Anucort HC Suppository Dosing
For hemorrhoidal symptoms, insert one Anucort HC (hydrocortisone acetate 25 mg) suppository rectally twice daily, morning and evening, for 2 weeks in nonspecific proctitis or until symptoms resolve, though the provided evidence does not contain FDA labeling for this specific product.
Standard Dosing Regimen
The evidence provided does not contain specific FDA labeling or guidelines for Anucort HC suppositories. However, based on general corticosteroid suppository principles and the hydrocortisone formulations discussed:
- Typical dosing: One suppository (25 mg hydrocortisone acetate) inserted rectally 2-3 times daily
- Duration: Usually 2 weeks for acute symptoms, though treatment duration should be based on clinical response
- Administration timing: Morning and evening applications are most common, with an optional midday dose if needed
Important Clinical Considerations
Absorption and Systemic Effects
- Rectal hydrocortisone suppositories can be systemically absorbed, particularly with prolonged use or in patients with extensive mucosal inflammation
- Unlike oral hydrocortisone for adrenal insufficiency (which requires 15-25 mg daily in split doses for replacement therapy), topical rectal preparations are intended for local anti-inflammatory effects 1
Monitoring and Duration
- Short-term use (≤2 weeks) typically does not require systemic monitoring
- Prolonged use (>2-3 weeks) may warrant assessment for hypothalamic-pituitary-adrenal axis suppression, particularly in patients using multiple corticosteroid formulations
- Patients should be evaluated for clinical response within 1-2 weeks; failure to improve warrants reassessment of diagnosis
Contraindications and Cautions
- Avoid in patients with systemic fungal infections, tuberculosis, or viral infections of the rectum
- Use cautiously in patients with existing adrenal insufficiency or those on systemic corticosteroids
- Rectal corticosteroids should not be used as replacement therapy for adrenal insufficiency, which requires oral hydrocortisone 15-25 mg daily in divided doses 1
Common Pitfalls
- Do not confuse topical rectal hydrocortisone dosing with systemic replacement therapy dosing for adrenal insufficiency
- Avoid prolonged continuous use without medical supervision, as this increases risk of systemic absorption and adrenal suppression
- Do not use as monotherapy for inflammatory bowel disease extending beyond the rectum; mesalamine suppositories (500 mg-1 g daily) are more appropriate for ulcerative proctitis 2, 3