Medications with Brand Names Used for Hemorrhoids
The primary medications used for hemorrhoid treatment include fiber supplements (psyllium), topical corticosteroids and analgesics, and micronized purified flavonoid fraction (MPFF/Daflon), though evidence supporting topical agents is limited. 1, 2
Systemic Medications
Micronized Purified Flavonoid Fraction (MPFF)
- Brand name: Daflon (Servier Laboratories) 2
- Generic: Diosmin - also available as Phlebodia 600 3
- Mechanism: Increases venous tone, lymphatic drainage, capillary resistance, and normalizes capillary permeability 2
- Evidence: Placebo-controlled trials showed symptomatic improvement, with meta-analysis demonstrating significant benefits for bleeding (OR 0.082), discharge/leakage (OR 0.12), and overall improvement (OR 5.25) 4
- Dosing: 2 tablets twice daily for 4 weeks, or continuous 35-40 day course 5, 3
- Important caveat: MPFF has not been FDA-approved in the United States 2
Fiber Supplements
- Psyllium (various brands including Metamucil)
- Evidence: One double-blind, placebo-controlled trial showed reduced hemorrhoidal bleeding and painful defecation, though other fiber studies showed less impressive results 2
Topical Medications
Combination Products
- Procto-Glyvenol (tribenoside + lidocaine) - available as suppository or rectal cream 6
- Provides fast, effective relief for low-grade hemorrhoids
- Demonstrated efficacy versus individual components and steroids
Topical Anesthetics
- EMLA cream (lidocaine 2.5% + prilocaine 2.5%) 7
- Primarily studied for post-hemorrhoidectomy pain
- Significantly reduced pain intensity and improved patient satisfaction
- Nitroglycerin ointment - relieves pain in thrombosed external hemorrhoids by decreasing anal tone 2
Topical Corticosteroids
- Various brands available (specific names not provided in guidelines)
- Critical warning: May ameliorate perianal inflammation but no data suggest they reduce hemorrhoidal swelling, bleeding, or protrusion 2
- Must avoid prolonged use - long-term use of high-potency corticosteroid creams is deleterious and should be limited to maximum 2 weeks 1, 8
Astringents
- Witch hazel (various brands) - limited scientific data supporting efficacy 8
Treatment Algorithm by Hemorrhoid Grade
First-degree hemorrhoids (bleeding, no prolapse):
- Start with fiber supplementation and dietary modifications 1
- Consider topical analgesics/corticosteroids for symptom relief (≤2 weeks) 1, 8
- MPFF (Daflon/Phlebodia) if available outside US 2, 4
Second-degree hemorrhoids (prolapse with spontaneous reduction):
- Same medical therapy as first-degree
- Proceed to office-based procedures (rubber band ligation, infrared coagulation) if medical therapy fails 1
Third-degree hemorrhoids (require manual reduction):
- Medical therapy has limited role
- Primarily managed with rubber band ligation or surgical referral 1
Critical Safety Considerations
- Topical steroids: Never exceed 2-week continuous use 8
- Immunocompromised patients: Increased risk of severe infection after rubber band ligation 1
- Pregnancy: Conservative management preferred - fiber, constipation treatment, topical ointments; defer banding/coagulation until postpartum unless symptoms persist 8
- Cirrhosis/coagulopathy: Infrared coagulation preferred over banding when platelets <50,000 or INR >2.0 8
Common Pitfall
The most significant pitfall is over-reliance on topical preparations without adequate evidence. While topical corticosteroids and analgesics are "ubiquitous in empirical treatment," data supporting their use are lacking, and they do not address the underlying hemorrhoidal pathology 2. The cornerstone remains fiber and water intake, with procedural intervention for refractory cases 1.