The Surrey & North West Sussex Area Prescribing Committee recommends Diltiazem 2% ointment as a 2nd line treatment option in the following circumstances:

• If a patient has had an adverse event or intolerance to 1st line glyceryl trinitrate (GTN) 0.4% ointment (Diltiazem 2% ointment will be considered GREEN on the traffic light system in this situation)

OR

• If an anal fissure has not managed to heal after 6 weeks of treatment with GTN 0.4% ointment (1st line), then the patient should then be referred to a specialist for investigation of the underlying cause of non-healing.

Patients initially prescribed GTN 0.4% ointment may be switched to diltiazem ointment by the primary care prescriber whilst waiting to be assessed by the specialist. Diltiazem 2% ointment will be considered GREEN on the traffic light system in this situation.

Note - Diltiazem 2% cream is not the preferred formulation but will remain a treatment option in case of supply problems with the 2% ointment.

See policy statement below for further information and links to associated guidance