Pramoxine Monograph for Professionals - Drugs.com

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# Pramoxine

Brand names: Analpram, Analpram HC, Campho-Phenique Cold Sore, Fleet Pain-Relief, Itch-X, ... show all 9 brands PrameGel, Preparation H, Proctofoam, Vagisil Medicated
Drug class: Antipruritics and Local Anesthetics
ATC class: D04AB07
VA class: DE700
CAS number: 637-58-1

Medically reviewed by Drugs.com on Mar 22, 2022. Written by ASHP.

## Introduction

Local anesthetic.

## Uses for Pramoxine

### Dermatologic Conditions

Self-medication for the temporary relief of pain and itching associated with minor lip or skin irritations (e.g., dermatoses, insect bites, minor burns or sunburns, minor cuts or scrapes, cold sores, hives, rashes due to poison ivy, poison oak, or poison sumac).

### Anorectal/Anogenital Disorders

Self-medication for the temporary relief of pain, soreness, burning, itching, or discomfort associated with hemorrhoids and other anorectal or anogenital disorders (e.g., inflammation, irritation, fissures, anogenital pruritus).

In fixed combination with hydrocortisone for relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses of the anal region.

## Pramoxine Dosage and Administration

### Administration

#### Topical

Apply topically to the skin as a gel, lotion, ointment, or solution.

Apply topically to the lip as an ointment.

Do not use topical skin preparations for vaginal, genital, or rectal itching.

For external use only; avoid contact with the eyes and nose. Do not apply to extensive areas of skin, open wounds, or damaged or blistered skin; do not use for prolonged periods.

Do not use on deep or puncture wounds, animal bites, or serious burns.

Apply to cold sores and fever blisters after blister has dried.

Shake lotion well before use.

#### Anorectal Topical Administration

Apply externally to the anorectal area as an aerosol foam, cream, ointment, lotion, or pledgets. Do not insert drug into rectum using fingers or any mechanical device.

Before applying drug, cleanse the affected perianal area with mild soap and warm water and rinse thoroughly whenever practical; dry by patting or blotting with toilet tissue or a soft cloth.

Shake aerosol foam before use. Disperse onto a clean tissue before applying to the affected area. Rub in gently. Do not insert any part of the aerosol container past anus into the rectum. Clean applicator thoroughly after each use.

Apply pledget by gently patting the affected area with pledget; use pledget only once, then discard.

#### Vaginal Topical Administration

Apply externally to vaginal area as vaginal pledgets.

Apply by gently patting or wiping the affected area from front to back; use pledget only once, then discard.

#### Anal Administration

Apply topically to anus as an aerosol foam.

In fixed combination with hydrocortisone: Apply aerosol foam using provided applicator for anal administration.

Shake aerosol foam before use. Do not insert any part of the aerosol container past anus into the rectum. Clean applicator thoroughly after each use.

### Dosage

Available as pramoxine hydrochloride; dosage expressed in terms of the salt.

#### Pediatric Patients

##### Dermatologic Conditions

###### Topical

Children ≥2 years of age (self-medication): Apply gel, lotion, ointment, or solution to the affected area up to 3 or 4 times daily.

Fixed combination with hydrocortisone: Apply cream, lotion, or ointment to the affected area as a thin film 3 or 4 times daily. Administer the least amount of topical preparations that provides effective therapy. (See Pediatric Use under Cautions.)

##### Anorectal/Anogenital Disorders

###### External Anorectal Topical

Children ≥12 years of age (self-medication): Apply cream, foam, ointment, or pledget to the affected area up to 4 or 5 times daily or after each bowel movement.

###### External Vaginal Topical

Children ≥12 years of age (self-medication): Apply as pledget to the affected area up to 3 or 4 times daily.

###### Anal Topical

Fixed combination with hydrocortisone: Apply foam to the affected area 3 or 4 times daily. (See Pediatric Use under Cautions.)

#### Adults

##### Dermatologic Conditions

###### Topical

As self-medication: Apply gel, lotion, ointment, or solution to the affected area up to 3 or 4 times daily.

