Instillagel

Instillagel is a gel that is used to numb the parts of the body it is applied to (local anaesthetic) and reduce the risk of infection (antiseptic) in many situations, including for people with gential herpes.

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About

What is Instillagel?

Instillagel is a gel that is used to numb the parts of the body it is applied to (local anaesthetic) and reduce the risk of infection (antiseptic) in many situations, including for people with gential herpes.  It is the only anaesthetic antiseptic lubricating gel, which is also a licensed medicine. 

What is Instillagel used for?

Instillagel is used when examining or putting an instrument into a body cavity, such as the mouth, bladder or vagina. The gel contains a local anaesthetic to prevent pain, antiseptic to reduce the risk of infection and provides lubrication to ease this process.

The gel may be used before you have a catheter (a soft hollow tube, which is passed into the bladder to drain urine) inserted or replaced. It may also be used in your throat, bladder, vagina, rectum or colon. This makes it easier for your doctor to look inside these parts of your body without causing you discomfort.

Instillagel is not currently licensed for the treatment of herpes in the UK. However, this doesn't mean that it is unsafe, as it has been widely used for this purpose.  It is generally used as an effective anaesthetic and antiseptic gel that helps to reduce the pain and risk of infection caused by a herpes outbreak. Instillagel can be used alongside other genital herpes treatments.

How long does it take for Instillagel to work?

The full local anesthetic and antiseptic action of Instillagel takes 5–10 minutes to work after the gel has been applied.

Am I still contagious when using Instillagel for genital herpes?

Infection with the herpes simplex virus (HSV), commonly known as herpes, can be due to either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral-to-oral (mouth-to-mouth) contact to cause infection in or around the mouth (oral herpes). HSV-2 is almost mainly sexually transmitted, causing infection in the genital or anal area (genital herpes). However, HSV-1 can also be passed on to the genital area through oral-to-genital contact to cause genital herpes.  

Both oral herpes and genital herpes conditions are lifelong and incurable.  So, you will probably need to take medication for the years to come. Bear in mind that for many, taking medicine is a part of modern life these days.  Everyone takes tablets for something or the other, even if it is just vitamins or supplements.

Medications can reduce the severity of the symptoms and their duration during a flare up.

As mentioned earlier, Instillagel is not currently licensed for the treatment of herpes in the UK; but is safe to be used for this purpose and can be used alongside other genital herpes treatments to reduce the severity and duration of a genital herpes outbreak.

There are three most effective antiviral medications for genital herpes: Aciclovir, also known as Acyclovir (brand name: Zovirax), Famciclovir (brand name: Famvir), and Valaciclovir, also known as Valacyclovir (brand name: Valtrex). These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.

Herpes infections are most contagious when symptoms are present, but can still be passed on to others when symptoms are absent.

Always be upfront and honest with potential partners and wear a condom for sex, even if you don’t have an outbreak at the time.  During an outbreak, make sure that the affected areas don’t come into direct contact with your partner. It is best to avoid sex during this time, until the symptoms have subsided.

Ingredients

Active ingredients

Instillagel contains active ingredients to provide local anaesthetic and reduce the risk of infection (antiseptic).  The active ingredients and what they provide are:

  • lidocaine hydrochloride (local anaesthetic) - lidocaine hydrochloride is the new name for lignocaine hydrochloride, the ingredient itself has not changed
  • chlorhexidine gluconate solution (antiseptic)
  • methyl hydroxybenzoate (antiseptic)
  • propyl hydroxybenzoate (antiseptic)

Inactive ingredients

The gel contains the following inactive ingredients: Hydroxyethylcellulose, Propylene Glycol and Purified Water.

Dosage

How to use Instillagel

A doctor or nurse will apply the necessary amount of Instillagel where it is needed, for examining or putting an instrument in a body cavity, such as the mouth, bladder or vagina.  Instillagel can also be applied by a patient in certain minor situations, such as to reduce the pain caused by a herpes outbreak. 

The gel is available in two sizes, 6ml and 11ml.   Usually, the complete contents of the size suitable for the procedure will be used.   Wash and dry the affected area.  The syringe is removed from its sterile package by tearing off the backing paper.  Before removing the blue cap from the end of the syringe, free the plunger by gently pressing it.  Remove the cap. Insert the nozzle into the opening of the area to be anaesthetised (numbed) and press the plunger slowly to push out the gel.  Apply the gel as needed to the affected area. Wash your hands immediately after use.  

The anaesthetic takes about 5 to 10 minutes to work after the gel has been applied.

Always use this medicine exactly as your doctor has told you. Check with your doctor if you are not sure.

Normally only small amounts of the local anaesthetic, lidocaine are absorbed into the blood from Instillagel. Too much lidocaine can be absorbed if the surface being treated is damaged. In these cases you may experience:

  • fits (convulsions)
  • unconsciousness
  • stop breathing (respiratory arrest)
  • low blood pressure (hypotension)
  • changes in your heart rate or rhythm (myocardial depression, bradycardia)
  • your heart stop beating (cardiac arrest)

If you have any further questions on the use of the gel, ask your doctor.

