From the Guidelines
The recommended SIG for diltiazem 2% ointment for chronic anal fissures is to apply a pea-sized amount to the affected anal area three times daily for at least 6 weeks, as this duration has been suggested to achieve significant healing rates 1. The primary goal of this treatment is to achieve internal anal sphincter (IAS) relaxation, reducing pain and facilitating the healing process, which is in line with the guidelines for anorectal emergencies 1.
- Key points to consider when using diltiazem 2% ointment for chronic anal fissures include:
- Applying the ointment using a gloved finger or applicator, gently inserting it just inside the anal canal and around the anal opening
- Washing hands thoroughly before and after application
- Potential mild side effects such as headache or temporary burning upon application
- Improvement typically seen within 2-3 weeks, but the full course should be completed even if symptoms resolve earlier
- Follow-up with a healthcare provider if no improvement occurs after 6-8 weeks or if symptoms worsen This treatment approach is supported by recent studies, including a systematic review and meta-analysis that found calcium channel blockers (CCBs) like diltiazem to be more effective than glyceryl trinitrate with less risk of headache and hypotension 1.
- The use of diltiazem 2% ointment has been associated with healing rates ranging from 65 to 95% and is considered a cost-effective treatment option compared to other non-operative treatments 1.
From the Research
SIG for Diltiazem 2% Ointment
- The standard instruction for the use of diltiazem 2% ointment for chronic anal fissures is to apply 2 cm (approximately 0.7 g) of the ointment to the anal verge twice daily for eight weeks 2.
- Alternatively, 8 mg of 2% diltiazem hydrochloride gel (equivalent to 2 cm of gel) can be applied three times daily 3.
- The application frequency and duration may vary depending on the specific treatment protocol and patient response, with some studies using a 6-week course of twice-daily topical application 4 or a 6-week course of topical diltiazem ointment 5.
Key Considerations
- Patients should be instructed to report any side effects or symptoms throughout the treatment period 2, 3.
- The treatment should be monitored for efficacy and safety, with follow-up assessments to evaluate the healing of the fissure and any adverse effects 2, 3, 4, 5.
- Patients who do not respond to diltiazem treatment may require further treatment, including surgical options such as sphincterotomy 2, 3, 4, 5.