AnaMantle HC

Lidocaine and hydrocortisone combination is generally used to alleviate pain and itching or other discomfort caused by certain clinical conditions such as hemorrhoids, sunburn or other minor burns, minor cuts and scratches, poison oak, poison ivy, insect bites or stings and many other sources of skin irritations on the body surface.

Lidocaine is currently the most widely used local anesthetic. Topical application of lidocaine causes reversible loss of sensory perception, especially of pain in a restricted area of the body. It blocks generation and conduction of nerve impulse at any part of the neuron with which it come in contact, without causing any structural damage. As a result no pain sensation takes place.

On the contrary, hydrocortisone is a corticosteroid that is used topically for a large variety of dermatological conditions. It relieves the redness, itching, and swelling caused by skin conditions by virtue of its anti-inflammatory, immunosuppressive, vasoconstrictor and antiproliferative actions. Further, it is highly effective in many eczematous skin diseases.

This combination drug is available in the following dosage forms only with your doctor’s prescription:

• Cream
• Gel/Jelly
• Lotion
• Pad

If you are about to start a drug therapy, the risk-benefit ratio of taking the drug should be considered carefully. Here, the suitable drug therapy is chosen with active participation of both the doctor and the patient.

There are some important factors such as

• drug interactions,
• metabolic impairment,
• hypersensitivity reaction,
• pregnancy,
• lactation etc.

which may alter the desired therapeutic effects of such medications.

Sometimes the presence of other health disorders affects the beneficial effects of this medicine and even may cause serious toxic effects.

If you have had any allergic reactions to any medicine, you must inform your doctor about that.

Further, make sure you mention your doctor if you have any other health problems or medical disorders, especially infection, large sores, broken skin, or severe injury at the area of application. The local anesthetics often fail to afford adequate pain control in inflamed tissues because of the following reasons:

• Blood flow to the inflamed area is increased, that’s why local anesthetic is removed more rapidly from the site.

• Inflammation lowers the pH of the affected tissues which inactivate greater fraction of such medications as it is in the ionized form hindering diffusion into the axolemma.

• Certain inflammatory products produced by the cells often oppose the anesthetic action of such medications.

In addition, certain drugs should not be used simultaneously along with such medications. For example, concurrent use of vasoconstrictors (e.g. adrenaline) prolongs the duration of action of local anesthetic by decreasing their rate of removal from the local site, which increases the chances of subsequent local tissue edema and necrosis as well as delays wound healing by reducing oxygen supply and enhancing oxygen consumption in the affected area.

Additionally, it may raise blood pressure and promote arrhythmia in susceptible individuals. Thus, it is always advised to consult with your doctor if you are in need of some other medications or even any over-the-counter medicine for another health problem.

However, studies performed with such medications in pregnant and lactating women have failed to demonstrate a risk to the fetus and the nursing baby respectively. Thus, this medicine can be used during pregnancy and lactation if clearly needed.

The dosage schedule and the duration of drug therapy depend on the particular medical problem for which you are using this medicine. The therapeutic dose may also vary with patient’s condition or requirement and the strength of the medicine as well.

Thus, you should use this medicine following the directions given by your doctor.

In order to treat pain and itching caused by minor skin problems, an adult should be treated with application of such medications over the affected area for 2 to 3 times in a day. The frequency of application may be increased up to 5 times a day if required. Children should be treated with great care and the dose should be determined by a healthcare professional. Moreover, the use of such medications is not suitable for those children who are below the age of 2 years.

If you miss any dose of this medicine, you should take it as soon as possible. But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule.

Further, it is advised to store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children as well as outdated medicines should be disposed by an appropriate way.

Firstly, regular visits to your doctor are recommended to check that this medicine is working properly or not. It is advised to wash your hands with soap and water before and after using this medicine. You should not apply this medicine over the area of open wounds, burns, or inflamed skin.

