Foam enemas

Liquids/semisolids Foams, enemas, ointments and gels ... 

Foam enemas can be easier to retain than liquid enemas and do have a... 

In a 4-week, randomized trial in 103 patients with mild to moderate left-sided ulcerative colitis or proctosigmoiditis, mesalazine gel enema 2 g/day was as effective as mesalazine foam enema 2 g/day in inducing remission (102). Patients in the foam group had significantly more... 

In an open, randomized trial in 266 patients with active distal ulcerative colitis, mesalazine foam enema 2 g/day was as effective as mesalazine standard liquid enema 4 g/ day (103). The number of adverse effects attributable to medication was higher in the foam group than in the liquid enema group (14 versus 4). The most commonly reported adverse effect was flatulence. 

Malchow H, Gertz B, CLAFOAM Study group. A new mesalazine foam enema (Claversal Foam) compared with a standard liquid enema in patients with active distal ulcerative colitis. Aliment Pharmacol Ther 2002 16(3) 415-23. 

Lee FI, Jewell DP, Mani V, et al. A randomized trial comparing mesalamine and prednisone foam enemas in patients with acute distal ulcerative colitis. Gut 1996 38 229-233. 

Rectal Avoids problems of stability in gastrointestinal tract No first-pass metabolism Useful if oral administration is not possible Unpopular Inconvenient Erratic absorption Irritation Suppositories, enemas (solutions, suspensions, emulsions), foams, ointments, creams... 

Hydrocortisone enemas, foam, or suppositories are used to maximize colonic tissue effects and minimize systemic absorption via topical treatment of active inflammatory bowel disease in the rectum and sigmoid colon. Absorption of hydrocortisone is reduced with rectal administration, although 15-30% of the administered dosage is still... 

Rectal 100 mg/60 mL unit retention enema 90 mg/applicatorful intrarectal foam Mesalamine (5-ASA)... 

Topical corticosteroid use is limited to disease located in the distal colon or rectum. Topical steroids are available for use as suppositories, enemas, or foams. The advantage of using topical steroids in acute mild to moderate disease is that it provides higher doses localized to the affected area. Although it was thought that topical therapy would decrease systemic effects of steroids, extensive anastomoses in the rectal area may lead to significant systemic absorption. 

D Hydrocortisone. Hydrocortisone is the only corticosteroid that is available as suppositories, enemas, and foams for rectal use. It is the best choice for this patient since the rectal route may have the potential to minimize systemic toxicities (i.e., behavioral disturbances, insomnia) that the patient previously experienced with the iV and PO corticosteroids. This patient s exacerbation is mild and his disease is localized to the rectum and distal colon. Therefore, per rectum corticosteroids wiil be able to target these areas successfully. 

Aqueous foams are formed from a three-dimensional network of surfactant films in air. Foams can be used as formulations for the delivery of enemas and topical products. Foams which develop in production of liquids or in ampoules are troublesome hence there is an interest in breaking foams and preventing foam formation. The breaking and prevention of liquid foams is less well understood than the stabilisation of foams, it is recognised, however, that small quantities of specific agents can reduce foam stability markedly. There are two types of such agent ... 

Glucocorticoid enemas are useful in patients whose disease is limited to the rectum (proctitis) and left colon. Hydrocortisone is available as a retention enema (100 mg/60 mL), and the usual dose is one 60-mL enema per night for 2 or 3 weeks. When administered optimally, the drug can reach up to or beyond the descending colon. Patients with distal disease usually respond within 3—7 days. Hydrocortisone also can be given once or twice daily as a 10% foam suspension (CORTIFOAM) that delivers 80 mg hydrocortisone per application this formulation can be useful in patients with very short areas of distal proctitis and difficulty in retaining fluid. 

CC>RnCOSTEi 0IP hydrocortisone prednisolone suppositories, enemas, foam) oral prednisolone... 

Vaginal foams Medicated vaginal tampons From the rectal dosage forms the suppositories, enemas, ointments and creams are important as extemporaneous pharmacy preparations from the vaginal dosage forms fliese are the vaginal suppositories (pessaries), solutions, creams and gels. 

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