Hi all,
I've been using 0.2% nitroglycerin ointment for my fissure for the past 4 weeks, and just got a prescription for 0.2% nifedipine ointment today. Has anyone used both of these together? I'm wondering if there are any adverse effects. I will be picking up the nifedipine from the pharmacy shortly so I will ask the pharmacist, of course, but thought I'd see if anyone had personal experiences.
Other medications I take right now are Valium (about 30 mg daily) for muscle spasms and Miralax (17 g daily) for stool softening. On occasion I take Percocet (oxycodone) for pain but that is infrequent.
If this regimen doesn't work then I'm on to either botox or LIS, most likely LIS. Thank you for any feedback.

Just thought I'd post a quick update on this. So I did a little experiment and tried both the 0.2% nitroglycerin and 0.2% nifedipine at the same time. It didn't seem to do much, I got a headache and a little lightheaded like I always do with nitro, but other than that didn't seem to notice any ill effects. I have a blood pressure monitor at home and my readings were still around what they normally are even when I'm not taking any drugs. I did some reading later and saw that the combination can potentially cause sudden severe hypotension, though, so I guess I won't try that little test again.
From what I can tell so far, the nitro seems to provide more symptomatic relief (albeit very short term) than the nifedipine. Not sure which one -- if either -- is doing anything for the fissure though.

Well, do be careful, NG! You are treading unknown waters there!
I would say the nitro immobilizes your sphincter, whereas the N just loosens up the anal canal, so what you say makes perfect sense and using them in concert may be the way to go, but that is uncharted territory!
But I am really not sure what the nitro does, exactly, so take what I say with a large grain of salt!

Yep, Kim, agreed. I asked my doctor what she thought would happen if I used them simultaneously, and she said I'd probably get dizzy/faint and it wasn't necessary. This doctor tells me nifedipine works better for fissures. The last two I saw told me nitro works better. So I'm not sure, and was just thinking that I'd throw everything I can at it since the time is drawing near when I'll have to make a decision on botox or LIS one way or the other.
I can say that nitro gives more pain relief immediately after a bad BM, and the side effects are barely noticeable anymore after the last few weeks of using it. But who knows what's really going on "in there" as far as actual healing (or lack thereof).
I think I'll stick to either just nifedipine OR nitro from now on, or maybe alternate every few days or so. The Valium and Percocet already reduce blood pressure so I guess I don't need more blood pressure and vasodilator meds in the mix. Good thing I have high blood pressure (borderline hypertension for my age) to begin with haha :-)

Btw hope you had a good time in Atlanta Kim!

They use nifedipine at Mayos.

cherylk wrote:They use nifedipine at Mayos.

Nice, thank you -- I think nifedipine is what I'm going to stick with mostly. The literature I've found online mostly indicates that it's more effective than nitro, and I've already been on nitro for 3 weeks with little improvement so I haven't got much to lose with nifedipine.
Every once in a while, if the post BM pain is bad, I might use a dab of nitro or the nitro/lidocaine/hydrocortisone compound for quick relief, but other than that I think I'll cast my lot with nifedipine for these few weeks.

Chen, could you copy and paste your post above to the sticky thread below...I am sure it will be of great help to future and current boardies!! I could do it, but I want you getting the credit!
http://anal-fissure.org/general-anal-fissure-discussion-f2/i-have-an-af-what-should-i-know-t1849.htm?sid=7a9b58ce8cee4e3bb1b5120605a47d2a#43587

Kim wrote:Chen, could you copy and paste your post above to the sticky thread below...I am sure it will be of great help to future and current boardies!! I could do it, but I want you getting the credit!
http://anal-fissure.org/general-anal-fissure-discussion-f2/i-have-an-af-what-should-i-know-t1849.htm?sid=7a9b58ce8cee4e3bb1b5120605a47d2a#43587

Kim, definitely, but pardon my ignorance: which post do you mean? Just want to make sure I get the right one :)

The first thread on this board (General Anal Fissure Discussion) entitled Sticky:I have an AF -- what should I know?
Thanks!