TOPICAL VASOCONSTRICTORS
Place in Therapy
Place in therapy
Topical vasoconstrictors (phenylephrine, ephedrine, and epinephrine) may produce vasoconstriction leading to the temporary relief of hemorrhoidal burning and itching. However, there is no evidence in the literature supporting the efficacy of topical vasoconstrictors for these symptoms. Additionally, there is no evidence suggesting that topical vasoconstrictors reduce hemorrhoidal bleeding.
Although there is no evidence supporting their efficacy, topical vasoconstrictors may still produce symptomatic relief from hemorrhoids. Their safety profile must be scrutinized for each patient. Topical vasoconstrictors are contraindicated in patients with coronary artery disease, MAO inhibitor use within the past 14 days, uncontrolled or severe hypertension, or urinary retention. Although systemic absorption is likely to be minimal, the risk increases when applied to abraded skin. This risk versus benefit must be carefully assessed in patients with arrhythmias, cardiovascular disease, diabetes mellitus, glaucoma, hypertension, hyperthyroidism, prostatic hypertrophy, or renal impairment.
References
1. Avsar AF, Keskin HL. Haemorrhoids during pregnancy.J ObstetGynaecol 2010; 30(3):231-7.
2. Canadian Pharmacists Letter.Hemorrhoids.January 2011; Vol. 27.Accessed June 14, 2012 from Canadian Pharmacist’s Letter.
3. Carruthers-Czyzewski P. Hemorrhoids.In Patient Self-Care 1st ed. (pp.287-293). Ottawa, ON: Canadian Pharmacists Association.
4. Epocrates, Inc. Preparation H Cooling Gel monograph. 2012. Accessed June 14, 2012 from Epocrates Online.
5. Johanson JF. Nonsurgical treatment of hemorrhoids.J GastrointestSurg 2002; 6(3):290-4.
6. Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am CollSurg 2007; 204(1):102-17.
7. Lexi-Comp. Phenylephrine (Topical). 2012. Accessed June 14, 2012 from Lexi-Comp Online.
8. Madoff RD, Fleshman JW.American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids.Gastroenterology 2004; 126:1463-73.
9. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54:1059-64.
10. Singer M. Hemorrhoids. In DE Beck, PL Roberts, TJ Saclarides, MJ Stamos, Wexner SD (Eds.). The ASCRS textbook of colon and rectal surgery, 2nd ed. (pp. 175-202). 2011. New York, NY: Springer.
11. Sneider EB, Maykel JA. Diagnosis and Management of Symptomatic Hemorrhoids.SurgClin North Am 2010; 90(1):17-32.
12. Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.GastroenterolClin North Am 2003; (32)1:309-22.
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Topical vasoconstrictors (phenylephrine, ephedrine, and epinephrine) may produce vasoconstriction leading to the temporary relief of hemorrhoidal burning and itching. However, there is no evidence in the literature supporting the efficacy of topical vasoconstrictors for these symptoms. Additionally, there is no evidence suggesting that topical vasoconstrictors reduce hemorrhoidal bleeding.
Although there is no evidence supporting their efficacy, topical vasoconstrictors may still produce symptomatic relief from hemorrhoids. Their safety profile must be scrutinized for each patient. Topical vasoconstrictors are contraindicated in patients with coronary artery disease, MAO inhibitor use within the past 14 days, uncontrolled or severe hypertension, or urinary retention. Although systemic absorption is likely to be minimal, the risk increases when applied to abraded skin. This risk versus benefit must be carefully assessed in patients with arrhythmias, cardiovascular disease, diabetes mellitus, glaucoma, hypertension, hyperthyroidism, prostatic hypertrophy, or renal impairment.
References
1. Avsar AF, Keskin HL. Haemorrhoids during pregnancy.J ObstetGynaecol 2010; 30(3):231-7.
2. Canadian Pharmacists Letter.Hemorrhoids.January 2011; Vol. 27.Accessed June 14, 2012 from Canadian Pharmacist’s Letter.
3. Carruthers-Czyzewski P. Hemorrhoids.In Patient Self-Care 1st ed. (pp.287-293). Ottawa, ON: Canadian Pharmacists Association.
4. Epocrates, Inc. Preparation H Cooling Gel monograph. 2012. Accessed June 14, 2012 from Epocrates Online.
5. Johanson JF. Nonsurgical treatment of hemorrhoids.J GastrointestSurg 2002; 6(3):290-4.
6. Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am CollSurg 2007; 204(1):102-17.
7. Lexi-Comp. Phenylephrine (Topical). 2012. Accessed June 14, 2012 from Lexi-Comp Online.
8. Madoff RD, Fleshman JW.American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids.Gastroenterology 2004; 126:1463-73.
9. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54:1059-64.
10. Singer M. Hemorrhoids. In DE Beck, PL Roberts, TJ Saclarides, MJ Stamos, Wexner SD (Eds.). The ASCRS textbook of colon and rectal surgery, 2nd ed. (pp. 175-202). 2011. New York, NY: Springer.
11. Sneider EB, Maykel JA. Diagnosis and Management of Symptomatic Hemorrhoids.SurgClin North Am 2010; 90(1):17-32.
12. Wald A. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.GastroenterolClin North Am 2003; (32)1:309-22.
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