SuppositoryRectalNon sterile Rx only

Hydrocortisone / Lidocaine Rectal Suppository

Suppository Base

A compounded rectal suppository pairing a corticosteroid with a local anesthetic, prepared to each prescriber's order for anorectal use.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

USP <795> compliant
USP <800> hazardous drug lab
PCCA member

At a Glance

Preparation details for Hydrocortisone / Lidocaine Rectal Suppository
Dosage form	Suppository
Route	Rectal
Active ingredients	Hydrocortisone, Lidocaine
Technology	Suppository Base
Strengths in literature	Hydrocortisone acetate 25 mg per suppository in the commercial single ingredient product
Commercial product	No U.S. commercial product
Strength and directions	Per prescriber
Dispensing	Valid prescription

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Phone (909) 378-7301. Fax (909) 378-7071

Clinical Advantages

Multiple actives in one base
Custom strength available
Rectal or vaginal route
Dye free option
No U.S. commercial equivalent

How It Works

What is Hydrocortisone / Lidocaine Rectal Suppository?

Hydrocortisone / Lidocaine Rectal Suppository is a compounded preparation that combines a corticosteroid with a local anesthetic in one suppository base. Prescribers order it for anorectal symptoms when they want both actives delivered to the anal canal in a single dose.

How it works

Corticosteroids applied to the rectum act through anti inflammatory, anti pruritic, and vasoconstrictive effects [1].
Lidocaine stabilizes the nerve membrane by blocking the ionic flux needed to start and carry an impulse [2].
The suppository base melts at body temperature and releases both actives along the anal canal [1].
Rectal tissue absorbs both drugs. About 26% of hydrocortisone acetate is absorbed from a rectal suppository in normal subjects, and absorption can rise across abraded or inflamed surfaces [1].

When prescribers choose it

Colorectal surgeons and gastroenterologists managing anorectal inflammation and discomfort
Primary care practices treating symptomatic hemorrhoids before referral
Prescribers who want a strength or an active combination that commercial suppositories do not offer
Prescribers whose patients react to an ingredient in a commercial anorectal product

Clinical Details

What does the evidence show?

The American Society of Colon and Rectal Surgeons published updated hemorrhoid guidelines in 2024, built on its 2018 guidelines, with 9 recommendations graded under the GRADE system [3].
The 2018 ASCRS guideline notes that topical preparations containing anesthetics, steroids, emollients, or antiseptics are commonly used, and that prolonged use can cause allergic reactions or sensitization [4].
Labeling for commercial hydrocortisone acetate 25 mg suppositories describes use in inflamed hemorrhoids, post irradiation proctitis, cryptitis, and other inflammatory anorectal conditions, with a usual dose of one suppository in the rectum morning and night [1].
Those commercial hydrocortisone acetate suppositories carry an FDA disclaimer stating the product has not been found by the FDA to be safe and effective and that the labeling has not been FDA approved [1].
Lidocaine labeling reports that absorption across mucous membranes depends on the site, the duration of exposure, the concentration, and the total dose [2].

Findings come from the cited studies and do not promise any individual outcome.

Why is it compounded, and how is it typically used?

Why it is compounded

No U.S. product combines hydrocortisone with lidocaine in a rectal suppository. Hydrocortisone acetate suppositories are marketed in a single 25 mg strength, and lidocaine anorectal products are sold as creams and ointments [1][2]. A prescriber who wants both actives in one suppository, or a strength other than 25 mg, orders it from a compounding pharmacy.

Dosage forms and strengths

Strength of each active set by the prescriber
Hydrocortisone base or hydrocortisone acetate, specified by the prescriber
Suppository base selected for melting behavior and patient comfort
Dye free versions on request

Commercial hydrocortisone acetate suppositories are labeled for use morning and night, with a defined course rather than open ended use [1]. Strength, frequency, and duration for a compounded suppository are the prescriber's decision.

How Mixwell prepares it

Mixwell compounds these suppositories in Chino, California under USP 795 standards for non sterile preparations [5]. The prescription should state each active, its strength per suppository, the quantity, and the directions, and our pharmacist confirms the salt form and the base before compounding. Batch records document each preparation, and finished suppositories ship across California.

Safety information

Rectal tissue absorbs corticosteroid. About 26% of hydrocortisone acetate is absorbed from a suppository in normal subjects, and absorption can increase across abraded or inflamed surfaces, so prescribers weigh strength and duration [1]. Local reactions reported with corticosteroid suppositories include burning, itching, irritation, dryness, folliculitis, hypopigmentation, allergic contact dermatitis, and secondary infection [1].

Lidocaine labeling warns that excessive dosage or short intervals between doses can produce high plasma levels and serious adverse effects, and it calls for extreme caution where mucosa is severely traumatized or infected, because absorption can be rapid [2]. Methemoglobinemia has been reported with local anesthetics, and infants under 6 months, patients with G6PD deficiency, and patients with cardiac or pulmonary compromise are more susceptible [2].

Anorectal symptoms can have causes other than hemorrhoids, so evaluation matters before and during treatment [4]. Patient selection, dosing, monitoring, and duration are the prescriber's responsibility.

References

Anusol-HC (hydrocortisone acetate) rectal suppositories, 25 mg. Labeling. DailyMed, U.S. National Library of Medicine. DailyMed label
Lidocaine Ointment USP, 5%. Prescribing information. Taro Pharmaceuticals, 2018. Prescribing information
Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2024;67(5):614 to 623. doi:10.1097/DCR.0000000000003276
Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2018;61(3):284 to 292. doi:10.1097/DCR.0000000000001030
United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding: Nonsterile Preparations. USP NF. Official November 1, 2023.

What to include on the prescription

APIs and strengths
Base or vehicle
Quantity
Directions for use
Refills
Allergies or dye free needs

Call (909) 378-7301 Fax (909) 378-7071

Compounded in Chino, CA. Delivered across California.

Chino
Chino Hills
Ontario
Pomona
Diamond Bar
Rancho Cucamonga
Eastvale

Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Compounded medications are not reviewed or approved by the FDA. Dispensed only with a valid prescription. Mixwell is a non sterile pharmacy and does not prepare sterile products or injectables. Compounded preparations are not presented as superior to commercially available products, and nothing here promises a specific result. Mixwell does not accept insurance. Call for pricing.

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