Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up

Katsinelos, Panagiotis; Papaziogas, B.; Koutelidakis, Ioannis; Paroutoglou, George; Dimiropoulos, S.; Souparis, A.; Atmatzidis, Konstantinos

doi:10.1007/s00384-005-0766-x

Cited by 47 publications

(19 citation statements)

References 30 publications

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“…Current treatment for anal fissures is dietary management, oral, injectable, topical medicines, dilation therapy and surgery. [7][8][9] Emulgel are emulsions, either oil-in-water or waterin-oil, which are gelled by mixing with a gelling agent. Emulgel is a most promising vehicle for the delivery of hydrophobic drugs.…”

Section: Introductionmentioning

confidence: 99%

Formulation, Development and Evaluation of Nifedipine Emulgel for Treatment of Anal Fissures Using Polymeric Emulsifiers

Shelke¹,

Kulkarni²

2019

IJPER

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Aim/Background: Nifedipine (NIF) is act as Calcium channel blocker which belongs to chemical class dihydropyridine and used in the treatment of hypertension. An anal fissure (AF) is the most common anorectal conditions encountered in clinical practice. Patient anal fissures experience anal pain with defecation and minor bleeding. Emulgel formulations are considered a combination of emulsion and gels and emulgel has advantages of both. Emulgels have better penetration of actives than conventional topical formulations. Materials and Methods: Emulgel formulations are prepared with the lowest concentration of emulsifiers 1.5-4.0%. Carbomer homopolymer type C used as a polymeric emulsifier while formulating the formulation. The concentrations of Polymeric emulsifiers, high HLB surfactant and low HLB surfactants are varied to two level concentrations two optimize the formulations. Sorbitan monooleate and Polysorbate 20 used as surfactants. Results: Emulgel formulations are evaluated for homogeneity, consistency, grittiness, compatibility, pH, Viscosity, drug content, spreadability, extrudability and in-vitro drug release from the formulations. The optimized formulation has been charged for stability study at room temperature and accelerated storage condition. Stability results are similar to the initial results. In-vitro drug release profile of the initial time point versus 3M stability time point at accelerated and room temperature storage condition is similar. Conclusion: Carbomer homopolymer type C can be employeed as polymeric emulsifiers to stabilize unstable to stable emulsion.

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Section: Introductionmentioning

confidence: 99%

Formulation, Development and Evaluation of Nifedipine Emulgel for Treatment of Anal Fissures Using Polymeric Emulsifiers

Shelke¹,

Kulkarni²

2019

IJPER

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“…Topical nifedipine is used for various purposes, such as treatment of periocular and face wrinkles (Innocenti et al, 2010;Calabro et al, 2014), closure of anal fissures (Golfam et al, 2010;Katsinelos et al, 2006), and particularly to promote healing of skin wounds (Smith 2010;Melo et al, 2008;Ebadi et al, 2003). Nifedipine (NFD) is a calcium channel blocker and its use was first recommended for treatment of cardiovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

Promotion of cutaneous penetration of nifedipine for nanoemulsion

Arantes

Santos

Freitas

et al. 2017

Braz. J. Pharm. Sci.

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This article reports the development and characterization of a nanoemulsion (NE) able to improve the cutaneous penetration of nifedipine. NE with nifedipine was development and characterized, presenting droplet size of 20 nm with low polydispersity index (IP<0.1), spherical shape without aggregation, pH compatible with typical skin levels and stability evaluated by seven months. In the permeation studies, a classical formulation based in an oil/water cream containing nifedipine was used for comparison with NE. Nanoemulsion promoted and improved the retention of nifedipine in the epidermis and dermis in relation to classical formulation. This promoting effect is related to the nanometric size of the droplets of the NE (20 nm), which give him a large superficial area, favoring the contact of the nanocarrier with the skin surface. The NE was efficient in promoting accumulation of nifedipine in the dermis, which is the site of vasodilation action. NE was not irritating according to the primary dermal irritation tests. NE is a promising release system to promote cutaneous penetration of nifedipine and can be used in the future in clinical trials to promote healing of lesions caused by peripheral vascular diseases.

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“…Chronic anal fi ssure (CAF), a linear ulcer situated in the distal anal canal, is a common anorectal condition, especially in young adults, with a roughly equal incidence in genders (1,2). It is characterized by pain and bleeding at defecation and anal spasm (3,4).…”

mentioning

confidence: 99%

“…It is characterized by pain and bleeding at defecation and anal spasm (3,4). Acute anal fi ssures heal spontaneously or by conservative treatment in 80 to 90 % of the cases (1,4,5). The cause is not known, but patients usually have a very high maximum resting anal pressure (MRAP) (3,6,7).…”

mentioning

confidence: 99%

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Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy

Yücel¹,

Akın²,

Sücüllü³

et al. 2012

BLL

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Objectives: The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fi ssures using the endoanal ultrasonography. Background: Lateral internal sphincterotomy is an effective method in treatment of chronic anal fi ssures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the effi ciency of the treatment. Methods: Totally, 40 patients with unhealed anal fi ssures after the lateral internal sphincterotomy were enrolled consecutively. The fi ssures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography. Results: There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superfi cial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be suffi cient, a localized abscess formation of less than 1 cm was detected at the anal crypts level. Conclusion: The use of endoanal ultrasonography in patients with unhealed or recurrent anal fi ssure is a benefi cial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).

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Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up

Abstract: Topical application of 0.5% nifedipine ointment represents a new, promising, easily handled, effective alternative to lateral internal sphincterotomy.

Cited by 47 publications

References 30 publications

Formulation, Development and Evaluation of Nifedipine Emulgel for Treatment of Anal Fissures Using Polymeric Emulsifiers

Formulation, Development and Evaluation of Nifedipine Emulgel for Treatment of Anal Fissures Using Polymeric Emulsifiers

Promotion of cutaneous penetration of nifedipine for nanoemulsion

Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy

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