Doctors prescribe diltiazem cream as a topical preparation for the treatment of anal fissures and for patients who have undergone hemorrhoid surgery. Other uses of diltiazem, sometimes marketed as nifedipine, include taking the medication in oral tablet form for the treatment of angina, hypertension, atrial fibrillation, and ventricular tachycardia. Patients experience fewer side effects from diltiazem cream than from other forms of the medication.
Anal fissures occur when the external anal surface cracks or tears. The tissue trauma generally occurs with constipation straining and passing hard stools. The irritation associated with diarrhea can also give rise to the condition, however. Individuals with fissures experience bleeding, itching, and moderate to severe pain. Before the introduction of diltiazem cream, physicians often prescribed topical glyceryl trinitrate, also known as nitroglycerin.
Diltiazem belongs to a group of medications known as calcium channel blockers. The formulation acts by inhibiting calcium ions from entering membranes. This causes muscular and vascular tissues to relax, dilating blood vessels and preventing muscular spasms. The reduction of painful spasms and increased blood flow to the area can then allow fissures to heal. Physicians in England developed the treatment, which gained acceptance in Australia and finally in the United States.
Using a glove or cellophane finger cot, patients typically apply a pea-sized amount of the 2% diltiazem cream to the external anal area twice daily for up to 12 weeks. Physicians may prescribe larger amounts of up to one inch (2.5 cm) when having patients apply the cream or ointment both externally and internally. The topical diltiazem dosage is less than one-tenth the amount commonly prescribed in oral form. Physicians recommend that patients wash their hands thoroughly following application, to prevent further skin absorption and additive effects.
More than one course of treatment may be required before healing occurs. Peri-anal itching or burning is the most common adverse reaction associated with diltiazem cream and may occur in up to 10% of the patients being treated. Other common side effects of diltiazem cream are headaches and dizziness. The dizziness occurs mainly when changing positions abruptly.
Patients should inform physicians of all current medications to prevent possible diltiazem drug interactions with other cardiac or hypertensive medications. Physicians generally recommend that patients suffering from chronic constipation increase daily amounts dietary fiber and water. Other treatments for anal fissure include botulinum injections or surgical repair.