Hydrocortisone rectal foam is a topical corticosteroid formulated for rectal administration to treat inflammatory conditions of the distal colon and rectum, primarily ulcerative colitis and proctitis. It is designed to deliver localized anti-inflammatory action directly to the affected mucosa with minimal systemic absorption compared to oral corticosteroids. Rectal foam formulations are especially useful when disease is limited to the rectosigmoid area and when suppositories or enemas are less tolerated or effective.
Pharmacological Classification
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Drug Class: Glucocorticoid (topical rectal corticosteroid)
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ATC Code: A07EA02
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Formulation: Rectal aerosol (foam)
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Concentration: Typically 10% w/w hydrocortisone acetate
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Administration Route: Rectal
Mechanism of Action
Hydrocortisone acts by binding to intracellular glucocorticoid receptors, modulating gene transcription to suppress pro-inflammatory cytokines and promote anti-inflammatory proteins. Its effects in the rectal mucosa include:
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Decreasing leukocyte infiltration
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Suppressing prostaglandin and leukotriene synthesis
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Reducing mucosal edema, erythema, and ulceration
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Stabilizing cell membranes and preventing mast cell degranulation
The foam vehicle enables better spread and retention along the distal colon and rectum, especially useful in proctitis and distal ulcerative colitis.
Indications
Approved Therapeutic Uses
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Ulcerative proctitis
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Ulcerative proctosigmoiditis
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Distal ulcerative colitis (limited to rectum or sigmoid colon)
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Radiation proctitis (symptomatic control)
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Crohn’s disease (limited to rectum/sigmoid) — off-label, less effective
Dosage and Administration
Typical Dosing Regimen
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Adults and adolescents:
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1 application (90–100 mg hydrocortisone foam) once or twice daily
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After 5–7 days, reduce to once daily or every other day
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Duration: 2–3 weeks, up to 8 weeks maximum depending on clinical response
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Administration Technique
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Shake canister well before use
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Insert applicator into rectum while lying on left side with knees bent
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Depress plunger to release foam slowly
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Hold position for 10–15 minutes post-application
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Clean applicator thoroughly after each use
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Best administered after a bowel movement
Pharmacokinetics
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Onset: Relief usually begins within 3–5 days
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Systemic absorption: Minimal when used as directed
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Metabolism: Liver via CYP3A4 (if absorbed)
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Excretion: Renal (metabolites)
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Peak concentration: Local (not typically measured in plasma)
Contraindications
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Hypersensitivity to hydrocortisone or excipients
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Systemic fungal, viral, or tubercular infections
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Obstruction or perforation of rectum
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Untreated bacterial proctitis
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Presence of abscess or perianal fistula without concurrent antimicrobial therapy
Precautions
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Long-term use may cause systemic corticosteroid effects, especially in children
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Avoid use in extensive colitis or deep ulceration
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Risk of mucosal atrophy with prolonged use
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Use with caution in patients with glaucoma, osteoporosis, diabetes, or hypertension
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Pediatric use requires specialist supervision
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Not intended for use with oral corticosteroids unless tapering systemically
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Discontinue if severe bleeding, pain, or infection occurs
Adverse Effects
Local Reactions
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Burning or stinging at application site
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Rectal discomfort or irritation
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Dryness of rectal mucosa
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Rare: mucosal ulceration, perforation, or hemorrhage if misused
Systemic (rare with proper use)
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HPA axis suppression (especially in long-term use or high doses)
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Cushingoid symptoms (moon face, striae, buffalo hump)
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Glucose intolerance or hyperglycemia
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Mood changes, insomnia, hypertension
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Infections due to immunosuppressive effects
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Growth suppression in children
Drug Interactions
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No major systemic drug interactions with correct local use
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If significant systemic absorption occurs (rare):
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CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): Increase systemic hydrocortisone levels
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Antidiabetic agents: May reduce effectiveness due to corticosteroid-induced hyperglycemia
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Live vaccines: Avoid if immunosuppressed from extended use
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NSAIDs: Additive risk of GI mucosal irritation
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Use in Special Populations
Pregnancy
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Generally considered safe when used locally and briefly
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Avoid long-term use due to potential fetal growth suppression
Lactation
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Very low systemic absorption; minimal risk to breastfeeding infant
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Monitor for signs of milk production suppression
Pediatric Use
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Use only under specialist supervision
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Risk of HPA axis suppression and growth retardation
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Shortest duration and lowest effective dose advised
Elderly
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Generally safe, but monitor for skin fragility, bruising, and blood sugar disturbances
Comparison with Other Rectal Corticosteroids
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Hydrocortisone suppositories:
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Better suited for low rectal disease only
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More limited spread than foam
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Hydrocortisone enemas:
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Suitable for more proximal disease (beyond sigmoid colon)
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Less tolerable and more leakage than foam
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Budesonide rectal foam:
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Less systemic absorption than hydrocortisone
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May be preferred for longer-term use due to lower HPA suppression risk
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Patient Counseling Points
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Explain that the foam is for rectal use only, not oral or vaginal
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Instruct on proper position and insertion technique
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Expect symptom improvement in a few days, full benefit in 2–3 weeks
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Do not stop abruptly if used for >2 weeks—gradual tapering preferred
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Report symptoms like rectal bleeding, severe pain, or signs of infection
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Maintain good hygiene with applicator and surrounding area
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Avoid concurrent use of rectal irritants or enemas unless prescribed
Availability
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Hydrocortisone rectal foam (10%)
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Brands may include:
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Colifoam®
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Proctofoam-HC®
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Cortifoam®
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Hydrocortisone Rectal Foam (Generic)
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Dispensed with applicator(s) and pressurized canister
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Usually available in 14–21 dose units
Storage
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Store upright at room temperature (15–25°C)
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Do not refrigerate or freeze
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Pressurized container – keep away from heat and flames
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Keep out of reach of children
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