What are the indications for Faktu (cinchocaine) rectal ointment?

Indications for Faktu Ointment

Faktu ointment (containing policresulen and cinchocaine) is indicated for symptomatic treatment of hemorrhoidal disease, anal fissures, perianal thrombosis, anal eczema and pruritus, proctitis, and wound care after proctological surgery.

Primary Indications

Hemorrhoidal Disease

• Bleeding internal and external hemorrhoids are the most established indication, with multicenter studies demonstrating 83% satisfactory outcomes in over 2,000 patients 1
• Effective for both acute symptomatic hemorrhoids and chronic hemorrhoidal pathology 2, 1
• Perforated or prolapsed external hemorrhoids (perianal thrombosis) respond well to treatment 2, 1

Anal Fissures and Wounds

• Fresh acute anal fissures are a primary indication with high success rates 2, 1
• Rhagades (small fissures or cracks in the anal region) 2, 1
• Postoperative wound treatment after proctological operations shows favorable results 2, 1

Inflammatory and Pruritic Conditions

• Anal eczema and anal pruritus are well-established indications 2, 1
• Proctitis (inflammation of the rectal mucosa) 1

Mechanism of Action

The therapeutic effects derive from two active components:

Policresulen Component

• Creates a highly acidic environment that selectively coagulates necrotic tissue while sparing healthy tissue 1
• Induces desquamation and removal of necrotic tissue, promoting rapid wound cleansing 1
• Produces reactive hyperemia in treated areas, enhancing epithelialization 1
• Provides marked bactericidal action against common pathogens and Candida albicans 1
• Demonstrates hemostatic properties through vasoconstriction of blood vessel myofibrils, controlling profuse bleeding from large areas 1

Cinchocaine Component

• Local anesthetic that provides initial pain relief 1

Clinical Evidence and Efficacy

Large-Scale Multicenter Data

• Seven-center study of 2,287 patients demonstrated 83.2% highly satisfactory results per physician assessment 1
• Patient-rated outcomes showed 82.2% most satisfactory results 1
• Earlier multicenter study of 585 patients confirmed 83.1% highly satisfactory outcomes 2

Safety Profile

• No serious adverse events reported in large multicenter trials 2, 1
• Mild to moderate local reactions (pruritus, burning, irritation) occur in approximately 10-16% of patients 2, 1
• Symptoms typically appear at treatment initiation and necessitate discontinuation in only 5.3% of cases 2
• Steroid-free formulation allows for prolonged treatment periods without corticosteroid-related concerns 2, 1

Important Clinical Considerations

When to Use

• First-line symptomatic treatment for mild-to-moderate hemorrhoidal disease with bleeding 1
• Adjunctive therapy for wound healing after proctological procedures 2, 1
• Alternative to steroid-containing preparations when long-term treatment is anticipated 2, 1

Limitations

• One controlled trial showed no significant reduction in postoperative pain after hemorrhoidectomy compared to placebo, though this was a small study (n=43) 3
• Evidence is primarily from observational studies and older multicenter trials rather than modern randomized controlled trials 2, 1

Common Pitfall

• Patients should be counseled that initial local discomfort is common but typically transient, occurring at treatment onset 2, 1
• Discontinuation should not be automatic with mild symptoms, as most resolve with continued use 2

Comparison to Alternative Treatments

While Faktu has established use in hemorrhoidal disease, note that:

• For inflammatory bowel disease affecting the rectum (proctitis), rectal 5-ASA preparations are first-line therapy with stronger evidence 4
• Sucralfate-based topical products show similar efficacy for hemorrhoidal symptoms with high patient satisfaction 5