Uses

This combination medication is used to treat pain, itching, swelling, and discomfort caused by hemorrhoids and other problems of the anal area (such as anal fissures). It may also be used before and after anal surgery (such as hemorrhoid removal and anal fissure repair).

This combination product contains dibucaine (also known as cinchocaine), an anesthetic that works by temporarily numbing the area, and hydrocortisone, a corticosteroid that reduces redness, itching, and swelling. It also contains an aminoglycoside antibiotic called framycetin (also known as neomycin B) that works by stopping the growth of bacteria. Framycetin works only on bacterial infections. It will not work for other types of infections (such as infections caused by fungi, viruses). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.

This product also contains esculin, a natural substance found in horse chestnut. Esculin is similar to hydroxycoumarin, which is a "blood thinner" (anticoagulant). It has been used to decrease swelling. It may increase the risk of bleeding and may be harmful if swallowed.

How To Use

Follow all instructions in the product package for using the applicator tip/cap/nozzle. Before use, clean the affected area with mild soap and water, rinse well, and pat dry. If applying inside the anus, gently insert the applicator tip inside the anus and apply the product in and around the anal opening as directed in the package instructions or by your doctor. Do not insert any part of the container into the anus.

To apply the product to the outside of the anus only, apply a small amount to the affected area and rub in gently.

Do not cover the area with plastic or waterproof bandages unless directed to do so by your doctor. Covering the treated area may increase the absorption of the medication through the skin. This may improve how well the drug works, but it may also increase the risk of side effects.

Wash hands immediately after use. Avoid getting the product in your eyes, nose, ears or mouth. If the medication gets in these areas, rinse the area immediately with clean water.

Use this product as directed by your doctor, usually twice daily and after each bowel movement. The dosage is based on your medical condition and response to treatment. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day.

Do not use more of this product, use it more often, or keep using it longer than prescribed by your doctor. If you have been using this medication for a long time or in high doses, do not suddenly stop using it without your doctor's approval. Some conditions may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition does not improve or if it worsens.

Side Effects

Redness, burning, or itching at the application site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including:

• rectal bleeding
• change in skin appearance (such as color, thickness)
• skin redness/tenderness/pus or other signs of infection
• easy bleeding/bruising
• hearing problems (such as ringing in the ears)
• slow/irregular heartbeat
• signs of serious infection (such as sore throat that doesn't go away, fever)

Rarely, it is possible this medication will be absorbed into the bloodstream. This can lead to side effects of too much corticosteroid. These side effects are more likely in children and people who use this medication for a long time. Tell your doctor right away if any of the following side effects occur:

• unusual/extreme tiredness
• weight loss
• headache
• swelling ankles/feet
• increased thirst/urination
• vision problems

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using this product, tell your doctor or pharmacist if you are allergic to dibucaine or other amide anesthetics (such as bupivacaine, prilocaine), hydrocortisone or other corticosteroids (such as prednisone), or framycetin or other aminoglycoside antibiotics (such as neomycin); or to any other ingredient in this product (such as esculin, lanolin); or if you have any other allergies. This product may contain inactive ingredients (such as latex), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• infections (especially fungal/viral infections, tuberculosis, rectal sores/infections)
• diabetes
• eye problems (such as glaucoma)
• liver disease
• stomach/intestinal problems

Rarely, using corticosteroid medications for a long time can make it more difficult for your body to respond to physical stress. Before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past few months.

Though it is unlikely, this medication may temporarily slow down a child's growth if used for a long time. See the doctor regularly so your child's height can be checked.

During pregnancy, this medication should be used only when clearly needed. It should not be used for long time or in large amounts. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug are:

• antiplatelet medication (such as clopidogrel)
• "blood thinners" (such as warfarin)
• desmopressin

Overdose

This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Alberta residents can call PADIS (Poison and Drug Information Service) 24 hours a day at 1-800-332-1414. Canada residents can call a provincial poison control center.

Notes

Lab and/or medical tests (such as cortisol levels) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in that case.

Missed Dose

If you miss a dose, use it as soon as you remember unless it is almost time for the next dose. In that case, skip the missed dose. Use your next dose at the regular time. Do not apply more of the medication or use more often to catch up.

If you have questions about missing a dose or you don't have more medication, contact your healthcare provider or pharmacist.

Storage

Store at room temperature. Do not refrigerate. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.