Nifedipine and diltiazem for treatment of chronic anal fissures

Nifedipine and diltiazem are calcium channel blockers. These medicines, which are taken by mouth (orally) to lower blood pressure, have been found to have some benefit in healing long-term (chronic) tears, or fissures, in the anus. Diltiazem is not yet available as an ointment in the United States. Some studies suggest that calcium channel blocker ointments may work better than nitroglycerin ointment and have fewer side effects.

One cause of fissures is increased tension (called resting pressure) and spasm in the internal anal sphincter, one of two muscles that control the anus. These medicines work by relaxing the smooth muscle, allowing the fissure to heal.

Although these medicines are not yet first-line treatment for anal fissures, more studies are showing that they lower anal resting pressure.¹

Citations

1. Jonas M, Scholefield JH (2001). Anal fissure. Gastroenterology Clinics of North America, 30(1): 167–181.