A topical combination formulation primarily used for the symptomatic relief of pain, itching, and inflammation associated with hemorrhoids (piles) and other anorectal disorders. Lidocaine provides rapid local anesthesia, Tannic Acid acts as an astringent to reduce swelling and exudation, and Zinc Chloride promotes wound healing and provides mild antiseptic properties. It is a first-line topical therapy in the Indian outpatient setting for grade I and II hemorrhoids.
Adult: Apply a thin layer to the affected anal area externally 3 to 4 times daily, especially after bowel movements. For internal use (using applicator): Insert rectally as directed, usually once in the morning and once at bedtime, and after each bowel movement. Do not exceed 4 applications per day.
Note: Clean and dry the anal area before application. Apply externally with a finger cot or clean tissue. For internal hemorrhoids, use the rectal applicator provided, insert gently, and squeeze the tube to deliver the medication. Wash hands before and after use. Do not use for more than 7 days unless directed by a physician.
This combination exerts a multi-modal action. Lidocaine blocks voltage-gated sodium channels on neuronal membranes, inhibiting the initiation and conduction of nerve impulses, leading to reversible local anesthesia. Tannic Acid precipitates proteins, forming a protective layer (coagulum) on the mucosa/skin, which reduces tissue permeability, shrinks swollen tissues, and decreases exudation. Zinc Chloride acts as a mild antiseptic, promotes granulation tissue formation, and has astringent properties that aid in wound contraction and epithelialization.
Pregnancy: Category B (US FDA). Lidocaine crosses the placenta. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Short-term, limited topical use is generally considered acceptable. Consult physician.
Driving: Unlikely to affect driving ability when used as directed. However, if symptoms of systemic absorption (dizziness, blurred vision) occur, patient should not drive or operate machinery.
| Class I Antiarrhythmics (e.g., Mexiletine, Tocainide) | Additive cardiotoxic and neurotoxic effects | Major |
| Beta-blockers (e.g., Propranolol) | May reduce hepatic blood flow and metabolism of lidocaine, increasing risk of toxicity | Moderate |
| CYP1A2 & CYP3A4 Inhibitors (e.g., Ciprofloxacin, Fluconazole, Amiodarone) | Increased plasma levels of lidocaine, risk of toxicity | Moderate |
| Other Topical Anesthetics or Products containing Local Anesthetics | Risk of additive systemic absorption and toxicity | Major |
| Sulfonamides (e.g., Cotrimoxazole) | Theoretical increased risk of methemoglobinemia with lidocaine | Moderate |
Same composition (Lidocaine (2% w/v) + Tannic Acid (2% w/v) + Zinc Chloride (1% w/v)), different brands: