Nifedipine for local use in conservative treatment of anal fissures

Antropoli, Carmine; Perrotti, Pasquale; Rubino, Mario; Martino, Antonio; Stefano, Giovanni; Migliore, Giuseppe; Antropoli, Massimo; Piazza, Pasquale

doi:10.1007/bf02236693

Cited by 134 publications

(64 citation statements)

References 27 publications

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“…4 Several drugs, such as glyceryl trinitrate (GTN), botulinum toxin, isosorbide dinitrate, Larginine, and calcium-channel blockers, have been used to reduce the IAS tone till the fissure heals. [5][6][7][8][9][10] Since minoxidil, a potassium-channel opener used in the treatment of hypertension and male pattern baldness, induces smooth muscle relaxation and vasodilatation. [11][12][13] we aspired to check its efficacy vis a vis a topical calcium channel blocker (diltiazem) in treatment of anal fissures.…”

Section: Introductionmentioning

confidence: 99%

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

et al. 2017

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Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No patient had systemic or local side effects.Conclusions: Treatment with minoxidil helps in faster healing of anal fissures and provides similar symptomatic relief as that of diltiazem.

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Section: Introductionmentioning

confidence: 99%

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

et al. 2017

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“…According to Antropoli et al, various pathologies of anal canal are extremely common [1,2]. About 30-40% of the population suffers from proctologic pathologies at least once in their lives.…”

Section: Introductionmentioning

confidence: 99%

Formulation and Evaluation of Diltiazem Hydrochloride Gels for the Treatment of Anal Fissures

Dhawan

2009

Sci. Pharm.

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The treatment for chronic anal fissure (CAF) has undergone a transformation in recent years from surgical to medical. Both the approaches share the common goal of reducing the spasm of anal sphincter. Though surgical treatment has a high success rate but it can permanently impair fecal continence in large number of patients. Smooth muscle relaxation seems to be a novel way by which more than 60% of the patients can be cured with the topical use of the agents. In the present investigation, diltiazem hydrochloride gels were prepared using FDA recommended polymers [hydroxypropylmethyl cellulose (HPMC), methylcellulose (MC) and polyethylene oxide (PEO grade 301 and 303)] for topical application in CAF. Increasing the concentration of the polymer significantly increased the consistency of the gels. All the formulations exhibited pseudoplastic flow with no thixotropy. The values of flow index (n) were found to be less than one for all the gels confirming the shear thinning behaviour of all the gels. HPMC and MC gels were found to be stable at accelerated stability conditions while the bioadhesion of PEO gels was highest. Even after exposure to heat and humidity, no significant change was observed in the content uniformity, pH, clarity, texture profile analysis and rheological properties of the HPMC and MC gels. The rheograms and various power law equation parameters of these gels were found comparable at various time points in the accelerated stability study. However, PEO gels failed in accelerated stability studies at one month sample. When four selected gel formulations (HPMCL4, MCL3, P1BL3 and P3BL3.5) were applied topically by six patients each, Gastrointestinal Quality of Life Index (GIQLI) score of each patient was improved at the end of 8 weeks. No adverse effects were reported by any of the patients. Hence 2% DTZ gel was found to be effective in the treatment of anal fissures. Keywords

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“…A fissura anal é uma lesão benigna, cujo principal sintoma é a dor anal que se exacerba durante o ato evacuatório, está associada à hipertonia do esfíncter interno do ânus e à redução do fluxo sanguíneo da mucosa (1,2,3) . O tratamento deve ser direcionado no intuito de reduzir a pressão do esfíncter interno do canal anal e embora os resultados da esfincterotomia cirúrgica se mostrem favoráveis, é importante o fato de que haverá uma lesão permanente do esfíncter podendo ocorrer incontinência fecal (1,2,3) .…”

Section: Introductionunclassified

“…O tratamento deve ser direcionado no intuito de reduzir a pressão do esfíncter interno do canal anal e embora os resultados da esfincterotomia cirúrgica se mostrem favoráveis, é importante o fato de que haverá uma lesão permanente do esfíncter podendo ocorrer incontinência fecal (1,2,3) . Na última década, com o intuito de diminuir os defeitos permanentes decorrentes da esfincterotomia cirúrgica , novas drogas têm sido introduzidas com a finalidade de promover relaxamento do esfíncter interno do ânus.…”

Section: Introductionunclassified

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Avaliação manométrica anal pré e pós tratamento da fissura anal crônica com nifedipina tópica 0,2%

Cesar

Jehá

Ferretti

et al. 2007

Rev bras. colo-proctol.

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RESUMO:No tratamento da fissura anal, novas drogas têm sido utilizadas, dentre elas os bloqueadores de canais de cálcio. O objetivo desta pesquisa foi à avaliação manométrica de pacientes com fissura anal crônica após tratamento com nifedipina tópica 0,2%, correlacionando com a cicatrização e a dor. Trata-se de estudo prospectivo realizado em pacientes atendidos no ambulatório de Coloproctologia do Hospital Universitário de Taubaté. Os pacientes foram submetidos ao exame manométrico antes e após 30 dias da utilização de nifedipina tópica gel 0,2% três vezes ao dia no ânus e margem anal. Para a análise estatística foi utilizado o teste de Mann-Whitney considerando significante, se p<0,05. Os dez pacientes não demonstraram nenhuma alteração manométrica provocada pelo tratamento com nifedipina, mas 50% deles relataram melhora dos sintomas e 40% dos pacientes apresentaram cicatrização da fissura, mostrando que a nifedipina foi efetiva no tratamento da fissura anal e segura do ponto de vista funcional, por não causar lesões esfincterianas. A avaliação manométrica demonstrou não haver alterações nas pressões anais demonstrando, entretanto, melhora da dor em 50% e cicatrização em 40% dos pacientes.Descritores: manometria, fissura, nifedipina, canal anal. INTRODUÇÃOA fissura anal é uma lesão benigna, cujo principal sintoma é a dor anal que se exacerba durante o ato evacuatório, está associada à hipertonia do esfíncter interno do ânus e à redução do fluxo sanguíneo da mucosa (1,2,3) . O tratamento deve ser direcionado no intuito de reduzir a pressão do esfíncter interno do canal anal e embora os resultados da esfincterotomia cirúrgica se mostrem favoráveis, é importante o fato de que haverá uma lesão permanente do esfíncter podendo ocorrer incontinência fecal (1,2,3) . Na última década, com o intuito de diminuir os defeitos permanentes decorrentes da esfincterotomia cirúrgica , novas drogas têm sido introduzidas com a finalidade de promover relaxamento do esfíncter interno do ânus. Dentre elas, destacam-se a toxina botulínica, os nitratos orgânicos e os bloqueadores de canais de cál-cio. São as chamadas "Esfincterotomias químicas" (1,2,3,4) . Essas drogas por diminuírem o tônus de repouso atuariam diminuindo os valores pressóricos de re-

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Nifedipine for local use in conservative treatment of anal fissures

Abstract: Our study clearly demonstrates that the therapeutic use of nifedipine, which at present is used only in cardiovascular pathologies, should be extended with local use to the conservative treatment of anal fissures.

Cited by 134 publications

References 27 publications

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

Formulation and Evaluation of Diltiazem Hydrochloride Gels for the Treatment of Anal Fissures

Avaliação manométrica anal pré e pós tratamento da fissura anal crônica com nifedipina tópica 0,2%

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