21 C.F.R. § 346.50 Labeling of anorectal drug products.
The labeling of the product contains the following information for anorectal ingredients identified in §§ 346.10, 346.12, 346.14, 346.16, 346.18, and 346.20, and for combinations of anorectal ingredients identified in § 346.22. Unless otherwise specified, the labeling in this subpart is applicable to anorectal drug products for both external and intrarectal use.
(a) Statement of identity. The labeling of the product contains the established name of the drug, if any, and identifies the product as “anorectal (hemorrhoidal),” “hemorrhoidal,” “hemorrhoidal (anorectal) (insert dosage form, e.g., cream, lotion, or ointment).”
(b) Indications. The labeling of the product states, under the heading “Indications,” any of the phrases listed in paragraph (b) of this section, as appropriate. Other truthful and nonmisleading statements, describing only the indications for use that have been established and listed in this paragraph, may also be used, as provided in § 330.1(c)(2) of this chapter, subject to the provisions of section 502 of the Federal Food, Drug, and Cosmetic Act (the act) relating to misbranding and the prohibition in section 301(d) of the act against the introduction or delivery for introduction into interstate commerce of unapproved new drugs in violation of section 505(a) of the act.
(1) (“For the temporary relief of,” “Gives temporary relief of,” or “Helps relieve the”) (As an option, select one or both of the following: “local” or “anorectal”) [select one or more of the following: “discomfort,” “itching,” or “itching and discomfort,” followed by: “in the perianal area” or “associated with” (select one or more of the following: “hemorrhoids,” “anorectal disorders,” “inflamed hemorrhoidal tissues,” “anorectal inflammation,” “hemorrhoidal tissues,” or “piles (hemorrhoids).”)]
(2) Additional indications. Indications applicable to each active ingredient of the product may be combined to eliminate duplicative words or phrases so that the resulting indication is clear and understandable. In addition to the indication identified in paragraph (b)(1) of this section, the labeling of the product intended for external or intrarectal use may also contain the following indications, as appropriate.
(i) For products for external use only containing any ingredient identified in § 346.10. “For the temporary relief of” (select one or more of the following: “pain,” “soreness,” or “burning”).
(ii) For products containing epinephrine or epinephrine hydrochloride identified in § 346.12 (b) and (c) for external use only, and for products containing ephedrine sulfate or phenylephrine hydrochloride identified in § 346.12 (a) and (d).
(A) “Temporarily reduces the swelling associated with” (select one of the following: “irritated hemorrhoidal tissue and other anorectal disorders” or “irritation in hemorrhoids and other anorectal disorders”).
(B) “Temporarily shrinks hemorrhoidal tissue.”
(iii) For products for external use only containing glycerin identified in § 346.14(a)(3) and for products for external and/or intrarectal use containing any protectant identified in § 346.14(a) (2), (4), (6) through (10), and (b) (1) through (4).
(A) “Temporarily forms a protective coating over inflamed tissues to help prevent drying of tissues.”
(B) “Temporarily protects irritated areas.”
(C) “Temporarily relieves burning.”
(D) “Provides temporary relief from skin irritations.”
(E) “Temporarily provides a coating for relief of anorectal discomforts.”
(F) “Temporarily protects the inflamed, irritated anorectal surface” (select one of the following: “to help make bowel movements less painful” or “from irritation and abrasion during bowel movement”).
(G) “Temporarily protects inflamed perianal skin.”
(H) “Temporarily relieves the symptoms of perianal skin irritation.”
(iv) For products containing aluminum hydroxide gel identified in § 346.14(a)(1) and for products containing kaolin identified in § 346.14(a)(5). “For the temporary relief of itching associated with moist anorectal conditions.”
(v) For products for external use only containing any analgesic, anesthetic, and antipruritic identified in § 346.16. (A) “For the temporary relief of” (select one or both of the following: “pain” or “burning”).
(B) “Can help distract from pain.”
(C) “May provide a cooling sensation.”
(vi) For products for external use only containing witch hazel identified in § 346.18(b), and for products for external use and/or intrarectal use containing calamine or zinc oxide identified in § 346.18 (a) and (c).
(A) “Aids in protecting irritated anorectal areas.”
(B) “Temporary relief of” (select one or both of the following: “irritation” or “burning”).
(vii) For products for external use only containing any ingredient identified in § 346.20. The indication in paragraph (b)(1) of this section applies.
