Hydrocortisone-Pramoxine

Proctofoam-HC is a topical foam used to help alleviate anorectal itching and inflammation. The combination therapy of a topical steroid and local anesthetic improves symptoms from hemorrhoids or general rectal irritation.

By clicking the “I Agree” button below, you certify under penalty of perjury that the following statements are true and correct and understand that a medical provider will rely on the truthfulness of your statements when determining whether a prescription is warranted and appropriate.

I agree that I:

• am 18 years or older
• have not had a hypersensitivity reaction to hydrocortisone, pramoxine, or any component of the formulation
  
• am not pregnant or breastfeeding
• understand that skin thinning and integrity affects medication absorption and should be avoided in older adults
  
• understand this medication may increase the risk of contact dermatitis
  
• will not insert any part of the container directly into the anus
  
• understand the topical formulation of this product, is unlikely to, but may cause systemic effects (e.g. Cushing syndrome, high blood sugar) if used for a prolonged period of time, applied to large areas, or wrapped in occlusive dressing
  
• will discontinue the use of this product if local sensitivity occurs or if no improvement after 2 to 3 weeks of use
  
• will contact my provider if symptoms remain for 7 days or longer after use
  
• will use the medication as prescribed for the appropriate treatment and duration
  
• understand this is not a comprehensive list of precautions, risks, side effects, or details about taking this medication
  
• understand that only major drug interactions are listed and have not been reviewed against the other medications, supplements, or herbal products I may be taking unless also filled by TelyRx
  
• understand that TelyRx LLC does not provide medical care and the providers who use TelyRx to provide telehealth services (“Telehealth Providers”) should not replace your primary provider.
  
• understand that the Telehealth Providers are not able to: (1) monitor ongoing health or lab values for side effects or efficacy, (2) observe how you (or your pet) tolerate any prescribed treatment, or (3) determine if the prescribed treatment is working as intended and assume any risks associated with this modality of care and waive any claim I may have in the future against TelyRx and/or the Telehealth Providers.
  
• understand that by using this site, I have created a patient-client-doctor relationship and I am being directed by the Telehealth Providers to consult my primary provider soon after beginning any treatment prescribed by the Telehealth Providers.
  
• understand that this is a supplemental mode of care for your convenience and the Telehealth Providers are not to be used, or relied on, as a replacement for in-person follow-up visits or interactions with your primary provider.