Hydrocortisone Acetate Rectal Foam / Enema

How it works

Delivered locally to the rectal and distal colonic mucosa, hydrocortisone exerts anti-inflammatory and immunosuppressive effects that reduce mucosal inflammation with limited systemic absorption.

Prescribing in practice

• Although topical, some systemic absorption occurs, so prolonged or high-frequency use can cause adrenal suppression and other corticosteroid effects and treatment should not be stopped abruptly after extended use.
• It is contraindicated where rectal corticosteroids are inappropriate, such as bowel obstruction, perforation or untreated local infection including fungal infection.
• The foam formulation can be easier to retain and may reach a more limited extent of bowel than a liquid enema, so choose the formulation to match disease location.

Monitoring

For short courses little monitoring is needed, but with prolonged use be alert to features of systemic corticosteroid exposure and adrenal suppression.

Counselling the patient

• Use the applicator as directed and try to retain the foam or enema to allow it to act on the inflamed bowel.
• Do not stop suddenly if you have used it for a prolonged period; follow the team's advice on tapering.

Evidence & guidelines

Topical rectal corticosteroids are recommended in NICE guidance as an option for active distal ulcerative colitis and proctitis.