Further, you should stop using this medicine and check with your doctor immediately

if your condition does not improve within a week, or if you have developed rashes, stinging, swelling, or irritation over the skin following application of such medications.

In addition, the following guidelines should be followed while you are using such medications:

• Beta-blockers like propranolol should not be used concurrently along with local anesthetics (e.g. lidocaine) because they may minimize the effectiveness of such anesthetics by reducing their metabolism.

• Vasoconstrictors (e.g. adrenaline) containing local anesthetic should be avoided for patients with ischemic heart disease, cardiac arrhythmia, thyrotoxicosis, uncontrolled hypertension, and those receiving beta-blockers or tricyclic antidepressants.

• Such medicines should be used cautiously in case of glucose-6-phosphodiesterase deficiency, methemoglobin reductase deficiency, and pyruvate-kinase deficiency.

• Penetration of the steroid at different sites differs markedly –high at axilla, groin, face, scalp, and scrotum; medium at limbs and trunk; low at palm, sole, elbow and knee. Areas of high penetration easily develop adverse effects –potent preparations should be avoided. Areas of low penetration do not generally respond to milder agents.

• Choice of vehicle is important. Lotions and creams (to some extent) allow evaporation, having a cooling, drying and antipruritic effect. Sprays and gels are appropriate for hairy regions. Ointments form an occlusive film and are good for chronic, scaly conditions.

• Occlusive dressing markedly enhances absorption of hydrocortisone (as much as 10 fold), retains moisture and results in maceration of the horny layer. Continuous occlusion promotes bacterial and fungal growth.

• Absorption is greater in infants and young children –milder agents should be used.

• Routine use of potent steroids is not justified. Use of potent preparations should be short term or intermittent to prevent adverse effects and tachyphylaxis.

• Sudden discontinuation should be avoided. Upon improvement a less potent preparation may be substituted or the steroid may be alternated with an emollient till the lesion resolves.

• More than 2 applications a day do not afford additional benefit. Generally twice daily application is satisfactory.

Although each drug comes with little or more side effects, but most of the time remain subtle. Sometimes you may need to consult with the doctor if you feel any discomfort like blurred vision, trembling or shaking of the limbs, chest pain or discomfort, feeling of irregular heart beat etc.

Usual side effects need no medical attention but in some conditions may demand emergency resolution as in unconsciousness or seizure. However, toxicity after topical application is influenced by the relative rates of absorption and metabolism.

You should seek medical help when the following problems become significant.

Adverse effects of lidocaine:

• Problems affecting central nervous system (CNS) are light-headedness, dizziness, sleepiness, auditory and visual disturbances, mental confusion, disorientation, shivering, involuntary movements, convulsions, CNS depression leading to respiratory arrest.

• Neurotoxicity (sensory and motor deficits) has been reported in certain individuals affecting peripheral nervous system.

• Cardiovascular toxicity of such local anesthetics is manifested as myocardial depression, vasodilatation, bradycardia, hypotension, cardiac arrhythmias and vascular collapse.

• Methemoglobinemia may also take place which lowers the amount of oxygen in your blood stream excessively resulting in medical emergency.

• Hypersensitivity reactions like rashes, angioedema, dermatitis, contact sensitization, asthma, and rarely anaphylaxis may occur.

• Additionally, methylparaben is often added as a preservative in certain local anesthetic solutions which may cause serious allergic reactions.

• Moreover, local anesthetics also reduce the release of acetylcholine from motor nerve endings. As a result, paralysis of the voluntary muscles supplied by that nerve may also occur but rarely.

Local adverse effects of hydrocortisone:

• Thinning of epidermis
• Dermal changes – atrophy
• Telangiectasia, Striae
• Easy bruising
• Hypopigmentation
• Delayed wound healing
• Increased risk of fungal and bacterial infections

Systemic adverse effects of hydrocortisone:

• Adrenal pituitary suppression can occur if large amounts are applied repeatedly. Infants and children are particularly susceptible.
• Rarely, Cushing’s syndrome has been reported.