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Cirkalm (V00032) is a topical rectal cream formulation of *Ruscus aculeatus* (butcher's broom) extract developed by Pierre Fabre Médicament. It is approved in France for the symptomatic relief of anal pain and hemorrhoidal disorders. The active components of the extract, primarily the steroidal saponins ruscogenin and neoruscogenin, act as agonists of alpha-1 and alpha-2 adrenergic receptors on vascular smooth muscle cells, promoting vasoconstriction and improving venous tone. Additionally, the extract exerts anti-inflammatory effects by inhibiting NF-κB activation and reducing the expression of intercellular adhesion molecule-1 (ICAM-1). Pierre Fabre has evaluated Cirkalm in a Phase 4 clinical trial in France to assess its efficacy and safety compared to placebo in patients experiencing anal pain.
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