So I was prescribed Nitro back in May and I used it pretty consistently throughout this year which has led to a build up of tolerance, it doesn't seem to work like it used to. My doctor prescibed me Diltiazem this past week and after 2 days of use I can't really tell if it works or not. The Nitro worked GREAT and I am really upset that it doesn't anymore. Anyone have any experience with Diltiazem? Was it effective for you? All I know so far is it stings a bit when I apply it and there is definitely not an immediate result, I used to enjoy getting the Nitro headache because I knew it was working. Is it possible to stop using Nitro for a bit and then use it again once my tolerance has subsided or is that not possible? Should I just start using more Nitro? Lots of questions, my fissure is getting worse by the day it seems despite dilligent effort on my part, very discouraging....I'm heading to Miami in a few days and I am dreading the car ride and the possible pain while so far from home. Ok, sorry about the lengthy post, sweet blahg right?

Hi, if you stopped using nitro for a while and went back to it later it should work again. I don't know how often you used it, but if you only use it once or twice a day it should be alright. I also tried the diltiazem cream and it burned like the devil and it didn't seem to help. Nifedipine ointment is good though, works just as good as nitro without headaches. Even with the ointments you need to keep your stools very soft and keep the area clean. Drink lots of liquid and try to get yourself into a routine where you have a bm around the same time every day, that helps too. If your spasms get really bad try sitting on a warm heating pad. If it gets to hot put a towel on the heating pad first. It really helps. As a last resort try some ibuprofen and a valium. It sometimes help break the cycle of the spasms. Happy Holidays, Suzy

I agree with Suzy, I would give the nitro a try again. I've been using it for months and I can put gobs on and never get the nitro headache anymore, so I know I definitely have some kind of tolerance for it now. It does seem to lose some efficacy after extended use.
I switch to nifedipine every few weeks for a little bit, and then switch back to the nitro. I'm not sure if it's all in my head or not but this does seem to "restore" some of the nitro's effectiveness. Overall I've found nitro to be more effective than nifedipine, but I think this will differ from person to person.
Like Suzy I've also used Valium and painkillers (Percocet in my case) for fissure pain and spasms. They are very effective but unfortunately the Valium is very addictive and I haven't been able to get off it completely. But I won't lie, it was worth it for relief from the fissure pain, and I'm saving that battle for after I somehow get the current situation in check! I don't think it'd be a bad idea to see if your doctor will give you a little bit to keep handy, just don't take it every day like I did and you should be just fine.

I was wondering about this too. I am using nitroglycerin. Got headaches the first day and nothing since, even though I use slightly more than at first was suggested by my CRS (when my fissure was almost healed -- it tore again!) Except I am using Nitro 0.4% not 0.2% for some reason.

But I wondered about diltiazem and found a couple of studies (one was a double-blind trial, impressive!) that showed it was more effective, although the 2010 study found that it didnt actually cure chronic fissures better than the nitropglycerin:

Local treatment of a chronic anal fissure with diltiazem vs. nitroglycerin. A comparative study (2010) http://www.sciencedirect.com/science/ar ... 7710700521

Topical diltiazem vs. topical glyceril trinitrate in the treatment of chronic anal fissure: a prospective, randomized, double-blind trial. (2012) https://www.ncbi.nlm.nih.gov/pubmed/23402088

Here's a summary I found helpful. I am thinking about asking for diltiazem if I get another recurrence, or even now as the current one heals (seems to be doing well but you never know!) http://www.pharmacytimes.com/publicatio ... -real-pain