From the Guidelines
To prescribe Proctofoam (hydrocortisone acetate and pramoxine hydrochloride) for anorectal conditions, it is recommended to use it only when patients are refractory to or intolerant of mesalamine suppositories, due to the potential safety concerns with long-term rectal corticosteroids and the superiority of rectal 5-ASA for inducing remission 1. When prescribing Proctofoam, the following guidelines should be considered:
- Apply a small amount (about the size of a marble) of the foam to the affected area 1-2 times daily, preferably after a bowel movement.
- The typical duration of treatment is 2-4 weeks.
- Instruct the patient to clean the area gently before application and to insert the applicator about 1 inch into the rectum for internal use.
- For external use, apply the foam directly to the affected area.
- Advise patients to avoid prolonged use beyond the prescribed duration, as it may lead to skin thinning. Key considerations for the use of Proctofoam include:
- The AGA suggests using mesalamine enemas rather than rectal corticosteroids for patients with ulcerative proctosigmoiditis 1.
- Rectal 5-ASA is superior to rectal corticosteroids for induction of remission, and both are superior to placebo 1.
- The quality of evidence comparing rectal 5-ASA to placebo for induction was moderate, while evidence for rectal corticosteroids vs placebo for induction was rated as high 1. It is essential to weigh the benefits and risks of using Proctofoam, considering the potential for skin thinning with prolonged use and the superiority of other treatments like mesalamine suppositories for inducing remission 1.
From the Research
Prescribing Proctofoam for Anorectal Conditions
To prescribe Proctofoam (hydrocortisone acetate and pramoxine hydrochloride) for anorectal conditions, consider the following:
- The combination of topical and oral treatments may be effective for anorectal conditions, as seen in the treatment of ulcerative proctitis 2
- Proctofoam-HC, a combination of a corticosteroid and a local anesthetic, has been proven effective for the treatment of hemorrhoids 3, 4
- When prescribing Proctofoam, consider the duration of treatment, as prolonged use may lead to adverse effects
- There is no direct evidence on the optimal length of Proctofoam prescription, but studies on opioid pain medication suggest that the optimal length of prescription lies between the observed median prescription length and the early nadir 5
Considerations for Specific Patient Populations
- For pregnant women, Proctofoam-HC has been shown to be safe and effective for the treatment of hemorrhoids in late pregnancy 3, 4
- For children and adolescents, opioids should not be prescribed as monotherapy for acute pain, and clinicians should use a multimodal approach that includes nonpharmacologic therapies and nonopioid medications 6
- When prescribing Proctofoam to patients with a history of chronic pain, clinicians should partner with other opioid-prescribing clinicians involved in the patient's care and/or a specialist in chronic pain or palliative care to determine an appropriate treatment plan 6
Key Points to Consider
- Proctofoam is a combination of a corticosteroid and a local anesthetic, and its effectiveness has been demonstrated in the treatment of hemorrhoids
- The optimal length of Proctofoam prescription is not well established, but consideration should be given to the duration of treatment and potential adverse effects
- Clinicians should be aware of the potential risks and benefits of Proctofoam and consider alternative treatments, such as nonpharmacologic therapies and nonopioid medications, when appropriate 2, 3, 4, 6