Anusol-HC 2.5% Cream
It is used to treat signs of hemorrhoids or rectal irritation.
Drug Class
Anti-inflammatory agent; Corticosteroid
Pharmacologic Class
Glucocorticoid receptor agonist
Pregnancy Category
C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Anusol-HC 2.5% Cream contains hydrocortisone, a type of steroid medicine. It works by reducing swelling, itching, and discomfort caused by conditions like hemorrhoids or other inflammation in the rectal area. It helps calm down the body's natural reaction to irritation.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is designed for rectal use only and should not be taken orally. It can also be applied to the skin around the anus as directed.
Continue using the medication as instructed, even if your symptoms improve. Before applying the medication, clean the area if possible, and gently pat it dry with toilet tissue or a soft cloth. Wash your hands before and after use to maintain hygiene.
Storage and Disposal
Store this medication at room temperature, avoiding freezing. Keep all medications in a secure location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of medications, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missed Dose Instructions
If you miss a dose, use it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Avoid using two doses at the same time or taking extra doses.
To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is designed for rectal use only and should not be taken orally. It can also be applied to the skin around the anus as directed.
Continue using the medication as instructed, even if your symptoms improve. Before applying the medication, clean the area if possible, and gently pat it dry with toilet tissue or a soft cloth. Wash your hands before and after use to maintain hygiene.
Storage and Disposal
Store this medication at room temperature, avoiding freezing. Keep all medications in a secure location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of medications, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missed Dose Instructions
If you miss a dose, use it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Avoid using two doses at the same time or taking extra doses.
Lifestyle & Tips
- Maintain good anal hygiene by gently cleaning the area after bowel movements.
- Avoid straining during bowel movements; consider increasing fiber and fluid intake to soften stools.
- Avoid prolonged sitting or standing.
- Consider warm sitz baths for additional relief.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Apply a small amount (e.g., about 1 inch) to the affected area 2-4 times daily, or as directed by a physician. For internal hemorrhoids, use an applicator.
Dose Range:
2 - 4 mg
Condition-Specific Dosing:
hemorrhoids:
Apply 2-4 times daily
proctitis:
Apply 2-4 times daily
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not generally recommended without medical supervision due to increased risk of systemic absorption and adrenal suppression. If used, under strict medical guidance and for short durations.
Adolescent:
Similar to adult dosing, but with caution and for short durations, especially in younger adolescents.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Dialysis:
No specific considerations for topical/rectal use due to limited systemic absorption.
Hepatic Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Pharmacology
Mechanism of Action
Hydrocortisone is a corticosteroid that exerts anti-inflammatory, antipruritic, and vasoconstrictive actions. It acts by inducing phospholipase A2 inhibitory proteins (lipocortins), which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. This reduces edema, capillary permeability, and the migration of polymorphonuclear leukocytes.
Pharmacokinetics
Absorption:
Bioavailability:
Variable (limited systemic absorption from rectal application, but can occur, especially with inflamed mucosa, prolonged use, or large surface areas)
Tmax:
Not precisely defined for rectal cream due to variable absorption
FoodEffect:
Not applicable for rectal administration
Distribution:
Vd:
Not precisely defined for topical/rectal use
ProteinBinding:
Approximately 90% (primarily to transcortin and albumin) once absorbed systemically
CnssPenetration:
Limited (not relevant for primary action)
Elimination:
HalfLife:
Approximately 8-12 hours (biological half-life for systemic effects, plasma half-life is shorter)
Clearance:
Not precisely defined for topical/rectal use
ExcretionRoute:
Renal (as inactive metabolites)
Unchanged:
Minimal
Pharmacodynamics
OnsetOfAction:
Symptomatic relief within minutes to hours
PeakEffect:
Anti-inflammatory effects build over hours to days of consistent use
DurationOfAction:
Several hours per application
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar: confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of a weak adrenal gland: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, extreme fatigue, mood changes, decreased appetite, or weight loss
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal
Changes in vision
Severe headache
Irritation at the site of application
Severe rectal bleeding or pain
Unexplained bruising or bleeding
Swelling
Bone or joint pain
Skin changes (acne, stretch marks, slow healing, hair growth)
Thinning of the skin
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you're bothered by any of the following side effects or if they persist, contact your doctor or seek medical attention:
Burning or stinging
Dryness
* Tingling
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar: confusion, drowsiness, unusual thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath
Signs of a weak adrenal gland: severe nausea or vomiting, severe dizziness or fainting, muscle weakness, extreme fatigue, mood changes, decreased appetite, or weight loss
