What is the daily dose of Proctofoam (hydrocortisone acetate) for ulcerative proctitis?

Dosage of Proctofoam for Ulcerative Proctitis

For ulcerative proctitis, Proctofoam (hydrocortisone acetate) should be administered twice daily for 2 weeks, then once daily for 4 weeks. 1

First-Line Treatment Considerations

While Proctofoam is a treatment option for ulcerative proctitis, it's important to note that current guidelines strongly recommend mesalamine suppositories as first-line therapy:

• Mesalamine 1g suppositories once daily are the preferred initial treatment for mild to moderate active proctitis 2
• Mesalamine suppositories are more effective than topical steroids for inducing remission 2
• Topical corticosteroids like Proctofoam should be considered as second-line therapy when patients fail to respond to rectal 5-ASA therapy 2

Proctofoam Dosing Regimen

When using Proctofoam for ulcerative proctitis (as a second-line option):

• Initial dosing: Apply twice daily for the first 2 weeks 1
• Maintenance dosing: Reduce to once daily application for an additional 4 weeks 1
• Total treatment duration: 6 weeks 1

Efficacy Considerations

Rectal corticosteroids like Proctofoam are effective for inducing remission in ulcerative proctitis, though not as effective as mesalamine:

• Rectal corticosteroids are significantly more effective than placebo for inducing remission (RR, 0.73 [0.66–0.80]) 2
• However, rectal 5-ASA is superior to rectal corticosteroids for induction of clinical remission (RR, 0.74 [0.61–0.90]) 2

Important Caveats and Monitoring

• Avoid long-term use of topical corticosteroids due to potential systemic absorption and side effects
• Monitor for signs of adrenal suppression with prolonged use
• Second-generation corticosteroids like budesonide have lower risk of adrenocortical suppression compared to hydrocortisone 2
• Consider combination therapy with oral and topical treatments for refractory cases 2

Treatment Algorithm for Ulcerative Proctitis

1. First-line: Mesalamine suppositories 1g once daily
2. If inadequate response after 4-8 weeks:
   • Add oral mesalamine (≥2g/day) OR
   • Switch to topical corticosteroid (Proctofoam) twice daily for 2 weeks, then once daily for 4 weeks
3. For refractory cases:
   • Consider combination of topical mesalamine and topical steroids
   • Evaluate for systemic steroids, immunosuppressants, or biologics if still refractory 2

Remember that patient preference and ability to retain the medication are important considerations when choosing between foam, suppository, or enema formulations.