Erian

• Anal Fissures and Hemorrhoids:
  For symptomatic relief of pain, itching, inflammation, and infection associated with hemorrhoids and anal fissures.
• Perianal and Perirectal Inflammatory Conditions:
  Treatment of inflamed, infected perianal skin conditions where bacterial infection and inflammation coexist.
• Post-Operative Analgesia and Infection Prevention:
  Used after anal or rectal surgery to manage pain, reduce inflammation, and prevent secondary bacterial infection.
• Off-label / Clinically Accepted Uses:
• Minor infected skin lesions around the anal or perianal area with inflammation
• Adjunctive treatment in anorectal pruritus with infection

• Adults:
• Apply a small amount of ointment or cream to the affected anal/perianal area 2–3 times daily after bowel movements and at bedtime
• Duration: Usually up to 7 days; prolonged use should be avoided unless directed by a physician
• Pediatrics:
• Safety and efficacy not well established; use only under medical supervision
• Elderly:
• Use standard adult dose; monitor for corticosteroid-related side effects if prolonged use
• Administration Route:
• Topical application to affected area
• Clean and dry the area before application
• Wash hands before and after application

This combination product exerts a multifaceted therapeutic effect:

• Cinchocaine is a potent local anesthetic that blocks nerve impulse conduction by inhibiting sodium ion influx through voltage-gated sodium channels in neuronal membranes, providing rapid analgesia and relief from pain and itching.
• Hydrocortisone is a low-potency corticosteroid that reduces inflammation by suppressing leukocyte infiltration, cytokine release, and inflammatory mediator production, leading to decreased redness, swelling, and itching.
• Framycetin is an aminoglycoside antibiotic that disrupts bacterial protein synthesis by binding to the 30S ribosomal subunit, effective mainly against gram-positive and some gram-negative bacteria, helping prevent or treat secondary bacterial infections.
• Esculin is a plant-derived compound with anti-inflammatory and antioxidant properties that promotes vascular health, aids microcirculation, and enhances tissue healing, thereby supporting recovery of damaged perianal tissues.

• Absorption: Minimal systemic absorption of all components when applied topically to intact skin or mucosa; absorption may increase if skin integrity is compromised.
• Distribution: Localized action at application site; negligible systemic distribution.
• Metabolism: Hydrocortisone undergoes hepatic metabolism if absorbed; framycetin and cinchocaine have minimal systemic metabolism due to low absorption.
• Elimination: Hydrocortisone metabolites excreted renally; framycetin eliminated unchanged in urine if systemically absorbed; cinchocaine metabolized hepatically if systemic absorption occurs.
• Onset: Cinchocaine provides analgesia within minutes; hydrocortisone and esculin exert effects over hours to days; framycetin acts as antibacterial agent during treatment course.

• Pregnancy:
• Hydrocortisone is generally considered Category C; topical corticosteroids should be used cautiously during pregnancy only if clearly needed.
• Cinchocaine and framycetin lack sufficient human data; use only if benefits outweigh risks.
• Lactation:
• Limited data on excretion in human milk; topical use likely results in minimal systemic absorption.
• Caution advised when applied to large areas or broken skin in breastfeeding mothers.

• Cinchocaine: Local anesthetic
• Hydrocortisone: Topical corticosteroid (anti-inflammatory)
• Framycetin: Aminoglycoside antibiotic
• Esculin: Anti-inflammatory, vascular protective agent (natural compound)

• Known hypersensitivity to any component (cinchocaine, hydrocortisone, framycetin, or esculin)
• Viral, fungal, or tuberculosis infections of the skin in the affected area (due to corticosteroid use)
• Severe bacterial infections not covered by framycetin spectrum
• Perianal abscess or fistula without appropriate surgical management
• Open or deep wounds unsuitable for topical corticosteroid or aminoglycoside use

• Avoid prolonged use of topical corticosteroids to prevent skin atrophy, striae, or systemic effects
• Monitor for signs of local allergic reactions or sensitization, especially with aminoglycoside component
• Use with caution in patients with renal impairment due to framycetin nephrotoxicity risk if systemic absorption occurs
• Avoid contact with eyes and mucous membranes
• Do not use if skin integrity is severely compromised without medical advice
• Discontinue use if no improvement within 7 days or if condition worsens

Common:

• Mild local burning or stinging sensation at application site
• Skin irritation or dryness
• Transient redness

Less common / Rare:

• Allergic contact dermatitis or hypersensitivity reactions
• Skin thinning, striae, or telangiectasia (with prolonged corticosteroid use)
• Secondary fungal or bacterial infections due to corticosteroid-induced immunosuppression
• Rare nephrotoxicity or ototoxicity if framycetin systemically absorbed (extremely rare in topical use)

• No significant systemic drug interactions expected due to minimal absorption
• Avoid concomitant use with other topical corticosteroids or aminoglycosides unless directed
• Caution advised if using other nephrotoxic or ototoxic agents (due to framycetin) in case of systemic absorption

• No major recent changes in approved indications or safety warnings
• Continued recommendation for combination use in symptomatic relief of anal fissures with associated infection and inflammation
• Emphasis on limiting corticosteroid duration to avoid skin atrophy
• Increasing interest in esculin’s role for microcirculatory improvement and tissue repair in anal disorders

• Store at 20°C to 25°C (68°F to 77°F)
• Protect from moisture, heat, and direct sunlight
• Keep container tightly closed when not in use
• Do not freeze
• Keep out of reach of children