Diltiazem Gel

Diltiazem Gel
Usage
Diltiazem gel is a compounded topical formulation used primarily for conditions where local smooth muscle relaxation and vasodilation are beneficial.
It is commonly prescribed for:
• Anal fissures, to reduce internal anal sphincter spasm and promote healing
• Localised vascular conditions, where improved blood flow may support tissue repair
• Other practitioner-directed uses requiring topical calcium channel blockade
Topical diltiazem is often used as a non-surgical treatment option for chronic anal fissures.

Dosage
Dosage and frequency should be determined by the prescribing practitioner based on the condition being treated.
Typical dosing considerations include:
• Apply a small amount (e.g., pea-sized) to the affected area
• Commonly applied twice daily, or as directed
• For anal fissures, applied to the anal canal and surrounding area using a gloved finger or applicator
• Hands should be washed before and after application
Patients should follow the instructions provided by their healthcare provider and avoid exceeding the recommended frequency.

Mechanisms of Action
Diltiazem is a calcium channel blocker that relaxes smooth muscle.
Its mechanisms include:
Inhibition of calcium influx
Diltiazem blocks L-type calcium channels, reducing calcium entry into smooth muscle cells.
Smooth muscle relaxation
This leads to relaxation of the internal anal sphincter, reducing resting pressure.
Improved blood flow
Vasodilation increases local blood supply, which may promote healing of fissures and damaged tissue.
Reduction of pain
Decreased sphincter spasm can help relieve pain associated with anal fissures.

Contraindications
Diltiazem gel should not be used in patients with:
• Hypersensitivity to diltiazem or other calcium channel blockers
• Allergy to any component of the formulation

Precautions
Diltiazem gel should be used with caution in patients with:
• Hypotension or cardiovascular disease
• Bradycardia or conduction abnormalities
• Conditions where systemic absorption could be clinically significant
Additional precautions include:
• Avoid application to severely damaged or infected skin unless directed by a healthcare professional
• Excessive use may increase the risk of systemic absorption, potentially leading to side effects such as dizziness or low blood pressure
• Mild local side effects such as irritation, itching, or redness may occur
Patients should seek medical advice if they experience significant dizziness, fainting, or worsening symptoms.

Storage
• Store below 25°C unless otherwise directed
• Keep the container tightly closed when not in use
• Protect from excess heat, moisture, and direct light
• Do not freeze unless specifically instructed
• Keep out of reach of children and pets
Patients should follow the storage instructions provided on the dispensing label supplied by the pharmacy.