Preparation H Maximum Strength Cream

This formulation combines two active pharmaceutical ingredients with a skin protectant base. Each targets a different hemorrhoid symptom, and understanding what they do helps you evaluate whether this product matches your primary complaint.

Phenylephrine HCl 0.25%

Phenylephrine is a sympathomimetic amine — a vasoconstrictor that narrows blood vessels. Applied topically to hemorrhoidal tissue, it reduces the blood flow keeping the hemorrhoid engorged, causing it to shrink. This is the active "shrinking" ingredient that distinguishes Preparation H from pain-only products. The 0.25% concentration is the maximum allowed under the FDA's OTC anorectal drug monograph (21 CFR Part 346).

Onset is typically 15–30 minutes. The shrinking effect is temporary — lasting 1–4 hours depending on severity — but repeated application provides cumulative benefit. For a broader comparison of how vasoconstrictors stack up against other active ingredients, see our hemorrhoid cream ingredient comparison.

Pramoxine HCl 1%

Pramoxine is a local anesthetic that blocks nerve signal transmission, numbing the affected area. At 1%, it provides moderate pain and itch relief within 5–10 minutes. Pramoxine is milder than lidocaine (found in RectiCare at 5% and Doctor Butler's at 4%) but carries a lower risk of allergic reaction.

The combination of phenylephrine plus pramoxine means this product both shrinks and numbs — addressing both the physical size of the hemorrhoid and the pain it causes. Products with only one mechanism require combining multiple products to achieve the same dual action.

White Petrolatum (14.4%)

The petrolatum base serves as a skin protectant, creating a moisture barrier that shields irritated tissue from stool, friction, and environmental irritation. It also keeps the active ingredients in contact with the tissue longer than a water-based formula would, improving absorption time.

Best Candidates

• External hemorrhoids with swelling and pain — the primary use case. Phenylephrine directly shrinks the external tissue it contacts.
• Mild thrombosed hemorrhoids within the first few days. The vasoconstrictor can help reduce engorgement while pramoxine manages pain.
• Users wanting a single all-in-one product. The shrink-plus-numb formula eliminates the need to layer separate products.
• Post-bowel movement application. The petrolatum barrier is especially helpful after cleaning, protecting freshly irritated tissue.

Not Ideal For

• Internal hemorrhoids above the dentate line. This cream is designed for external application and cannot effectively reach internal tissue. See our guide on identifying your hemorrhoid type.
• Severe pain requiring maximum numbing. Pramoxine 1% provides moderate relief. For intense pain, a 5% lidocaine product offers stronger anesthesia.
• Extended use beyond 7 days. Phenylephrine should not be used continuously for more than 7 days without physician guidance.

Medical Cautions

Phenylephrine is a vasoconstrictor that can theoretically affect blood pressure through systemic absorption. While this is rare with topical anorectal application at OTC concentrations, the following groups should consult their physician before use: individuals with uncontrolled hypertension, heart disease, thyroid disorders, or diabetes. If you are taking MAOIs or blood pressure medication, check for interactions. Pregnant or breastfeeding women should review pregnancy-safe options with their OB before using this product.

How to Apply

• Clean the affected area gently with water or a gentle wipe and pat dry before application.
• Apply a thin layer to the affected external area. A pea-sized amount per application is typical.
• Apply up to 4 times daily and after each bowel movement.
• Do not insert into the rectum unless using a product specifically formulated with an applicator for internal use.
• Wash hands thoroughly after application.
• For best results, combine with a warm sitz bath — apply cream after the soak, once the area is dry.

Duration

Use for up to 7 consecutive days. If symptoms do not improve within one week, or if they worsen, discontinue use and consult a healthcare provider. Many mild external hemorrhoids respond well within 5–7 days of consistent application. Learn more about typical hemorrhoid healing timelines.

Side Effects

• Common: Mild burning or stinging on initial application. This typically fades within 1–2 minutes and is caused by the anesthetic interacting with broken skin.
• Uncommon: Allergic contact dermatitis — increased redness, swelling, or rash at the application site. Discontinue immediately if this occurs.
• Rare: Systemic effects from phenylephrine (elevated heart rate, blood pressure changes). Clinically rare at OTC topical concentrations but possible in individuals with cardiovascular sensitivity.

If you experience severe burning, swelling of the face or throat, or difficulty breathing, seek emergency medical attention. These would indicate an allergic reaction to one of the ingredients.

Alternatives to Consider

• Doctor Butler's Hemorrhoid Ointment — Contains 4% lidocaine for stronger numbing plus herbal ingredients. A good choice if you prefer a formulation with natural components alongside pharmaceutical ones. Does not contain a vasoconstrictor, so it numbs but does not actively shrink tissue.
• RectiCare Anorectal Cream — Contains 5% lidocaine, the maximum OTC numbing concentration. Best for users whose primary complaint is pain rather than swelling. No vasoconstrictor.
• Tucks Medicated Pads — Witch hazel-based. The gentlest option with no pharmaceutical ingredients. Best for mild symptoms, pregnancy, or users who prefer natural-only products.
• Generic phenylephrine/pramoxine creams — Same active ingredients at the same concentrations, typically at lower cost. The formulation base may differ, affecting texture and absorption.

Price and Value

At $10.99 for a 1.8 oz tube, Preparation H Maximum Strength provides approximately 25–30 applications at the recommended pea-sized amount. That works out to roughly $0.37–0.44 per application. Compared to premium lidocaine products ($12–18 for similar tube sizes), it offers competitive value — particularly given its dual-action formula. For a full price comparison across the category, see our complete cream buying guide.

Our Assessment

Preparation H Maximum Strength is the most well-rounded OTC hemorrhoid cream available. Its dual-action formula (vasoconstrictor + anesthetic) addresses both swelling and pain in a single product, backed by the highest review volume in the category (40,000+ Amazon ratings at 4.6 stars). It is particularly well-suited for external hemorrhoids where tissue shrinkage and pain relief are both needed.

Where it falls short: the 1% pramoxine provides moderate rather than maximum pain relief, and the phenylephrine component means it is not appropriate for all patients. If your primary complaint is severe pain, a dedicated lidocaine product may serve you better. If you want a gentler, long-term maintenance product, witch hazel is safer for extended use.

For most users experiencing a standard external hemorrhoid flare-up, this is a strong first choice.