This information is intended for use by health professionals
Perinal Cutaneous Spray
Hydrocortisone 0.2% w/w
Lidocaine hydrochloride monohydrate 1.0% w/w
For the full list of excipients, see section 6.1.
Colourless to pale yellow aqueous cutaneous spray solution
For the symptomatic relief of anal and perianal itch, irritation and pain, such as associated with haemorrhoids.
The same dosage schedule applies to all age groups, although the spray is not normally recommended for children under 14 years unless on medical advice:-
Spray once over the affected area up to three times daily, depending on the severity of the condition.
Not to be used if sensitive to lidocaine or any of the other ingredients. Not to be used on broken skin owing to the possibly increased risk of systemic side effects (see section 4.9). Not to be used on infected skin including bacterial, viral, tuberculous or fungal lesions of the skin. Not to be used internally (inside the anus), or anywhere other than the anal area.
Perinal Spray is intended for use for limited periods and so should not be used continuously for longer than 7 days without medical advice. Patients should be instructed to seek medical advice if they experience persistent pain or bleeding from the anus, especially where associated with a change in bowel habit, if the stomach is distended or if they are losing weight. Prompt medical treatment may be very important under such circumstances. Perinal Spray should not be ingested or applied into the mouth, inside the nose or in the eyes.
Avoid prolonged, excessive use as this may produce local atrophy of the skin, striae or systemic corticosteroid effects such as suppression of adrenocortical function.
Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.
Due to possible lidocaine additive effects, Perinal cutaneous Spray should be used with caution in patients taking Class III antiarrhythmic drugs (such as amiodarone), or other local anaesthetics at the same time.
Medicinal products that reduce the clearance of lidocaine (eg cimetidine or betablockers) may increase the risk of overdose (see section 4.9), although the risk is considered very low for Perinal Cutaneous Spray owing to the low doses applied.
Medical supervision is required if used in conjunction with other medicines containing steroids, owing to possible additive effects.
There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intra-uterine growth retardation. There may therefore be a very small risk of such effects in the human foetus. Perinal Cutaneous Spray should only be used during pregnancy if the patient's physician considers that the potential benefits outweigh the potential risks to the foetus.
A temporary tingling sensation may be experienced locally after initial application. Hypersensitivity to lidocaine has rarely been reported.
Not known (frequency cannot be estimated from the available data): Vision, blurred (see also section 4.4).
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
Under exceptional circumstances, if Perinal Spray is used excessively, particularly in young children, it is theoretically possible that adrenal suppression and skin thinning may occur. The symptoms are normally reversible on cessation of treatment.
Overdose may cause systemic side effects such as nervous system excitation and, in severe cases, central nervous and cardiovascular depression.
In case of suspected overdose, discontinue use of this product and seek urgent medical attention.
Pharmacotherapeutic group: Antihemorrhoidals for topical use (products containing corticosteroids), ATC code: C05AA.
The preparation combines the well-known local anti-inflammatory and antipruritic properties of hydrocortisone and the analgesic effect of lidocaine in an aqueous spray formulation. On application, finger contact with the affected area can be avoided which makes for improved hygiene, and lessens the risk of infection.
The active ingredients of the formulation are readily available for intimate contact with the skin and mucous membranes, as the preparation is sprayed in small droplets which dry after application to leave the active ingredients in close contact with the affected area.
Because the preparation is a clear solution, it is entirely homogeneous, and the availability of the active ingredient is optimal.
No special information.
Macrogol cetostearyl ether (cetomacrogol)
Citric acid monohydrate
Do not store above 25°C
30 ml high density polyethylene/aluminium/EAA copolymer collapsible laminate tube with spray pump and cap.
The spray operates when held in any direction. The container is ozone-friendly. It is not an aerosol and does not contain any potentially irritant propellants.
Diomed Developments Limited
T/A Dermal Laboratories
Hertfordshire, SG4 7QR
5 June 2002/18 August 2010 (unlimited validity)