Fixed combination with hydrocortisone: Apply cream, lotion, or ointment to the affected area as a thin film 3 or 4 times daily.

##### Anorectal/Anogenital Disorders

###### External Anorectal Topical As (self-medication)

Apply cream, foam, ointment, or pledget to the affected area up to 4 or 5 times daily or after each bowel movement.

###### External Vaginal Topical As (self-medication)

Apply as pledget to the affected area up to 3 or 4 times daily.

###### Anal Topical

Fixed combination with hydrocortisone: Apply foam to the affected area 3 or 4 times daily.

### Special Populations

#### Hepatic Impairment

No specific dosage recommendations at this time.

#### Renal Impairment

No specific dosage recommendations at this time.

#### Geriatric Patients

Careful dosage selection recommended due to possible age-related decrease in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy; use lowest effective dosage.

Detailed Pramoxine topical dosage information

## Cautions for Pramoxine

### Contraindications

- Known hypersensitivity to pramoxine or any ingredient in the formulation.

### Warnings/Precautions

#### Warnings

##### Administration Precautions

For external use only. Avoid contact with the eyes and nose.

Do not use topical skin preparations (intended for skin irritation) for vaginal, genital, or rectal itching.

Do not apply to extensive areas of skin, open wounds, or damaged/blistered skin.

Do not use for prolonged periods.

Do not use on deep or puncture wounds, animal bites, or serious burns.

Do not insert the drug preparation into the rectum using fingers or any mechanical device. Do not insert any part of an aerosol container into the rectum.

Discontinue and consult a clinician if erythema, irritation, swelling, pain, or other symptoms develop or worsen during therapy, or if pain or itching persists for >7 days, worsens, or resolves and occurs again within a few days, or if rectal bleeding occurs during use.

Discontinue use of fixed-combination pramoxine and hydrocortisone aerosol foam if condition worsens or does not improve in 2–3 weeks.

#### Sensitivity Reactions

##### Hypersensitivity Reactions

Allergic reactions may occur.

If allergic reaction occurs, discontinue the drug and consult a clinician.

##### Cross-sensitivity

Low index of sensitization; cross-sensitization with other local anesthetics is unlikely.

#### General Precautions

##### Use of Fixed Combinations

When used in fixed combinations with allantoin, calamine, dimethicone, hydrocortisone acetate, neomycin, phenylephrine hydrochloride, polymyxin B, or zinc oxide, consider the cautions, precautions, and contraindications associated with the concomitant agent.

#### Specific Populations

##### Pregnancy

Category C.

##### Lactation

Not known whether topical pramoxine is distributed into milk.

##### Pediatric Use

Safety and efficacy of topical gel, lotion, ointment, or solution not established in children <2 years of age.

Safety and efficacy of topical vaginal pledgets, anorectal cream, foam, ointment, or pledgets not established in children <12 years of age.

Fixed-combination preparations containing hydrocortisone: Limit topical therapy in children to the minimum amount necessary for therapeutic efficacy.

### Common Adverse Effects

Local burning or stinging.

## Pramoxine Pharmacokinetics

### Absorption

#### Bioavailability

Minimally absorbed following topical application.

### Distribution

#### Extent

Not known whether pramoxine crosses the placenta or is distributed into milk.

## Stability

### Storage

#### Topical

##### Aerosol

Upright at 20–25°C; do not refrigerate. Do not puncture, burn, or expose to temperatures >49°C.

##### Cream

Tight container at 15–30°C.

##### Lotion

15–25°C.

##### Ointment

Tight container at 15–30°C; some preparations 20–25°C.

## Actions

- Structurally similar to dyclonine; does not contain the usual ester or amide linkage of the procaine-type drugs.

- Stabilizes neuronal membrane of nerve endings with which it comes into contact.

- Temporarily forms a protective coating over inflamed tissues to help prevent drying.

- Dries the oozing and weeping of poison ivy, poison oak, and poison sumac.

