What is the role of calcium channel blockers in the treatment of anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Oral and topical calcium channel blockers (diltiazem and nifedipine) have been shown to be effective treatment options for anal fissures. Calcium channel blockers work by vasodilating blood vessels. In one review, calcium channel blockers were shown to be as effective as topical nitrates. Adverse effects such as headaches are common, especially with the use of oral calcium channel blockers. [25] Oral calcium channel blockers have been shown to yield decreased healing rates compared with topical calcium channel blockers, as well as higher rates of adverse effects. [26]

However, a prospective controlled trial that compared 2% diltiazem versus lateral internal sphincterotomy (LIS) for treatment of chronic anal fissures in 90 patients found LIS was more effective for not only complete healing at 6 weeks (96%) than diltiazem (71%) but also for pain relief. [27]  The investigators suggested the use of topical diltiasem may be an initial conservative therapeutic option before consideration of surgical intervention.

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