Signs of Cushing's syndrome: weight gain in the upper back or abdomen, moon face, severe headache, or slow wound healing
Signs of infection: fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal
Changes in vision
Severe headache
Irritation at the site of application
Severe rectal bleeding or pain
Unexplained bruising or bleeding
Swelling
Bone or joint pain
Skin changes (acne, stretch marks, slow healing, hair growth)
Thinning of the skin
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people experience no side effects or only mild ones. If you're bothered by any of the following side effects or if they persist, contact your doctor or seek medical attention:
Burning or stinging
Dryness
* Tingling
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Worsening rectal pain, itching, or bleeding
- Severe burning, irritation, or rash at the application site
- Signs of infection (e.g., fever, pus, increased redness, warmth)
- Unusual weight gain or swelling in ankles/feet (rare, but indicates possible systemic absorption with prolonged/excessive use)
- Muscle weakness or fatigue (rare, indicates possible systemic absorption)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Bowel blockage
+ Fistula
+ Fungal infection
+ Holes, sores, or wounds in the rectal area
+ Peritonitis (inflammation of the lining of the abdominal cavity)
+ Recent bowel surgery
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* All your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Bowel blockage
+ Fistula
+ Fungal infection
+ Holes, sores, or wounds in the rectal area
+ Peritonitis (inflammation of the lining of the abdominal cavity)
+ Recent bowel surgery
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* All your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Regular monitoring is crucial, so be sure to undergo blood tests and bone density checks as directed by your doctor. If you are using this medication long-term, you should also have your eye pressure checked periodically. Discuss this with your doctor to determine the best schedule for these checks.
As this medication may increase your risk of developing infections, it is vital to practice good hygiene by washing your hands frequently and avoiding close contact with individuals who have infections, colds, or flu. If you are exposed to someone with chickenpox or measles and you have not had these diseases or been vaccinated against them, consult your doctor promptly.
If you have diabetes (high blood sugar), inform your doctor, as this medication may cause an increase in blood sugar levels. Monitor your blood sugar levels as instructed by your doctor.
Before using any other medications or products in the rectal area, consult your doctor. Avoid applying this medication to cuts, scrapes, or damaged skin, as this can exacerbate the condition. In the event that this medication is ingested, seek immediate medical attention or contact a poison control center.
Use this medication only for the duration prescribed by your doctor. Prolonged use may increase the risk of developing cataracts or glaucoma, so discuss any concerns with your doctor.
When administering this medication to children, exercise caution, as the risk of certain side effects may be higher in this age group. In some cases, this medication can affect growth in children and teenagers, necessitating regular growth checks. Consult your doctor to determine the best course of action.
Note that some formulations of this medication may not be suitable for all age groups of children. If you have any questions or concerns, consult your doctor.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
Regular monitoring is crucial, so be sure to undergo blood tests and bone density checks as directed by your doctor. If you are using this medication long-term, you should also have your eye pressure checked periodically. Discuss this with your doctor to determine the best schedule for these checks.
As this medication may increase your risk of developing infections, it is vital to practice good hygiene by washing your hands frequently and avoiding close contact with individuals who have infections, colds, or flu. If you are exposed to someone with chickenpox or measles and you have not had these diseases or been vaccinated against them, consult your doctor promptly.
If you have diabetes (high blood sugar), inform your doctor, as this medication may cause an increase in blood sugar levels. Monitor your blood sugar levels as instructed by your doctor.
Before using any other medications or products in the rectal area, consult your doctor. Avoid applying this medication to cuts, scrapes, or damaged skin, as this can exacerbate the condition. In the event that this medication is ingested, seek immediate medical attention or contact a poison control center.
Use this medication only for the duration prescribed by your doctor. Prolonged use may increase the risk of developing cataracts or glaucoma, so discuss any concerns with your doctor.
When administering this medication to children, exercise caution, as the risk of certain side effects may be higher in this age group. In some cases, this medication can affect growth in children and teenagers, necessitating regular growth checks. Consult your doctor to determine the best course of action.
Note that some formulations of this medication may not be suitable for all age groups of children. If you have any questions or concerns, consult your doctor.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Local skin irritation
- Skin thinning or atrophy at the application site
- Increased hair growth in the area
- Acne-like eruptions
- If absorbed systemically over a long period (very rare with typical rectal use): symptoms of Cushing's syndrome (e.g., moon face, buffalo hump, central obesity, high blood pressure, muscle weakness, mood changes, easy bruising, stretch marks).