(c) Warnings. Warnings applicable to each active ingredient of the product may be combined to eliminate duplicative words or phrases so that the resulting warning is clear and understandable. The labeling of the product contains the following warnings under the heading “Warnings”:
(1) “If condition worsens or does not improve within 7 days, consult a doctor.”
(2) “Do not exceed the recommended daily dosage unless directed by a doctor.”
(3) “In case of bleeding, consult a doctor promptly.”
(4) For products for external use only. “Do not put this product into the rectum by using fingers or any mechanical device or applicator.”
(5) For products for intrarectal use to be used with a special applicator such as a pile pipe or other mechanical device. “Do not use this product with an applicator if the introduction of the applicator into the rectum causes additional pain. Consult a doctor promptly.”
(6) For products for external use only containing any local anesthetic identified in § 346.10, menthol identified in § 346.16(c), or resorcinol identified in § 346.20(b). “Certain persons can develop allergic reactions to ingredients in this product. If the symptom being treated does not subside or if redness, irritation, swelling, pain, or other symptoms develop or increase, discontinue use and consult a doctor.”
(7) For products containing any vasoconstrictor identified in § 346.12. (i) “Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland unless directed by a doctor.”
(ii) “Ask a doctor or pharmacist before use if you are [bullet]
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presently taking a prescription drug for high blood pressure or depression.”
(iii) For products containing ephedrine sulfate identified in § 346.12(a). “Some users of this product may experience nervousness, tremor, sleeplessness, nausea, and loss of appetite. If these symptoms persist or become worse, consult your doctor.”
(8) For products containing aluminum hydroxide gel identified in § 346.14(a)(1) and for products containing kaolin identified in § 346.14(a)(5). “Remove petrolatum or greasy ointment before using this product because they interfere with the ability of this product to adhere properly to the skin area.”
(9) For products for external use only containing resorcinol identified in § 346.20(b). “Do not use on open wounds near the anus.”
(d) Directions. Directions applicable to each active ingredient of the product may be combined to eliminate duplicative words or phrases so that the resulting information is clear and understandable. The labeling of the product contains the following information under the heading “Directions”:
(1) “Adults: When practical, cleanse the affected area” (select one or both of the following: “with mild soap and warm water and rinse thoroughly” or “by patting or blotting with an appropriate cleansing pad”). “Gently dry by patting or blotting with toilet tissue or a soft cloth before application of this product.” [Other appropriate directions in this section may be inserted here.] “Children under 12 years of age: consult a doctor.”
(2) For products for external use only. “Apply externally to the affected area” (insert appropriate time interval of administration as identified in paragraphs (d)(6), (7), (8), or (9) of this section).
(3) For products for external use that are pads containing anorectal ingredients. “Gently apply to the affected area by patting and then discard.”
(4) For products for intrarectal use that are wrapped suppositories. “Remove wrapper before inserting into the rectum.”
(5) For products for intrarectal use that are to be used with a special applicator such as a pile pipe or other mechanical device. “FOR INTRARECTAL USE: Attach applicator to tube. Lubricate applicator well, then gently insert applicator into the rectum.”
(6) For products for external use only containing any of the local anesthetics identified in § 346.10; analgesics, anesthetics, and antipruritics identified in § 346.16; or alcloxa or resorcinol identified in § 346.20. Apply to the affected area up to 6 times daily.
(i) For products for external use only containing dibucaine or dibucaine hydrochloride identified in § 346.10 (c) and (d). Apply to the affected area up to 3 or 4 times daily.
(ii) For products for external use only containing pramoxine hydrochloride identified in § 346.10(g). Apply to the affected area up to 5 times daily.
(7) For products containing vasoconstrictors identified in § 346.12. Apply to the affected area up to 4 times daily.
(8) For products for external use only containing glycerin identified in § 346.14(a)(3) or witch hazel identified in § 346.18(b), and for products for external and/or intrarectal use containing any protectant identified in § 346.14(a)(1), (2), (4), (5), (6), (7), and (9), and (b)(1), (2), (3), and (4), or any astringent identified in § 346.18(a) and (c). Apply to the affected area up to 6 times daily or after each bowel movement.
(9) For products containing petrolatum or white petrolatum identified in § 346.14(a)(8) and (10). Apply liberally to the affected area as often as necessary.
(e) The word “physician” may be substituted for the word “doctor” in any of the labeling statements in this section.