- Glyceryl trinitrate ointment
- Works by reducing anal
resting pressure, a "chemical sphincterotomy."
- 80 pts with "chronic" anal fissures randomized
to 0.2% GTN ointment BID vs. placebo x 8 wks; 68% healing
with GTN vs. 8% with placebo (sig.) 58% of GTN users had
headaches at one point but only 1 had to stop tx b/c of
this (Lancet 349:11, 1997-JW)
- "Recvit" (NTG ointment 0.4%)-WIll be released in U.S. in
- Botulinum toxin injected into internal anal sphincter
30 pts with chronic anal fissure randomized to botox vs.
placebo, sig. higher rates of healing (73% vs. 13% and sx
relief (87% vs. 27%) at 2mos w/botox. No complications or
relapses noted during 16mos of f/u (NEJM 338:217,
- 50pts with chronic posterior anal fissure randomized to
Botulinum toxin (1 injection into each side of internal
anal sphincter) vs. 0.2 NTG ointment BID x 6wks.
Botulinum toxin group had higher healing rates at 2mos
(96% vs. 60%) (NEJM 341:65, 1999--JW)
- Topical nifedipine-lidocaine ointment (0.3%-1.5%)
- When administered Q12h x 6wks vs.
topical lidocaine-hydrocortisone ointment Q12h, was associated with sig. higher
healing rates (94.%% vs. 16.4%) in a 6wk randomized trial of 100 ptd with
symptomatic anal fissure x > 2mos; no sig. side f/x noted (Dis. Col.
Rect. 45:1468, 2002--AFP)
- In a study in 50 pts with chronic anal fissure randomized
to nitroglycerin 0.2% ointment BID vs. Botox injections, with crossover to
alternative treatment if not healed at 4wks, 2wk response rates were sig.
higher in nitroglycerin group (52% vs. 24%) (Am. J. Gastroent. 101:2107,