Recent advances in the pharmacotherapy of chronic anal fissure: an update.
Surgical sphincterotomy reduces anal tone and sphincter spasm and promotes ulcer healing. Because the surgery is associated with the side effect of faecal incontinence, pharmacological agents to treat chronic anal fissure have been explored recently. Glyceryl trinitrate (GTN) ointment (0.2%) has an efficacy of up to 68% in healing chronic anal fissure, but it is associated with headache as the major and most common side effect. Though botulinum toxin injected into the anal sphincter healed over 80% of chronic anal fissures, it is more invasive and expensive than GTN therapy. Diltiazem ointment achieved healing of chronic anal fissure comparable to 0.2% GTN ointment but was associated with fewer side effects. Other drugs that have been tried are lidocaine, the alpha-adrenergic antagonist indoramin, and the potassium channel opener minoxidil.
Medhi
Bikash
B
Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drbikashus@yahoo.com
Rao
Ramya Sankarnarayan
RS
Prakash
Ajay
A
Prakash
Om
O
Kaman
Lileswar
L
Pandhi
Promila
P
D000287:Administration, Topical; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage; D001003:Anal Canal; D001905:Botulinum Toxins / Q000008:administration & dosage*; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002908:Chronic Disease / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004110:Diltiazem / Q000008:administration & dosage; D005401:Fissure in Ano / Q000188:drug therapy*; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007217:Indoramin / Q000008:administration & dosage; D015552:Injections, Intralesional; D008012:Lidocaine / Q000008:administration & dosage; D009543:Nifedipine / Q000008:administration & dosage; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000009:adverse effects; D009824:Ointments
D000317:Adrenergic alpha-Antagonists; D002121:Calcium Channel Blockers; D009824:Ointments; D007217:Indoramin; D008012:Lidocaine; D001905:Botulinum Toxins; D004110:Diltiazem; D005996:Nitroglycerin; D009543:Nifedipine