DoloPosterine® N (Cinchocaine)

DoloPosterine® is a prescription-only combination product for the treatment of hemorrhoids that contains NO corticosteroid. Instead, bufexamac – a non-steroidal anti-inflammatory drug (NSAID) – is combined with the local anesthetic lidocaine.

DoloPosterine® is available as a rectal cream and as suppositories. It is used for hemorrhoids, anal eczema, and anal fissures when cortisone-free treatment is preferred.

Note: Bufexamac has been restricted by the EMA in some dosage forms (dermal). The rectal form is still available in Germany.

DoloPosterine® combines two active ingredients:

1. Bufexamac (non-steroidal anti-inflammatory):

• Inhibits cyclooxygenase (COX) locally
• Reduces prostaglandin synthesis in the inflamed mucosa
• Anti-inflammatory effect without cortisone
• No skin atrophy with longer use
• Reduces swelling and relieves itching

2. Lidocaine (local anesthetic):

• Local numbing
• Blocks the sodium channels of pain fibers
• Relieves pain, burning, and itching
• Onset of action within a few minutes
• Duration of action: 1–2 hours

Combined effect: Lidocaine provides pain relief, while bufexamac fights the underlying inflammation.

DoloPosterine® is suitable for:

• Grade I and II hemorrhoids
• Anal eczema
• Superficial anal fissures
• Proctitis

Especially recommended for:

• Patients who do not want to or must not use cortisone
• Recurrent hemorrhoid symptoms (no risk of atrophy)
• Mild to moderate symptoms

Not suitable for:

• Severe hemorrhoids (grade III–IV)
• Hypersensitivity to bufexamac or lidocaine
• Infections in the treatment area (fungal, viral)
• Known contact allergy to bufexamac

Rectal cream:

• Apply a thin layer 2–3 × daily
• More often at first for acute symptoms
• After improvement: 1–2 × daily

Suppositories:

• Insert 1 suppository rectally 2–3 × daily
• After improvement: 1 × daily

Duration of use:

• Recommended: 1–2 weeks
• Maximum 3–4 weeks without a new medical assessment
• No strict time limit as with corticosteroid products, but medical monitoring is recommended

Available dosage forms:

• DoloPosterine® rectal cream (with applicator)
• DoloPosterine® suppositories

Rectal cream:

• Gently clean and dry the anal area before use
• Apply a thin layer (externally)
• For internal hemorrhoids: use the applicator
• Wash your hands after use

Suppositories:

• Preferably insert after a bowel movement
• Insert the suppository with moistened fingers
• Rounded end first

Important notes:

• Watch for allergic reactions when using it for the first time
• If symptoms get worse or do not improve after 1 week: see a doctor
• Do not use for bleeding hemorrhoids without a medical evaluation
• Latex condoms can be damaged by the ointment base

General measures:

• High-fiber diet and adequate fluid intake
• Avoid straining hard during bowel movements
• Gently clean the anal area after bowel movements

DoloPosterine® N must not be used in cases of:

• Hypersensitivity to cinchocaine or any of the other ingredients
• Children under 12 years of age

Use with caution in cases of:

• Fungal infection in the treatment area (a locally acting antifungal agent is additionally required)

Other ingredients: Butylated hydroxytoluene (cream and suppositories) can cause local skin irritation (e.g. contact dermatitis) and irritation of the eyes and mucous membranes. Cetostearyl alcohol (cream) can cause local skin irritation (e.g. contact dermatitis).

Pregnancy and breastfeeding: There are insufficient data on use during pregnancy. During pregnancy, use only if your doctor considers it necessary after careful assessment. It is not known whether cinchocaine passes into breast milk; during breastfeeding, use only after your doctor has carefully weighed the benefits and risks.

Uncommon (0.1–1%):

• Burning at the application site (temporary)
• Local itching
• Skin redness

Rare:

• Contact allergic reaction to bufexamac
• Contact dermatitis (may present as a worsening of symptoms)
• Allergic reaction to lidocaine (very rare)

Note on contact allergy: Bufexamac has a certain potential for contact sensitization. This was the reason for restrictions on dermal use in some countries. The risk is lower with rectal use. If symptoms get worse during treatment, a contact allergy may be present – stop use immediately and consult a doctor.

Clinically relevant interactions: With rectal use, systemic interactions are practically ruled out.

Theoretically possible:

• Other local anesthetics: additive lidocaine effect
• Latex condoms: can be damaged by the ointment base

Note: Systemic absorption of bufexamac and lidocaine with rectal use is too low for clinically relevant drug interactions.