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Topical Diltiazem – Anal Cut Aka Anal Fissure 101

written by Dr. HaVy Ngo - Jan 4, 2022
medically reviewed by Dr. Christine Bishara, MD - Feb 7, 2022

Photo Credit: by Tim Mossholder,
Photo Credit: by Tim Mossholder,

What is diltiazem?

Diltiazem is the generic name for other brand name products such as Cardizem. Diltiazem CD, Diltiazem SR, and Diltiazem LA. CD, SR, and LA stand for controlled delivery, sustained release, and long-acting, respectively – these drugs are designed to have a rate that leads to drug delivery for a prolonged period of time, like 12 hours or 24 hours. Diltiazem belongs to a drug class called calcium channel blockers (CCBs) that work by relaxing the muscle of your heart and blood vessels. Calcium plays a significant role in your bone health. Most people do not know that calcium is also vital in heart function and activity. Every time calcium moves into your heart cells, it results in a strong and consistent contraction of the heart muscle, which allows your heart to squeeze.

Patients with high blood pressure and other heart conditions will have a higher than normal force of blood flowing through the arteries. This higher force is due to the narrowing of the blood vessels, causing the heart to work harder to pump blood to the rest of the body. Calcium channel blockers (CCBs) reduce the amount of calcium flowing into your heart and arteries, resulting in lowering blood pressure, reducing heart rate, and widening narrowing blood vessels.

Keep in mind that the effects above occur when you take diltiazem orally, resulting in systemic effects. Please continue to read to learn more about the use of diltiazem ointment and other valuable tips for this high-demand product at our pharmacy. All diltiazem products are prescription-only medications. Please always consult with your doctor or pharmacist for taking it for the best efficacy and safety.

What are the significant differences between topical diltiazem and oral diltiazem?

Diltiazem oral tablets are available in the strength of 30 mg, 60 mg, 90 mg, and 120 mg. Diltiazem hydrochloride topical ointment is available in the strength of 2%, and a 90 gm-tube will be compounded by our pharmacy on demand. Diltiazem with lidocaine (2%/5%) is another compounding-eligible product by our pharmacy, coming in the 30-gm product size.

The main difference between the topical and oral diltiazem is their indications. Oral diltiazem is to be taken by mouth for a systemic effect; it is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders.

Diltiazem 2% ointment is indicated to help heal the tear in the skin of the anus. By doing so, using this ointment will reduce the pain and discomfort caused by these tears. You may have heard another term for this, "anal fissure." - this is the condition where there are small tears in the thin, moist skin lining of the anus.

You are probably wondering how the vasodilating effect of CCBs can help with anal fissure. As mentioned earlier, CCBs cause the blood vessels to relax by reducing the amount of calcium flowing into the cells. The exact mechanism happens here; diltiazem ointment, relaxes the muscle around the anus (the anal sphincter). By doing so, the diltiazem ointment reduces the anal pressure while promoting blood flow to the affected area to improve healing.

What are the side effects of diltiazem?

The following symptoms can be signs of an allergic reaction which, left untreated, can be life-threatening. You should watch out for the following symptoms: difficulty breathing, hives (rash on the body), swelling of the face, lips, tongue, or throat.

The great thing about the topical diltiazem is that it does not produce systemic, or all over the body, adverse effects like oral diltiazem. Some of the common side effects of diltiazem ointment include:

• Headache - These headaches are not supposed to be severe and long-lasting. They are usually relieved by using over-the-counter painkillers such as Tylenol (acetaminophen) or Advil (ibuprofen). Let your doctor know if your headache worsens or has a very high intensity.

• Dizziness, lightheadedness - one of the notable side effects of diltiazem is orthostatic hypotension - This is a condition where your blood pressure drops drastically when you stand up from laying down or sitting down. You should change position slowly and hold on to the bedside or the chair's armrest if needed, especially at the beginning of the treatment when you don't know how your body would respond to this medication.

• Local reactions such as burning, itching, or rectal bleeding; please let your doctor know immediately if these symptoms worsen or do not resolve.

This is not a complete medication guide. You should talk to your doctor or pharmacist if you have any other questions about usage and topical diltiazem's side effects.

What do I need to tell my doctor before using diltiazem ointment?

You should not use diltiazem if you are allergic to it. If you have very low blood pressure or have a severe heart condition called "sick sinus syndrome," diltiazem is not a safe choice for you. Also, you should not use diltiazem if you have recently had a heart attack or a build-up fluid in your lungs.

Please contact your doctor immediately if you experience sudden weight gain, swelling in your feet or ankles, stomach pain, or shortness of breath, as these can be signs of worsening heart problems.

Before using topical diltiazem, let your doctor know if you have:

-kidney disease.

-liver disease.

-congestive heart failure.

-if you are taking digoxin or a beta-blocker such as atenolol, carvedilol, metoprolol, propranolol, sotalol, and others.

As with any other medications, you should tell your doctor your entire medical history, including a complete list of medications you are taking, such as prescriptions, over-the-counter products, and herbal supplements.

How do I use the diltiazem topical ointment?

Wash your hands thoroughly with soap and water before and after administering this medication. Dry your hand before putting on gloves or finger covering. Apply a small amount to your finger - pea-sized or approximately 1 inch or 2.5 centimeters, and place the cream just inside the anus, right at the entrance. The usual direction for diltiazem ointment is to use it twice daily (morning and evening), in addition to before and after bowel movements for two months. You should use this ointment every day and finish the entire course of treatment even if your symptoms have improved. Compliance is critical for this therapy to be successful. After you finish the first treatment, your physician will evaluate your presentations thoroughly to determine the need for the continuation of therapy.

Pharmacist tips

Integrating non-pharmacological interventions with medication therapy is important. Below are some simple self-care tips that can help with pain and discomfort from anal fissures.

Stay well-hydrated

Being well-hydrated is not only good for this specific condition; it is vital for your overall health. For healthy adults in a temperate climate, it is recommended that men should drink 3.7 liters per day, and women should drink 2.7 liters per day. Keep in mind that your daily fluid intake also comes from food and fruits. Everybody's required fluid inputs are different based on their medical conditions and environmental factors. For example, people with kidney disease should consume a lot less fluid than normal people due to their increased risk of fluid retention leading to swelling of the body. Talk to your doctor or dietitian if you are unsure of your recommended daily fluid intake.

Consume a fiber-rich diet

To avoid constipation, you should eat approximately 20 to 35 grams of fiber every day. An unknown fact to many people about this staple food is that it provides so many benefits for bowel health, cholesterol, and blood sugar. Some fiber-rich foods are oat bran, wheat bran, whole grains, prunes, citrus fruits. You should incorporate fiber into your regular diet by gradually increasing the amount of fiber daily. Fiber is always the first line of defense for constipation. However, over-the-counter laxatives are also relatively safe and effective if fiber is not effective enough.

Next, do not ignore your urge to go, and don't strain or sit on the toilet too long.

Also, avoid skin irritants such as scented soap and lotion. Keep the area dry and clean to prevent infection and slow wound healing.

Lastly, sitz baths or hip baths can be used to relieve pain and discomfort.

You can soak the rectal area in a tub of lukewarm water two to three times a day for 10 to 15 minutes. Warm water can help improve blood flow and relax the anal sphincter while relieving discomfort.

If you have any questions or concerns, please do not hesitate to reach out to us. At Canada Online Pharmacy, we take pride in providing the best saving on medications for our customers with no-hassle shipping. I invite you to check out our website to learn more about our services and wide varieties of natural supplements and pharmacological therapies.



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