Oral lacidipine in the treatment of anal fissure.
The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel blocker with a better tolerability in comparison to other calcium antagonists. Twenty-one consecutive patients (16 women, 76.2%) with AF (16 chronic, situated posteriorly in 17 patients (81.0%), anteriorly in 4) with a mean age of 37.1 years (SD, 13.6, range, 20-6) were treated with oral lacidipine (6 mg daily) and warm sitz baths for 28 days, adding only stool softeners for patients with constipation. Blood pressure, pain scores (assessed from 0 to 10 on a visual analogue scale) and fissure healing were monitored at 14 days, 28 days and 2 months. At the 14-day and 28-day follow-ups, the mean systolic and diastolic pressures were not significantly different from pre-treatment levels. Seven patients (33.3%) developed side effects, but only one, who developed dyplopia, withdrew from the study at the 14-day control (non-compliance rate with treatment, 4.8%). Pain scores were significantly reduced after 14 days and continued to show a significant reduction throughout the treatment period. Three fissures (14.3%) healed by 14 days and a total of 19 (90.4%) after 28 days: among the healed AF no recurrences were seen at the 2-month control. Among the two treatment failures, one was the patient who withdrew from the study at the 14-day control due to dyplopia and the other was a patient who failed to heal up to the 2-month follow-up, although completely asymptomatic. Both patients underwent left lateral sphincterotomy and healed. In conclusion, oral lacedipine is quite well tolerated and may offer a promising alternative treatment for AF.
Ansaloni
L
L
Department of Emergency Surgery, S. Orsola-Malpighi Hospital, Via Massarenti 9, I-40138 Bologna, Italy. So10790@iperbole.bologna.it
Bernabè
A
A
Ghetti
R
R
Riccardi
R
R
Tranchino
R M
RM
Gardini
G
G
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use*; D004095:Dihydropyridines / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D013997:Time Factors
D002121:Calcium Channel Blockers; D004095:Dihydropyridines; C060285:lacidipine; D009543:Nifedipine