Proctocort vs. Preparation H: Not the Same Medications
No, Proctocort (hydrocortisone) and Preparation H are fundamentally different medications with distinct mechanisms of action and clinical indications. Proctocort is a prescription corticosteroid used to treat inflammatory conditions of the rectum, while Preparation H is an over-the-counter product primarily containing vasoconstrictors and protectants for symptomatic hemorrhoid relief.
Key Differences in Composition and Mechanism
Active Ingredients:
- Proctocort contains hydrocortisone acetate (typically 90 mg per application as a foam), which is a corticosteroid that reduces inflammation through immunomodulatory effects 1
- Preparation H contains phenylephrine (a vasoconstrictor), petrolatum, and other protectants—it does NOT contain corticosteroids and works by shrinking swollen blood vessels and providing a protective barrier
Clinical Applications
Proctocort is indicated for:
- Active ulcerative proctitis and proctosigmoiditis, where it demonstrates effectiveness in inducing remission (50% remission rate in clinical trials) 2
- Inflammatory rectal conditions requiring anti-inflammatory therapy 1
- The hydrocortisone acetate in Proctocort foam shows minimal systemic absorption, maintaining normal morning cortisol levels even after treatment 3
Preparation H is indicated for:
- Symptomatic relief of hemorrhoids (itching, burning, discomfort)
- Temporary reduction of swelling associated with hemorrhoids
- Does NOT treat underlying inflammation
Important Clinical Considerations
Efficacy Comparison:
- When compared to other treatments for proctitis, hydrocortisone foam (like Proctocort) is less effective than 5-aminosalicylic acid enemas (50% vs 67% remission rates) 2
- Proctocort requires prescription and medical supervision, while Preparation H is available over-the-counter 2, 3
Safety Profile:
- Proctocort carries potential risks of corticosteroid-related side effects with long-term use, though short-term topical therapy has low risk 1
- Hydrocortisone acetate foam demonstrates minimal systemic absorption when used rectally 3
- Preparation H has a different side effect profile related to its vasoconstrictor components
Common Clinical Pitfall
Do not substitute one for the other. Patients with inflammatory bowel disease (proctitis, proctosigmoiditis) require anti-inflammatory therapy like Proctocort, not just symptomatic relief from Preparation H 1. Conversely, patients seeking simple hemorrhoid symptom relief do not need prescription corticosteroids and can use Preparation H.
Bottom line: These are distinct therapeutic agents—Proctocort treats inflammation with corticosteroids, while Preparation H provides symptomatic relief through vasoconstrictors and protectants. The choice depends entirely on the underlying condition requiring treatment.