Low Dose Naltrexone, Nifedipine/Lidocaine Ointment, Diltiazem for Anal Fissures, Hemorrhoids, Crohn’s, Ulcerative Colitis, Proctitis, and More.
Painful and bothersome gastrointestinal and rectal issues can negatively affect a person’s quality of life. If you have problems such as hemorrhoids, anal fissures, rectal spasms, Crohn’s disease, Ulcerative Colitis, rectal itching, pain and so on, you may be searching for answers if your problem or some of your symptoms are not resolved quick enough or at all.
What if you have tried addressing hemorrhoids multiple times with over-the-counter medications and it just doesn’t work? What if you have hemorrhoids after being pregnant and it’s the worst? Learn more about hemorrhoids >>
Using a rectal rocket suppository may not sound comfortable, but neither are painful difficult hemorrhoids! We use a suppository mold that looks like a rocket; and we compound drugs into it that help with pain and inflammation.
The suppositories are compounded with suppository base that melts at body temperature. It contains drugs to reduce inflammation of the hemorrhoid. It is inserted at bedtime and melts slowly overnight.
The slow melt keeps the drugs directly in contact with the hemorrhoid for a long period of time. The problem is usually taken care of in one night but could sometimes take 3 nights depending on severity. Your doctor should have access to our prescription order form.
Hemorrhoid Removal (Hemorrhoidectomy)
Compounding pharmacies are necessary if the doctor wants to prescribe metronidazole 10% after surgery since the drug is only commercially available at a chain drug store at a much lower strength (1%).
What Causes Anal Fissure Pain?
- The initial pain of an anal fissure will cause the internal anal sphincter muscle to tighten and go into spasm.
- This spasming of the sphincter muscle aggravates the fissure causing extreme pain during and after a bowel movement.
- The tightening/spasming of the sphincter muscle also restricts blood flow to the affected area, which delays healing.
What medications are being used?
Topical calcium channel blockers (e.g., Nifedipine, Diltiazem) work by relaxing the sphincter muscle and increasing blood supply to the fissure. They are designed to be applied to the anal mucosa (soft lining of the anal canal) where it can be absorbed by the internal anal sphincter muscle. Nitroglycerin is not our favorite due to side effects.
The Hemorrhoid Centers of America in Georgia has a patient education sheet and the first paragraph states:
“Diltiazem ointment is a calcium channel class of medication we use to help heal anal fissures, promote wound healing, or addressing external thrombosed hemorrhoids. The ointment relaxes the smooth muscle around the rectum and promotes blood flow to help the growth of new skin over the tear in the lining of the rectum. The ointment reduces anal canal pressure, which diminishes pain and spasm. We use a 2% concentration mixed with Lidocaine and Aloe Vera. It is only available at compounding pharmacies.”
These medications can be compounded into a cream or ointment with something for the pain added to it.
We recommend DoseRite applicators for anal fissures.
The Effect of Topical Nifedipine in Addressing Chronic Anal Fissure
Studies showed that nifedipine also includes a local anti-inflammatory effect and modulates microcirculation. In various studies, nifedipine has a healing rate up to 95% and worked better than diltiazem that had a 67% rate of healing.
Nitroglycerin aka Glyceryl Trinitrate (NTG, GTN)
Nitroglycerin is also used and is commercially available as a 0.4% ointment, however, the cost may be prohibitive if not mostly covered by insurance, and a side effect often noted by patients is a headache.
Compounding pharmacists can prepare nitroglycerin ointment at lower strengths if necessary. Learn more >>
Proctalgia fugax is pain in the anal area that doesn’t have a specific cause and is usually caused by intense muscle spasms in or around the canal of the anus. The pain can come on suddenly and can be severe.
The duration of pain may be a few minutes and sometimes up to 30 minutes. It’s similar to levator ani syndrome (LAS), which is also anal pain that may last longer, and in severe cases, the pain can persist for many hours and can recur frequently.
Your doctor may call the pharmacy for commonly prescribed formulations.
Proctitis is inflammation in the lining of the rectum and is a very painful condition. It can cause discomfort, bleeding, and discharge of mucus.
Radiation Proctitis occurs when the rectum is damaged and inflamed from radiation therapy. The increase in numbers of prostate, rectal, and cervical cancer cases is causing an increase in patients with proctitis.
Studies say that “Close to 75% of people who have radiation therapy in the pelvis will develop acute proctitis symptoms, while 20% may experience chronic, long lasting symptoms.”
Compounding pharmacies can make various vehicles to deliver medication; one being a thick enema that can keep the drug in contact with the area longer than just a liquid enema that will rinse away quickly.
Adult Diaper Rash & Infant Diaper Rash
Finally, adult diaper rash may not seem like an issue for the general population. However, when people are elderly or bedridden, or when someone has a gastrointestinal condition that causes frequent diarrhea, the perineal tissue can become injured.
This skin irritation known as adult diaper rash is also a huge challenge for people with incontinence, where rubbing of the diaper can cause irritation as well as wetness from the diaper. The skin is very irritated and is painful when touched.
- Replace oils in the skin
- Promote skin’s barrier to moisture
- Active Ingredients
- Humectants such as glycerin (glycerol), methyl glucose esters, honey, hyaluronic acid, propylene glycol—attract water from the dermis and environment
- Emollients such as cetyl or stearyl alcohol contribute to smooth supple skin
- Occlusives such as petroleum jelly/p
- Moisture Barriers or Skin Protectants
- Ointment or paste formulation
- Pastes are the most hardy and desirable barriers followed by ointments(ointments are superior to creams and lotions)
- Selected FDA approved Active Ingredients
- Petrolatum 30–100%
- Zinc oxide 1–25%
- Dimethicone 1–30%
- Lanolin 12.5–50%
- Calamine 1–25%
- Allantoin 0.5–2%
Our pharmacy has custom formulations to share with your doctor as well!
Crohn’s Disease/Ulcerative Colitis
Drugs that reduce inflammation are commonly used for these conditions and may be prescribed both orally and also in a suppository or enema form. Compounding pharmacies are very helpful when it comes to formulating combination therapies or dosage forms that are not commercially available for specific drugs.
An option beyond traditional therapy for Crohn’s disease that prescribers often request is low dose naltrexone.