Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Topical steroid + local anaesthetic Pregnancy: Xyloproct should not be used during pregnancy unless considered essential by the physician. Breast-feeding: lidocaine and hydrocortisone acetate are excreted into breast milk, but at therapeutic doses of Xyloproct effects on the breastfed newborn/infant are unlikely. Fertility: there is no fertility data available.

Hydrocortisone with lidocaine

Brand names: Xyloproct

Hydrocortisone with lidocaine is a topical/rectal preparation (cream, ointment or suppository) combining a corticosteroid with a local anaesthetic, used for short-term symptomatic relief of perianal conditions such as haemorrhoids and proctitis.

Adult dose

Dose: Anorectal symptom relief: apply topically to the anal / peri-anal area for the relief of anal and peri-anal pruritus, pain and inflammation associated with haemorrhoids, anal fissure, fistulas and proctitis (the SPC also lists pruritus vulva). The SPC gives NO quantity per application — the posology is qualitative: the ointment is 'to be applied several times daily according to the severity of the condition'. For intrarectal use, apply the ointment with the special applicator.
Route: Topical (anorectal). For intrarectal use, apply the ointment with the special applicator; cleanse the applicator thoroughly after use. When using the special applicator, care should be taken to avoid instillation of excessive amounts of ointment into the rectum.
Frequency: Several times daily, according to the severity of the condition. The duration of treatment may vary between ten days and three weeks; if the treatment is prolonged, a free interval can be recommended, especially if irritation due to lidocaine or hydrocortisone is suspected.
Max: The SPC states no absolute maximum quantity per application. It states verbatim: 'A daily dose of 6 g ointment is well within safety limits.' Treatment is intended for limited periods only — the duration of treatment may vary between ten days and three weeks. Excessive dosage of lidocaine, or short intervals between doses, may result in high plasma levels of lidocaine and serious adverse effects; patients should be instructed to strictly adhere to the recommended dosage.
INDICATION CONFIRMED BY §4.1 (newly captured): 'Xyloproct rectal ointment is indicated in adults and children of all ages for the relief of symptoms such as anal and peri-anal pruritus, pain and inflammation associated with haemorrhoids, anal fissure, fistulas and proctitis. Pruritus vulva.' STRENGTH ATTRIBUTION DELIBERATELY OMITTED: the product is titled 'Xyloproct 5%/0.275% Ointment', but §2 (qualitative and quantitative composition) was never fetched and no captured section states which percentage belongs to which active — the SPC's own §4.6 even lists the actives in the opposite order to the title ('Lidocaine and hydrocortisone acetate are excreted into breast milk'). No per-component strength is asserted here; read the strengths off the SPC or the pack before prescribing. ELDERLY / DEBILITATED: 'Debilitated or elderly patients should be given doses commensurate with their age, weight and physical condition.' BEFORE USE: exclude the possibility of malignancy; give appropriate antibacterial, antiviral or antifungal therapy alongside Xyloproct if infection is present at the site of application. DISCONTINUE if irritation or rectal bleeding develops; if local irritation disappears after cessation, sensitivity to lidocaine or hydrocortisone can be investigated, e.g. by a patch test. SOURCE COMPLETENESS: all six captured eMC sections (§4.1, §4.2, §4.3, §4.4 with the §4.5 interaction text appended, §4.6, §4.8) are complete and untruncated in this bundle.

Paediatric dose

Dose: No numeric paediatric dose is published in this SPC. §4.2 Paediatric population, verbatim and in full: 'Children should be given doses commensurate with their age, weight and physical condition.'
Route: N/A — this SPC states no separate paediatric route; the adult route has NOT been carried across
Frequency: N/A — this SPC states no separate paediatric frequency; the adult frequency has NOT been carried across
Max: Not stated for children
The product IS licensed for children: §4.1 states it is indicated 'in adults and children of all ages'. But §4.2 gives children no dose, no route, no frequency and no minimum age — only 'doses commensurate with their age, weight and physical condition' — so nothing numeric or procedural is published here and nothing has been scaled or lifted from the adult posology. PAEDIATRIC SAFETY, §4.4 verbatim: 'When using the special applicator, care should be taken to avoid instillation of excessive amounts of Xyloproct Ointment into the rectum. This is of particular importance in infants and children. Systemic absorption of lidocaine may occur from the rectum, and large doses may result in CNS side-effects. On rare occasions convulsions have occurred in children.' Verify any paediatric use against a children's formulary.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1, or to local anaesthetics of the amide type
  • Use on atrophic skin
  • Patients with untreated infections of bacterial, viral, pathogenic fungal or parasitic origin
  • Patients being treated with a class III anti-arrhythmic drug outside of hospital — hospitalised patients treated with class III anti-arrhythmics (e.g. amiodarone or sotalol) should be kept under close surveillance and ECG monitoring considered, since cardiac effects may be additive

