title: Comparison of captopril (0.5%) cream with diltiazem (2%) cream for chronic anal fissure: a prospective randomized double-blind two-centre clinical trial.
abstract: OBJECTIVE
  This study compared the efficacy of topical captopril with topical diltiazem in the treatment of chronic anal fissure (CAF).
  
  
  METHODS
  Fifty patients aged between 15 and 75 years with CAF were included in a prospective randomized, double-blind clinical trial. They were randomly allocated to either captopril (0.5%) cream or diltiazem (2%) cream in a dose of 2 cm of cream on the perianal skin every 12 h for 8 weeks. The intensity of pain upon defaecation was evaluated every 10 days using a visual analogue scale. Bleeding on defaecation, pruritus and the presence of perianal irritation were also recorded before and during the trial.
  
  
  RESULTS
  The average pain scores were lower in the diltiazem group on the 20th and 30th days. From day 40 to the end of the trial the average pain scores of the two groups did not differ significantly. There were no significant differences in bleeding or perianal irritation between the groups, but the incidence of pruritus was considerably higher in the captopril group, and at the end of the trial 45.8% of the patients in this group still suffered from pruritus.
  
  
  CONCLUSIONS
  Topical captopril and diltiazem were found to be equally effective in the management of pain, bleeding and perianal irritation due to CAF, but due to the high incidence of pruritus observed with topical captopril this medication is not recommended for the treatment of CAF.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Ala
authors.affiliation: Department of Pharmaceutical Sciences, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Enayatifard
authors.affiliation: Department of Surgery, Imam Khomeini General Hospital affiliated to Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Alvandipour
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Qobadighadikolaei
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000187:drug effects; D002216:Captopril / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D003672:Defecation; D004110:Diltiazem / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011538:Pruritus Ani / Q000139:chemically induced; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D002216:Captopril; D004110:Diltiazem
keywords: Captopril; chemical sphincterotomy; chronic anal fissure; diltiazem; pain upon defaecation