Phenylephrine and Pramoxine
Medically reviewed by Drugs.com. Last updated on Jun 10, 2020.
(fen il EF rin) and (pra MOKS een)
- Phenylephrine HCl and pramoxine HCl
- Phenylephrine hydrochloride and pramoxine hydrochloride
- Pramoxine and phenylephrine
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Preparation H: Phenylephrine hydrochloride 0.25%, pramoxine hydrochloride 1%, glycerin 14.4%, and white petrolatum 15% (26 g, 51 g) [contains cetyl alcohol, edetate disodium, methylparaben, propylene glycol, propylparaben, sodium benzoate]
Preparation H Totables: Phenylephrine hydrochloride 0.25%, pramoxine hydrochloride 1%, glycerin 14.4%, and white petrolatum 15% (5.7 g [DSC]) [contains cetyl alcohol, edetate disodium, methylparaben, propylene glycol, propylparaben, sodium benzoate]
Brand Names: U.S.
- Preparation H Totables [OTC] [DSC]
- Preparation H [OTC]
- Alpha-Adrenergic Agonist
- Antihemorrhoidal Agent
- Local Anesthetic
Phenylephrine: Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces local vasoconstriction.
Pramoxine: Like other anesthetics, it decreases the neuronal membrane's permeability to sodium ions; both initiation and conduction of nerve impulses are blocked, thus depolarization of the neuron is inhibited.
Use: Labeled Indications
Hemorrhoids: Temporary relief of pain, soreness, burning, local itching, and discomfort associated with hemorrhoids.
Hemorrhoids: Rectal: Apply externally to affected area up to 4 times daily.
Refer to adult dosing.
Hemorrhoids: Children ≥12 years: Refer to adult dosing.
Cleanse affected area by patting or blotting with cleansing wipe, and gently dry before applying cream. Apply externally or in the lower portion of the anal canal only. For application in the lower anal canal, remove cover from dispensing cap and attach dispensing cap to tube; lubricate dispensing cap well, then gently insert dispensing cap partway into the anus. Thoroughly cleanse dispensing cap after each use and replace cover.
Store at 20°C to 25°C (68°F to 77°F).
Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy
AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy
Ergot Derivatives: May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Avoid combination
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification
Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy
Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid. Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Consider therapy modification
Procarbazine: May enhance the adverse/toxic effect of Sympathomimetics. Management: Consider alternatives to this combination when possible. Procarbazine prescribing information states that this combination should be avoided. Consider therapy modification
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy
Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Monitor therapy
See individual agents. There are no adverse reactions listed in the manufacturer’s labeling.
• Cardiovascular disease, including ischemic heart disease: Use caution.
• Diabetes mellitus: Use caution.
• Hyperthyroidism: Use caution.
• Intraocular pressure (increased): Use caution.
• Prostatic hyperplasia: Use caution.
• Elderly: Use caution.
• Self-medication (OTC use): For external use only. When used for self-medication, notify healthcare provider if condition worsens or does not improve within 7 days or if bleeding occurs; clears up and occurs again within a few days; or if accompanied by additional symptoms (eg, swelling, rash, irritation).
Refer to individual monographs.
What is this drug used for?
• It is used to treat signs of hemorrhoids or rectal irritation.
WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
• Rectal bleeding
• Rectal pain
• Severe rectal irritation
• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.
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