## Advice to Patients

- For external use only; avoid contact with the eyes and nose.

- Importance of not using topical skin preparations for vaginal, rectal, or genital itching.

- Importance of using as directed; importance of not applying to extensive areas of skin, open wounds, or damaged or blistered skin; importance of not using for prolonged periods.

- Importance of discontinuing therapy and consulting clinician if dermatologic condition worsens, if symptoms persist for >7 days or clear and occur again within a few days, if rash or irritation develops during therapy, or if rectal bleeding occurs.

- Importance of discontinuing therapy and consulting clinician if condition worsens or if there is no evidence of improvement after 2–3 weeks of using aerosol foam containing pramoxine in fixed combination with hydrocortisone.

- Importance of not inserting the drug preparation into the rectum using fingers or any mechanical device including any part of an aerosol container.

- Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.

- Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription OTC drugs as well as any concomitant illnesses.

- Importance of informing patients of other important precautionary information. (See Cautions.)

## Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pramoxine Hydrochloride
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer
--- | --- | --- | --- | ---
Topical | Aerosol, foam suspension | 1%* | Proctofoam | Schwarz
|  |  | Pramoxine Hydrochloride Foam |
| Cream | 1% | Hemorrhoidal Anesthetic Cream | Clay-Park
| Gel | 1% | Itch-X | Ascher
|  |  | PrameGel | Doak
| Lotion | 1% | Prax Lotion | Ferndale
| Ointment | 1% | Campho-Phenique Cold Sore Treatment for Scab Relief | Bayer
| Pledgets (saturated with solution) | 1% | Fleet Pain-Relief Pads | Fleet
|  |  | Vagisil Anti-itch Medicated Wipes | Combe
| Solution | 1% | Itch-X Spray | Ascher

Pramoxine Hydrochloride Combinations
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer
--- | --- | --- | --- | ---
Topical | Aerosol, foam suspension | 1% with Hydrocortisone Acetate 1% | Proctofoam-HC | Schwarz
| Cream | 1% with Hydrocortisone Acetate 1% | Analpram HC | Ferndale
|  |  | Pramosone | Ferndale
|  | 1% with Hydrocortisone Acetate 2.5% | Analpram HC | Ferndale
|  |  | Pramosone | Ferndale
|  |  | Preparation H Maximum Strength | Wyeth
|  | 1% with Neomycin 0.35% and Polymyxin B 10,000 units/g | Neosporin + Pain Relief | Pfizer
|  | 1% with Phenylephrine Hydrochloride 0.25% | Hemorid Creme | McNeil
|  | 1% with Zinc Oxide 5% | Tronolane | Monticello
| Lotion | 1% with Calamine 8% | Caladryl Lotion | McNeil
|  | 1% with Hydrocortisone Acetate 1% | Pramosone | Ferndale
|  | 1% with Hydrocortisone Acetate 2.5% | Analpram HC | Ferndale
|  |  | Pramosone | Ferndale
|  | 1% with Zinc Acetate 0.1% | Caladryl Clear | McNeil
| Ointment | 1% with Allantoin 1.5% | Neosporin LT Lip Treatment | Blistex
|  | 1% with Dimethicone 2% | Blistex Pro Relief | Blistex
|  | 1% with Hydrocortisone Acetate 1% | Pramosone | Ferndale
|  | 1% with Hydrocortisone Acetate 2.5% | Pramosone | Ferndale
|  | 1% with Neomycin 0.35% and Polymyxin B 10,000 units/g | Neosporin + Pain Relief | Pfizer
|  | 1% with Phenylephrine Hydrochloride 0.25% | Hemorid | McNeil
|  | 1% with Zinc Oxide 12.5% | Tucks Hemorrhoidal | McNeil

AHFS DI Essentials™. © Copyright 2023, Selected Revisions April 1, 2008. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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## More about pramoxine topical

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- Drug class: topical anesthetics
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### Patient resources

- Drug Information

### Related treatment guides

- Pruritus
- Atopic Dermatitis
- Hemorrhoids
- Anal Itching
- Pain

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