typically twice daily for the initial 2–3 weeks, then once daily as symptoms improve.
  4. Can hydrocortisone rectal foam cause side effects?
    Yes, common side effects include local irritation, pain, or itching. Rarely, systemic absorption may lead to adrenal suppression.
  5. Can children use hydrocortisone rectal foam?
    It is not recommended for children under 12 years unless prescribed by a doctor.
  6. Is hydrocortisone rectal foam safe during pregnancy?
    Consult your doctor before use. It may be prescribed if the benefits outweigh the risks.
  7. How should hydrocortisone rectal foam be stored?
    Store at room temperature, away from heat and direct sunlight. Do not freeze.
  8. How long does hydrocortisone rectal foam take to work?
    Symptom relief may occur within a few days, but full improvement can take up to 2–6 weeks.
  9. Can I use hydrocortisone rectal foam for haemorrhoids?
    Yes, it can reduce inflammation, swelling, and itching caused by haemorrhoids.
  10. How do I clean the applicator after use?
    Wash the applicator thoroughly with warm soapy water and allow it to dry.
  11. Can hydrocortisone rectal foam be used for bleeding?
    It may help reduce bleeding associated with inflammation, but consult a doctor if bleeding persists.
  12. Does hydrocortisone rectal foam interact with other medications?
    Minimal systemic absorption reduces the likelihood of interactions, but consult your doctor if taking corticosteroids or NSAIDs.
  13. Can I stop using hydrocortisone rectal foam abruptly?
    Yes, for short-term use. For prolonged use, consult your doctor to taper the dosage if necessary.
  14. Is hydrocortisone rectal foam safe for elderly patients?
    Yes, but monitor for side effects such as local irritation or systemic absorption.
  15. What should I do if I miss a dose?
    Apply it as soon as you remember, but skip it if it is close to the next dose. Do not double up.