Side effects

  • Contact sensitivity to lidocaine has been reported after perianal use
  • Contact sensitivity may also occur after the use of topical hydrocortisone
  • In extremely rare cases amide-type local anaesthetic preparations have been associated with allergic reactions, in the most severe instances anaphylactic shock
  • Serious adverse effects from high plasma lidocaine levels may follow excessive dosage or short intervals between doses; systemic absorption of lidocaine from the rectum with large doses may cause CNS side-effects, and on rare occasions convulsions have occurred in children
  • Prolonged and excessive use of hydrocortisone may produce systemic corticosteroid effects, or local effects such as skin atrophy — with the recommended dosage systemic effects of hydrocortisone are unlikely
  • Local irritation or rectal bleeding — discontinue treatment if these develop
  • Cetyl alcohol and stearyl alcohol excipients may cause local skin reactions (e.g. contact dermatitis)

Monitoring

  • Exclude the possibility of malignancy before starting treatment
  • Discontinue treatment if irritation or rectal bleeding develops
  • Limit the duration of use — treatment is intended for limited periods, typically ten days to three weeks, with a free interval thereafter if treatment is prolonged
  • Ensure the patient strictly adheres to the recommended dosage and dosing intervals — excessive dosage of lidocaine, or short intervals between doses, may produce high plasma lidocaine levels and serious adverse effects
  • Hospitalised patients treated with class III anti-arrhythmic drugs (e.g. amiodarone or sotalol) — keep under close surveillance and consider ECG monitoring, since cardiac effects may be additive
  • Use lidocaine with caution in patients receiving anti-arrhythmic drugs, local anaesthetics or agents structurally related to local anaesthetics, since the toxic effects of these compounds are additive
  • Give appropriate antibacterial, antiviral or antifungal therapy alongside Xyloproct if infection is present at the site of application
  • In infants and children, take particular care to avoid instillation of excessive amounts into the rectum
  • If local irritation disappears after cessation of treatment, the possibility of sensitivity to lidocaine or hydrocortisone can be investigated, e.g. by a patch test
  • Acute porphyria — the ointment is possibly porphyrinogenic and should only be prescribed to such patients when no safer alternative is available
  • Watch for local skin reactions (e.g. contact dermatitis) from the cetyl alcohol and stearyl alcohol excipients

Clinical monograph

How it works

Hydrocortisone exerts a local anti-inflammatory and anti-pruritic effect, while lidocaine reversibly blocks neuronal sodium channels to produce local anaesthesia and reduce pain and itching at the application site.

Prescribing in practice

  • Limit treatment to short courses, as prolonged or excessive perianal corticosteroid use can cause skin atrophy and the preparation should be avoided where untreated anal/perianal infection (bacterial, fungal or viral) is present.
  • Apply sparingly to the affected area, typically after defaecation and at night, and review rather than continue indefinitely if symptoms do not settle.
  • Lidocaine sensitivity in the perianal skin is recognised; stop if local irritation, rash or worsening symptoms develop and reconsider the diagnosis.

Monitoring

No routine laboratory monitoring is needed for short topical use; review symptom response and local tolerability and reassess if there is no improvement.

Counselling the patient

  • Use only for the short course advised and apply a thin amount to the affected area, washing your hands afterwards.
  • Seek review if bleeding, severe pain or symptoms persist, as these may need further assessment.

Evidence & guidelines

Combined corticosteroid–local anaesthetic anorectal preparations are long-established for symptomatic relief; UK guidance and the SPC emphasise short-term use alongside conservative measures.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways