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Nifedipine is a calcium channel blocker that relaxes smooth muscle. Applied topically to the anal canal, it reduces internal anal sphincter tone and improves blood flow to enable fissure healing.
No FDA-approved topical nifedipine exists. Compounding allows the 0.2–0.3% concentration proven effective in clinical trials — often combined with lidocaine for dual analgesia and sphincter relaxation.
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Multiple RCTs demonstrate 60–80% healing rates for chronic anal fissures with topical nifedipine — comparable to glyceryl trinitrate but with fewer headache side effects. Also used for Raynaud's phenomenon.
Chronic anal fissure (primary indication), Raynaud's phenomenon, esophageal spasm (off-label)
0.2–0.3% ointment applied to anal canal 2–3x daily for 6–8 weeks
Headache, flushing, mild hypotension. Generally well tolerated at local doses.
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