Treatment Guides Topical Ointments
Active Ingredients
• Diltiazem (calcium channel blocker)
• Nitroglycerin (nitrate)
• Nifedipine ointments (calcium channel blocker)
Relaxing the smooth muscle around the anus promotes blood flow. This helps heal small tears and reduce anal canal pressure which diminishes pain, spasm, swelling and bleeding. Diltiazem, nitroglycerin, nifedipine are used to treat anal fissures, bleeding internal hemorrhoids, and external thrombosed hemorrhoids.
Additional active ingredients are listed below:
• Lidocaine
• Marcaine
• Bupivacaine
• Aloe Vera
• Hydrocortisone
• Metronidazole
Anal Fissure Care Instructions for Use:
• Continue ointment treatment for 2+ months for the fissure to completely heal. DO NOT stop treatment early because you feel better. The fissure can reopen.
• Avoid constipation.
• Apply 3-4 times per day – typically for 8 weeks. Ointment should be applied morning, evening, before and after bowel movements.
• Ointment may be applied 1-2 times per day for an additional 6 weeks.
• A pea size drop should be placed on clean or gloved index finger or a cotton-tipped applicator.
• Gently insert ointment inside the anus about 1 cm inside –just the tip of your index finger.
External Thrombosis Care Instructions for Use:
• Most thromboses will resolve within 4-8 weeks.
• Apply 3-4 times per day – typically for 8 weeks. Ointment should be applied morning, evening, before, and after bowel movements.
• Rub the ointment over any external swelling or areas of pain.
• You may use petroleum jelly to help coat the finger or dilute the ointment.
• Gently insert ointment inside the anus about 1 cm inside –just the tip of your index finger.
Hemorrhoid Care Instructions for Use:
• Continue ointment until otherwise instructed by physician.
• Apply 3-4 times per day – typically for 8 weeks. Ointment should be applied morning, evening, before, and after bowel movements.
• Rub the ointment over any external swelling or areas of pain.
• You may use petroleum jelly to help coat the finger or dilute the ointment.
• Gently insert ointment inside the anus about 1 cm inside –just the tip of your index finger.
General Care While Undergoing Treatment:
• Add fiber to your diet, use stool softeners, increase water intake (>8 glasses per day), use daily relaxing baths or sitz baths for 10–15 minutes, in the bathtub and avoid prolonged sitting and straining on the commode.
• Avoid trying to pass a dry stool by coating the anus with your prescription ointment before and after a bowel movement (for lubrication).
• If you don’t have access to prescription ointment, you may use petroleum jelly or Aquaphor.
• While undergoing treatment, you may be asked to limit physical exercise, standing, prolonged sitting and/or receptive anal intercourse.
Side Effects:
Side effects are not common.
• Dizziness, headache, burning at the application site, weakness, nausea or swelling of the hands or feet may rarely occur.
• If any of these side effects persist or worsen, go to the ER.
• STOP using the ointment if you develop severe side effects such as severe dizziness, fainting, fast/pounding heartbeat, irregular heartbeat, chest pain, seizures, or allergic reaction (rash, swelling, dizziness, trouble breathing).
• STOP the ointment and CALL your physician for directions if you are having a reaction.
Notifications and Alerts:
DO NOT USE OINTMENT IF:
• You are allergic to Nitroglycerin, diltiazem or any other calcium channel blocker.
• You have severe anemia, low blood pressure, dehydration, chronic heart failure, cardiomyopathy, recent heart attack or any condition reducing blood flow to the brain.
• You have kidney or liver failure or severe angina.
• While driving or operating machinery if you are drowsy, dizzy, have lightheadedness or blurred vision.
• While taking drugs for sexual problems (e.g., Sildenafil, Tadalafil, Vardenafil).
• Flagyl (Metronidazole) may be added to your ointment: Do not drink alcohol while using Flagyl.
• Limit alcoholic beverages while using the medication.
• To minimize dizziness and lightheadedness, get up slowly when rising from sitting or lying position.
• Elderly people may be more prone to dizziness or falling.
Pregnancy or breastfeeding patients:
The use of topical diltiazem and nifedipine is safe in pregnant or breastfeeding women. There are not adequate studies to confirm the safety of nitroglycerin-based ointments in pregnant or breast-feeding women.
Wait at least one hour after applying ointment before breastfeeding.
Storage:
• Store the ointment at room temperature and keep away from light and moisture. Close container tightly after each use.
• Medication may be stored in a low humidity bathroom.
• Keep away from children and pets – if ingested, contact poison control.