Use in children

The systemic absorption of lidocaine (local anaesthetic) may be increased in children and caution is therefore required.

Instillagel dosage

Instillagel comes in packs of 1 or 10 individually prefilled sealed sterile disposable syringes, containing either 6ml or 11ml of gel.  It is suitable for use in adults and children aged 2 years and above. The dosage varies for adults and children. 

For adults: the usual dose for men is 11ml and the usual dose for women is 6ml. No more than 4 doses should be given during a 24-hour period.

For children: your doctor will instruct you on the right dose for your child, as this will depend on age and weight.  In general, the maximum dose should not exceed 2.9mg of lidocaine hydrochloride (local anaesthetic) per kg of body weight in children between 2 and 12 years of age. This is equivalent to 1.5 ml of Instillagel 6 ml/11 ml per 10 kg of body weight.

If you use more Instillagel dose than you should

There is no known information on overdose.

Side Effects

Instillagel side effects and reporting

Like all medicines, Instillagel can cause side effects, although not everybody gets them. 

Possible side effects include:

  • serious allergic reaction that might cause difficulty with breathing or dizziness (anaphylaxis),
  • low blood pressure (hypotension),
  • changes in heart rate (bradycardia),
  • fits (convulsions).

It is not known how frequently these side effects occur.

You might feel a slight stinging just after the gel is used, but this stops as soon as the anaesthetic starts to work.  Most people find that there are no problems after the gel has been used, but there may be a slight soreness when the effect of the local anaesthetic has worn off.

If you feel that you have had any reaction to the gel or get any side effects, tell your doctor, pharmacist or nurse as soon as possible.  This includes any possible side effects not mentioned above.

You can also report side effects directly via the Yellow Card Scheme on the website of the Medicines and Healthcare products Regulatory Agency (MHRA): www.mhra.gov.uk/yellowcard.  The MHRA is a government body that regulates medicines, medical devices and blood components for transfusion in the UK. 

The Yellow Card Scheme is a programme that helps the MHRA monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and those that use them.  By reporting side effects you can help provide more information on the safety of this medicine.

Contraindications

Instillagel must not be used in patients with known hypersensitivity or intolerance (undesirable reactions produced by the normal immune system, including allergies) to the active ingredients (amide-type anaesthetics, chlorhexidine and alkyl hydroxybenzoates) or any of the substances formulated alongside the active ingredients of a medication (excipients).  Instillagel should not be used in patients who have damaged or bleeding mucous membranes (moist, inner lining of some organs and body cavities) because of the risk of absorption of too much of the local anaesthetic, lidocaine hydrochloride in the blood.

When you must not use Instillagel

Instillagel is suitable for most people, but a few should not use it.   If you are in any doubt, talk to your doctor.

Do not use the gel if:

  • you are allergic to any of the ingredients of the gel
  • the moist lining (mucous membrane) of the application site (mouth, bladder, urethra, vagina, colon or rectum) is damaged or bleeding
  • in children under 2 years

Warnings and precautions for use

You should tell the person who is going to give you Instillagel if you have or suffer from any of these conditions:

  • heart problems (cardiac insufficiency, heart failure)
  • liver problems (hepatic insufficiency, liver failure, cirrhosis)
  • epilepsy

When used in the mouth or throat, Instillagel may cause difficulty with swallowing because of its numbing effect.  Numbness of the tongue and lining of the cheeks may increase the chance of you accidentally biting them.

Drug interactions

When you take two or more medicines at the same time, the effects of one medicine can be changed by the other.  This is known as an interaction. 

You should tell your doctor if you are taking or have recently taken or might take any other medicines, including medicines obtained without a prescription. You should also tell your doctor if you are taking drugs for irregular heartbeat (antiarrhythmic drugs).   It is important to tell your doctor about other medications you are taking, so that he or she can prescribe Instillagel safely.

Instillagel with food and drink

You should ask your doctor about what you can eat or drink when using Instillagel.

Instillagel and pregnancy/breastfeeding

If you are pregnant, think you may be pregnant or are planning to have a baby, ask the person who is going to give you Instillagel for advice.  You should only have Instillagel applied if absolutely necessary during the first three months of pregnancy. As only very small amounts of lidocaine (local anaesthetic from the gel) get into breast milk, you can continue to breastfeed.

Instillagel and driving/using machines

You may feel drowsy after using Instillagel. If so, do not drive or use any machinery.

Treatment Options

Instillagel v Aciclovir

Instillagel is a prescription gel that is used to numb the parts of the body it is applied to (local anaesthetic), reduce the risk of infection (antiseptic) and when used in examining or putting an instrument into a body cavity, such as the mouth, bladder or vagina, it also provides lubrication to ease this process.  Instillagel is available on prescription and the only triple-action anaesthetic antiseptic lubricating gel, which is also a licensed medicine. It is generally used in many situations, including for people with gential herpes, as an effective anaesthetic and antiseptic gel that helps to reduce the pain and risk of infection caused by a herpes outbreak. Instillagel can be used alongside other genital herpes treatments, such as Aciclovir, also known as Acyclovir, a generic (non-branded) name for the brand name, Zovirax.

