How It Works
Lidocaine-hydrocortisone cream functions through two distinct pathways. The first component, lidocaine, is a numbing agent. It works by temporarily blocking the nerve signals that send pain messages from the skin to the brain. By reducing nerve sensitivity in the area of application, lidocaine provides relief from the burning and sharp pain often experienced during bowel movements or physical activity.
The second component, hydrocortisone, is a topical corticosteroid. It works by lowering the production of inflammatory chemicals in the body that cause redness, itching, and tissue swelling. By calming the immune response at the site of the hemorrhoid or fissure, hydrocortisone helps shrink swollen tissues and reduces the persistent urge to scratch, which can otherwise lead to further skin damage.
Together, these two ingredients address the cycle of pain and inflammation. The cream base also provides a protective layer that may help soothe the area.
| Quick Facts | |
|---|---|
| Common Brands | AnaMantle HC (discontinued), LidaMantle HC (discontinued) |
| Drug Class | Local anesthetic and corticosteroid combination |
| Generic Status | Generic |
| Availability | Prescription only |
Dosing
Standard guidelines recommend applying a thin layer of lidocaine-hydrocortisone cream to the affected area twice daily. For external symptoms, a small amount is gently rubbed into the skin around the anal opening. If internal treatment is required, some products include a specialized applicator that delivers the medication directly into the rectum. It is generally recommended to use the bathroom before applying the cream to ensure the cream is not immediately washed or wiped away.
Before applying the medication, the area should be cleaned with mild soap and water or a gentle cleansing wipe and patted dry. Washing hands thoroughly before and after use is essential to prevent the medication from getting into the eyes or spreading germs to the sensitive area. Only the smallest amount necessary to cover the irritated site should be used to minimize the risk of the body absorbing too much of the steroid component.
Note: The dosing information below is for educational purposes only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
Approved Uses
Most topical lidocaine-hydrocortisone products are not approved by the FDA for treating specific conditions, though they are still commonly prescribed for the relief of pain, itching, soreness, and discomfort of hemorrhoids, anal fissures, pruritus ani, and other conditions of the anal area.
Side Effects
Most people experience few side effects when using this medication for a short duration. However, the sensitive nature of the application site means localized reactions may occur. It is important to monitor the skin for any changes that do not resolve quickly after application.
Common Side Effects
- Temporary stinging or burning upon application
- Skin redness
- Temporary lightening of the skin (pale skin)
- Local dryness or irritation
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur.
- Severe allergic reactions: Symptoms include hives, swelling of the face or throat, or trouble breathing. Get emergency medical help for these symptoms.
- Skin thinning (atrophy): Prolonged use of the steroid component can cause the skin to become fragile, leading to easy bruising or discoloration.
- Low adrenal gland function: If absorbed in high amounts, the steroid can interfere with natural hormone production. Signs include nausea, loss of appetite, extreme weakness, or dizziness.
- Secondary infection: This medication can lower the body’s ability to fight germs. Contact a provider if you notice pus, increased warmth, or worsening pain at the application site.
Call your doctor immediately if you experience any other concerning or prolonged symptoms.
Pharmacist Tips
Clean the Area First
Gently wash the affected area with water, then pat it dry with soft toilet paper or a cloth before applying the cream.
Use the Bathroom Before Application
Emptying the bowels before applying the medication, if needed, ensures the cream remains in contact with the tissue for as long as possible.
Avoid Contact with the Eyes
Lidocaine can numb the surface of the eye, which can lead to accidental injury. Always wash your hands thoroughly after applying the cream.
Apply Sparingly
A thin film is all that is required. Applying a thick layer does not improve symptom relief and may increase the risk of the medication entering the bloodstream.
Store at Room Temperature
Do not freeze the medication, as this can alter the cream’s consistency and effectiveness.
Watch the Calendar
Use this medication for the duration recommended by your provider. Long-term use increases the risk of skin damage.
Check the Applicator
If your product includes an applicator for internal use, follow the package instructions for cleaning and/or disposal.
