Anusol HC Shortage: What Providers and Prescribers Need to Know in 2026

Patients are increasingly reporting difficulty filling prescriptions for Anusol HC (hydrocortisone acetate rectal) — even though there is no formal FDA shortage declaration. For prescribers, understanding the supply landscape, available therapeutic substitutes, and how to help patients navigate access challenges can significantly improve patient outcomes and reduce treatment interruptions.

Current Supply Status for Anusol HC (2026)

Anusol HC is not currently listed on the FDA Drug Shortages database. The generic active ingredient, hydrocortisone acetate rectal, is produced by multiple manufacturers, which provides supply resilience relative to some other specialty rectal medications. However, clinicians should be aware of the following:

• Brand-name Anusol HC (Salix Pharmaceuticals): Distributed by Bausch Health US. Prescriptions written specifically for brand Anusol HC with 'dispense as written' notation may be subject to stock unavailability at many pharmacies, particularly for the 25 mg suppository.
• Generic hydrocortisone acetate rectal: Generally more available. Multiple NDCs exist for the 25 mg suppository and 2.5% cream. Prescribing generically allows pharmacists flexibility to source from available manufacturers.
• 2.5% cream vs. suppository: The cream formulation has consistently better availability than the suppository across most pharmacy chains in 2026. Where clinically appropriate, prescribing the cream may reduce fill delays.

Clinical Profile of Anusol HC

For reference, Anusol HC is indicated for:

• Inflamed hemorrhoids and hemorrhoidal proctitis
• Pruritus ani (anal itching)
• Factitial proctitis (post-irradiation)
• Adjunct therapy for ulcerative colitis of the rectum and cryptitis

Standard dosing for the 25 mg suppository: 1 suppository rectally twice daily (morning and night) for 2 weeks in nonspecific proctitis. For severe cases: 1 suppository 3x daily or 2 suppositories twice daily. For factitial proctitis: 6-8 weeks based on response.

Therapeutic Substitution Options by Indication

If a patient cannot obtain Anusol HC, the following substitution options are organized by clinical appropriateness:

Direct substitutes (same active ingredient):

• Anucort-HC 25 mg rectal suppository: Therapeutic equivalent. Manufactured by Cosette Pharmaceuticals. Generally more available than brand Anusol HC.
• Proctocort 25 mg rectal suppository: Another AB-rated generic. Same formulation, widely available.
• Generic hydrocortisone acetate 2.5% rectal cream (Proctosol-HC, Proctozone HC): Best availability of any Rx hydrocortisone rectal formulation. Appropriate for perianal and internal application for most hemorrhoid and proctitis indications.

Same-class alternatives with additional anesthetic component:

• Pramosone / Analpram HC (hydrocortisone + pramoxine): For patients with significant pain component. The cream formulation (Pramosone) tends to have better availability than Proctofoam HC in 2026.
• Ana-Lex (hydrocortisone + lidocaine): Alternative combination product for patients requiring analgesia alongside anti-inflammatory action.

For ulcerative proctitis extending beyond suppository reach:

• Cortenema (hydrocortisone 100 mg/60 mL rectal enema): Appropriate for patients with disease extending beyond the reach of suppositories. Generally good availability.

Prescribing Guidance to Minimize Fill Issues

• Prescribe generically: Write "hydrocortisone acetate 25 mg rectal suppository" rather than "Anusol HC" to give the pharmacist flexibility to use any available generic.
• Avoid 'dispense as written' unless clinically necessary: Brand-specific orders significantly restrict pharmacist substitution options.
• Consider the cream formulation when clinically equivalent: Generic 2.5% rectal cream has better availability and is appropriate for many patients who might otherwise receive suppositories.
• Offer a backup prescription: For patients who require consistent therapy (e.g., chronic ulcerative proctitis), consider writing a secondary prescription for Anucort-HC or Proctozone HC in case their primary fill is unavailable.

Insurance Considerations for Providers

Generic hydrocortisone acetate rectal is typically Tier 1-2 on most commercial formularies and usually does not require prior authorization. Brand-name Anusol HC may trigger step therapy requirements or require prior authorization on some plans. When writing for brand-only, be prepared for PA requests.

Medicare Part D plans generally cover generic hydrocortisone rectal products. Verify coverage tier through the plan's formulary before writing the prescription to avoid fill delays at the pharmacy.

How medfinder Supports Your Patients

When patients struggle to fill a prescription you've written, the resulting delays can impact treatment outcomes. medfinder for providers helps your patients locate their medication at nearby pharmacies quickly — reducing treatment gaps and minimizing the support burden on your office staff. You can direct patients to medfinder.com when they're having trouble with a fill. For the current patient-facing shortage update, see: Anusol HC Shortage Update: What Patients Need to Know in 2026.