Aciclovir is an antiviral medication used to treat infection caused by the herpes virus, including cold sores, genital herpes, chicken pox and shingles. It is available on prescription as an oral medication (taken through the mouth), or as a topical cream (applied to a particular place on or in the body), which can be bought over- the-counter, without a prescription.  Aciclovir cream is usually a sufficient treatment for cold sores, but should not be used inside the vagina, mouth or eyes. For more serious outbreaks of herpes infection, such as genital herpes, or for preventing chronic outbreaks, your doctor may prescribe Aciclovir tablets for a period of time.  However, if you have six or more genital herpes outbreaks a year, your doctor may also recommend herpes suppression therapy.

Non-prescription alternatives

There are several things you can do to make yourself more comfortable and promote healing, if you have an outbreak of herpes. Holding a cold compress against the affected area can help to soothe discomfort. You should avoid itching and ensure the area is kept clean. You can take painkillers, such as ibuprofen, to ease pain and inflammation. There are creams and sprays which are available over-the-counter without a prescription.  They are applied directly to the skin to speed up the healing process of the blisters. You may talk to your pharmacist to find the right over-the-counter treatment that suits your needs.

Q&A

Will Instillagel affect my contraception?

Instillagel can be used for contraception inserted in the womb (uterus) called intrauterine contraceptive device (IUCD or ICD) or coil, to reduce pain caused by the procedures, including difficult insertions and removals of the device.  However, a study carried out in 2013 found that pain relief was not widely considered in such procedures. This could mean that the effect of Instillagel on contraception might not be widely known. 

While some medicines may stop hormonal contraception working as well, some hormonal contraceptives may change the effect of other medicines.

There are certain types of medicine that can increase the enzymes (proteins that speed up chemical reactions) in the body.  These medicines are known as being “enzyme-inducing” and can affect hormonal contraception, including the pill, implant, patch and vaginal ring.

No studies on interaction (the effects of one medicine changed by the other) have been carried out.

If you’re considering using Instillagel, it is important to talk to your doctor first about your contraception and whether Instillagel can affect it.

Does Instillagel treat genital herpes?

Instillagel is not currently licensed for the treatment of herpes in the UK. However, this doesn't mean that it is unsafe, as it has been widely used for this purpose.  It is generally used as an effective anaesthetic gel that helps to reduce the pain caused by a herpes outbreak. Instillagel can be prescribed in combination with other genital herpes treatments like Aciclovir.

Can Instillagel be used for other conditions?

Instillagel can be used for problems of the genital/anal area, itching caused by hemorrhoids, dental plaque and bacteria, scrapes, minor burns, eczema, insect bites, pain during certain medical procedures, common and mild form of gum disease (gingivitis), skin cleansing and other conditions. 

You should talk to your doctor or pharmacist to get the right advice for your specific condition.

How should I store and dispose of Instillagel?

As with all medicines, keep Instillagel out of the sight and reach of children.

Do not store above 25°C.

The syringe is for single-use only.  Do not use Instillagel after the expiry date shown on the packaging.  Once open, use the disposable syringe immediately and discard any remaining gel. 

Do not throw away any medicines in wastewater or household waste.  Ask your pharmacist how to dispose of medicines you no longer require.  These measures will help to protect the environment.

If your medicine becomes discoloured or shows any sign of worsening, consult your pharmacist who will advise you what to do.

Sources

CliniMed, Instillagel® Anaesthetic Antiseptic Lubricant,  [website] 2019,

https://www.clinimed.co.uk/urology-continence-care/products/urology-products/instillagel, (accessed 7 October, 2019).

MHRA, Instillagel® Patient Information Leaflet,  [website] 2019, http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1489123992281.pdf, (accessed 7 October, 2019).

Nursing Times, Selecting gel types for urinary catheter insertion, [website] 2015 https://cdn.ps.emap.com/wp-content/uploads/sites/3/2015/06/240615_Selecting-gel-types-for-urinary-catheter-insertion.pdf, (accessed 7 October, 2019).

Manifest Health, Anal Fissure, [website] 2017

https://www.manifesthealth.co.uk/information-centre/enemas-colonics/anal-fissures/, (accessed 7 October, 2019).

NHS, SUMMARY OF PRODUCT CHARACTERISTICS, [website] 2014

https://www.pat.nhs.uk/downloads/patient-information-leaflets/urology/Instillagel.pdf, (accessed 10 October, 2019).

FARCO, Instillagel®, [website] 2018, https://www.farco.de/en/produkte/gleitgele/instillagel, (accessed 10 October, 2019).

WHO, Herpes simplex virus, [website] 2017, https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus, (accessed 10 October, 2019).

Prescriber, Recommended management of common STIs in general practice, [website] 2011, https://onlinelibrary.wiley.com/doi/pdf/10.1002/psb.806, (accessed 10 October, 2019).

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