Drug Interactions
While this medication is applied topically, a small amount can be absorbed through the skin, potentially interacting with other drugs.
- Antiarrhythmic heart medications: Drugs used to control heart rate or rhythm, such as amiodarone or sotalol, can interact with lidocaine if they are absorbed systemically.
- Other topical steroids: Using multiple steroid creams on the same area can significantly increase the risk of skin thinning and adrenal suppression.
- Local anesthetics: Using other numbing agents simultaneously can lead to toxic levels of anesthetics in the body, which may affect the central nervous system or heart.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
Is it safe to insert this cream into the rectum?
Many versions of this prescription medication are designed for rectal use. If your product includes an applicator, use it to deliver the cream just inside the anal opening. However, you should do this only if your specific prescription and product labeling provide instructions for internal use.
How many times a day should lidocaine-hydrocortisone cream be applied?
Standard guidelines typically recommend applying a thin layer of the medication twice daily. Following a consistent schedule, such as morning and evening, helps maintain steady symptom relief.
Can long-term use cause fungal overgrowth in the perianal area?
Yes, the hydrocortisone component of this cream can suppress the local immune response. If used for too long or inappropriately, this can allow fungi or bacteria to grow more easily, leading to a secondary infection. Follow your healthcare provider’s recommendation for how long you should use this medication.
What is the difference between prescription-strength and over-the-counter versions?
Prescription versions typically contain higher concentrations of lidocaine or hydrocortisone, or a combination of both in one product. Similar over-the-counter products, like Preparation H, often use different active ingredients, such as phenylephrine or lower-strength hydrocortisone alone.
Do you have to clean the area before applying the cream?
It is highly recommended to clean the area with water and pat it dry before application. This removes irritants and ensures the medication makes direct contact with the skin.
Is lidocaine-hydrocortisone cream safe for use during pregnancy or for childbirth-induced hemorrhoids?
It is not fully known how this medication affects a pregnancy. You should talk to a healthcare professional about the risks if you are pregnant, planning to become pregnant, or are treating hemorrhoids after childbirth.
Can you have an allergic reaction to the lidocaine, hydrocortisone, or the preservatives?
Allergic reactions can occur with any of the ingredients, including the active medications or the inactive preservatives in the cream. If you have ever had a reaction to anesthetics, inform your provider before use because you may react to this medication.
How quickly does the numbing effect of the lidocaine begin after application?
The numbing effect typically begins shortly after application, possibly within minutes.
Does topical lidocaine interact with heart medications?
There is a small risk of interaction with certain heart medications used to treat irregular rhythms. This risk is generally very low with topical use unless the medication is used excessively or on large areas of broken skin. Be sure to discuss your medications with your healthcare provider.
Comparable Medications
Lidocaine-Hydrocortisone Cream vs Phenylephrine, Hydrocortisone Suppositories, Nitroglycerin Ointment, or Lidocaine 5%?
Phenylephrine
This is a common ingredient in over-the-counter products like Preparation H. It acts as a vasoconstrictor, temporarily reducing swelling in hemorrhoidal tissue. Unlike lidocaine-hydrocortisone, it does not provide active numbing or the same level of anti-inflammatory power.
Hydrocortisone Suppositories
From $47.99
These are solid inserts used specifically for internal hemorrhoids. While they provide the same anti-inflammatory benefit as the hydrocortisone in the cream, they lack the immediate numbing effect of lidocaine. Suppositories are often preferred for symptoms located higher up in the rectal canal.
Nitroglycerin Ointment
This prescription medication is used primarily for anal fissures. It works by relaxing the anal sphincter muscle and increasing blood flow to the area to promote healing. It does not contain an anesthetic or a steroid. A common side effect of nitroglycerin is a severe headache, which is not typically seen with lidocaine-hydrocortisone.
Lidocaine 5%
This is a higher-strength version of the anesthetic alone, often used for significant surface pain or before minor procedures. While it may provide stronger numbing than the combination cream, it lacks the hydrocortisone needed to reduce swelling and inflammation. Lidocaine-hydrocortisone addresses both pain and swelling.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.