What to Do:
Discontinue use and consult a healthcare professional. For systemic symptoms, medical evaluation and supportive care are necessary. Call 1-800-222-1222 (Poison Control) for advice if accidental ingestion or significant overdose is suspected.
Drug Interactions
Monitoring
Baseline Monitoring
Assessment of rectal symptoms (pain, itching, inflammation, bleeding)
Rationale: To establish baseline severity and guide treatment.
Timing: Prior to initiation of therapy
Visual inspection of affected area
Rationale: To assess the extent of inflammation, presence of fissures, or other conditions.
Timing: Prior to initiation of therapy
Routine Monitoring
Symptomatic improvement (reduction in pain, itching, inflammation)
Frequency: Daily
Target: Significant reduction in symptoms
Action Threshold: If symptoms worsen or do not improve within 7 days, re-evaluate diagnosis and treatment.
Local adverse effects (e.g., irritation, burning, itching, skin atrophy, thinning, striae)
Frequency: Daily
Target: Absence of new or worsening local effects
Action Threshold: Discontinue if severe irritation or signs of skin atrophy develop.
Signs of systemic absorption (e.g., Cushing's syndrome, adrenal suppression)
Frequency: Rarely needed for typical use; consider with prolonged, extensive use or in pediatric patients.
Target: Absence of systemic signs
Action Threshold: If suspected, discontinue therapy and consult physician for appropriate evaluation (e.g., plasma cortisol levels).
Symptom Monitoring
- Rectal pain
- Rectal itching
- Rectal bleeding
- Inflammation/swelling
- Burning sensation
- Irritation
- Signs of infection (e.g., pus, fever)
Special Patient Groups
Pregnancy
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. While systemic absorption from rectal application is generally limited, caution is advised. Consult a healthcare provider before use.
Trimester-Specific Risks:
First Trimester:
Potential for fetal harm cannot be ruled out; use with caution and only if clearly needed.
Second Trimester:
Similar considerations as first trimester; limited data on specific risks.
Third Trimester:
Similar considerations; potential for adrenal suppression in the neonate with prolonged, high-dose maternal use, though unlikely with typical rectal application.
Lactation
L3 (Moderately safe). Hydrocortisone is excreted in breast milk, but systemic absorption from rectal application is limited, making infant exposure low. Use with caution, especially with prolonged or high-dose use. Advise applying after breastfeeding to minimize potential infant exposure.
Infant Risk:
Low risk of adverse effects in breastfed infants with typical maternal use due to limited systemic absorption. Monitor infant for any unusual symptoms.
Pediatric Use
Use with caution in pediatric patients, especially infants and young children, as they may be more susceptible to systemic adverse effects (e.g., adrenal suppression, growth retardation) due to a larger skin surface area to body weight ratio. Not recommended for children under 12 years without medical supervision and for short durations only.
Geriatric Use
No specific dose adjustments are typically required. However, geriatric patients may have thinner skin and be more prone to local adverse effects like skin atrophy or thinning. Monitor closely for these effects.
Clinical Information
Clinical Pearls
- Anusol-HC 2.5% Cream is for external and/or intrarectal use only. Do not take by mouth.
- Wash hands thoroughly before and after applying the cream.
- For external hemorrhoids, apply a thin film to the affected area. For internal hemorrhoids, use the provided applicator, inserting it gently into the rectum and squeezing the tube.
- Do not use for prolonged periods (typically more than 7 days) without consulting a healthcare professional, as this can increase the risk of local or systemic side effects.
- This medication is not for treating fungal, viral, or bacterial infections. If an infection is present, it should be treated with appropriate antimicrobial therapy.
- Avoid contact with eyes. If contact occurs, rinse thoroughly with water.
Alternative Therapies
- Local anesthetics (e.g., lidocaine cream/ointment)
- Astringents (e.g., witch hazel pads, zinc oxide ointment)
- Vasoconstrictors (e.g., phenylephrine rectal preparations)
- Protectants (e.g., petrolatum, mineral oil)
- Bulk-forming laxatives (to prevent straining)
- Sitz baths (warm water soaks for symptomatic relief)
- Surgical interventions for severe hemorrhoids
Cost & Coverage
Average Cost:
Price varies widely by pharmacy and formulation (cream, ointment, suppository) per tube/box
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (often preferred generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.