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What is Diltiazem:
Many doctors prescribe diltiazem hydrochloride to treat anal fissures. Diltiazem is a calcium channel blocker, which works by dilating blood vessels. Calcium works with another substance in the body to cause contraction of the heart muscle, which helps the heart pump blood. Calcium also causes blood vessels to constrict, or get smaller. Blocking the calcium, as the calcium channel blockers in diltiazem do, allows the blood vessels to relax and widen. Diltiazem ointment relaxes the sphincter muscle, which alleviates pain and allows stool to pass more easily. This medication also promotes blood flow, which allows the healing process to begin. The ointment reduces pressure within the anal canal pressure, which diminishes pain and spasm.
Because of the area of application, producing an ointment for anal fissures requires special considerations. Diltiazem ointment tends to contain large particles of its active ingredient, which can make the final product gritty. This grittiness can be uncomfortable in the application area; it can also interfere with the absorption of the ointment into the rectal tissue. When compounding the 2% Diltiazem ointment, it is important to run the ointment thru an ointment mill to reduce the particle size and lessen the grittiness of the final product. This procedure, also allows a larger amount of the drug to be absorbed into the rectal tissue. As any patient can tell you, there is nothing worse than a gritty rectal ointment that does not absorb well!
Because it is in an ointment form, topical diltiazem is easy for patients to use. Patients simply apply a pea-sized drop ointment to the skin just inside the anus three times per day, or as often as directed. Depending on the severity of the anal fissure, it may take several weeks of treatment for the fissure to heal. Patients should continue using diltiazem-ointment for the entire prescribed treatment period, which can be up to 3 months or more as directed. Complete healing can take several months – up to 2 years in some cases – so patients should add fiber to their diet, increase their consumption of water, take sitz baths, and avoid prolonged sitting or straining on the commode.