Hey All,
Hope you all had a festive and jolly Christmas and New Year!
Recently, I abandonded the use of Rectogesic due to side effects and called my CRS for a prescription of Nefedipine, as it was the only one I hadn't tried yet. I was told that it wasn't available in New Zealand, even as a compounded medicine, so they gave me a script for Diltiazem instead. I'd already tried Diltiazm once before, but it had burned so badly when I used it that I went back to using the Rectogesic. I needed to use something, and was a bit desperate, so I decided to give it another try. The burning wasn't as bad this time and passed very quickly. I've been using it every day, twice a day, for about four days now, but sadly, it really doesn't seem to be working very well.
As I've said, I been prescribed this stuff twice now, and honestly, I just can't believe that other people could find the consistancy alright for use on a fissure. It's gritty ... quite gritty! I had it prepared at a different pharmacy the first time and wasn't impressed with the grittiness (even worse the first time) so had it done somewhere else the second time.
I later spoke with the person who dispensed it over the phone and they said that "it would be gritty" because they get Diltiazem in tablet form and when they compound it, they have to first, grind the tablets up with a mortar and pestle. I explained to them, that this stuff was useless to me in this state, as I was applying it to an open wound. They were uninterested.
This time, I spoke directly to the pharmacist beforehand and gave her a full run down on the situation. She said that they prepared it in the same way, and that it was the way it would be done at any pharmacy, but she was very nice and said she would do her best to make it smooth.
Well ... It isn't smooth! It's a hell of a lot better than last time, but not smooth.
To apply, it's a bit as you would imagine sand mixed with parafin would be if you rubbed it all round and inside your bottom ... wait, no ... EXACTLY as you would imagine that being!
I know the packaged version won't be like this, but has anybody else using the compounded medicine run into this problem? Hope you guys can help!
Rant Over! Sorry! ... bit frustrated!

Hey there, I had 3 RX's of diltiazem compounded when I had my fissure and none of them were gritty. They were all smooth like vaseline.
I can see why that would be frustrating trying to apply that on a fissure!

ditto

Thanks guys,
Well I just don't understand that! I just called the pharmacy at a hospital and asked them. The woman I spoke to was very helpful and told me that they would open a Diltiazem capsule and use the granules rather than a tablet to make a paste with parafin. Apparently, this would be ground with a motar and pestle and so would have a little "sand-like" grit in it, but that I shouldn't notice it because the cream contains just 2% of the active ingredient. She added that in any case, once those small pieces become "moist and warm" (forgive the imagery), they will readily disolve. She didn't seem to understand why this had happend twice either. If I'm to try it again, I guess I need a new prescription. REALLLLLY don't want to go back to the Rectogesic! Hmmmmm

I used compounded diltiazem ointment before too and it wasn't gritty at all. The consistency should be totally smooth. I wouldn't be totally shocked if you could look really hard and see a granule or two, but that shouldn't be common, and you definitely shouldn't be able to feel it.
Some of it might have to do with the fact that they used diltiazem tablets with a mortar and pestle. Ideally you'd start with diltiazem powder and run it through an ointment mill. That's how you get a nice compound with even distribution and therefore absorption (not to mention it'd obviously be more comfortable to apply).
Is the place you had the prescription filled a pharmacy that specializes in compounding? Not sure about down under, but here in the States, some "regular" pharmacies will use a mortar and pestle to crush up pills to make compounds. But pharmacies that specialize in compounding will generally do their best to start with power and use an ointment mill. If you have other places you can check with, it might be worth the effort to see what approach they use first before filling your prescription.

So sorry to hear that : ((( - as if it is not enough to have painful and irritated anus to begin with - they are crazy !!!! Creams should be smooth without any grittiness at all !!!!
I used all 3 of them and made in different (but allll compounding) pharmacies and every time creams were nice and smooth
Bottom line - you are right and they are wrong !!!!

Ok, I feel a bit silly now ... for letting all these people tell me that this is "to be expected". As far as I can tell, pretty much all of the pharmacies in NZ are "regular". It seems that none of them have made it beyond motar and pestle technology. However, after an online search, I've found a local company who specialise in compounding. Their web site is very thorough, and there's a picture of a man in a white coat, with a self-assured smile and a clipboard. I feel very confident.
Of all the people/professionals I've spoken with, not one of them suggested I take my prescription to a compounding pharmacy. I'm not sure any of them know such a thing exists! So thanks guys. Hopefully the Diltiazem will be helpful. :D
Another thing ... The hospital pharmacist I spoke with suggested I try an experiment with the paste. I guess that she was concerned that the active ingredient wouldn't even disolve in that state. She told me to try mixing some of the grit with a tiny bit of water. Of course, that was never going to work, as the parafin is not water soluble. So I tried heating the mixture instead. The gritty particles DID NOT disolve, not even with persistant heating! So not only did they have me slathering an open wound with an abrasive, but with an abrasive that couldn't possibly work!
I've now feel ridiculous! ... I need to go and apologise to my bottom ...... How can I make it up to you my friend? .........

lol sphinctersaurus ok I know this isn't exactly funny, but your description is pretty hilarious
If you want to be doubly sure, you could try asking the place you found if they specifically use an ointment mill (basically a motorized version of a mortar and pestle but a lot more effective) and whether they start with diltiazem tablets or powder. If they use powder and an ointment mill, that would guarantee good results as far as consistency and distribution of active ingredients.

i was giving a rx the day before i was leaving to japan and it was like 4 pm and no pharmacy could make it - as it was compounded - i was like what is that?
i must have called like 10 pharmacies using search on the iphone (i was parked in my car outside a CVS pharmacy who didn't have either the lido or dilti) and finally i found a pharmacy that was closing in 30 minutes that was about 30 minutes away but with rush hour traffic was more like 50 minutes away.
driving conservatively but with a little urgency on the gas pedal and shifting gears smoothly through all sorts of unexpected delays and detours and then not being able to find a parking spot to the pharmacy (it is located downtown where parking is virtually non-existent!)....
the pharmacist, who i will always think of, said i took a chance on you and made the compound thinking you would be here....and i was like you saved my sanity and well, he was like this is going to cure you....
i don't know what he did but the diltiazem was the best thing since hot french baguette with loads of butter.
*
anyway, the compound on my label said made with petroleum. not sure if that is the same as parafin, but it definitely is a smooth consistency and not gritty at all.
by the time i apply it going in my anus, it is like soft, melting butter.

Mmmmmm buuuuttter ... baguette ...
I picked up my Diltiazem from the newly discovered compounding pharmacy a couple of days ago. I actually saw the mythical "man in a white coat, with the self-assured smile and a clipboard"!!!
IN PERSON! It was very exciting ... Until I took a closer look and my delight was crushed by the terrible difference between myth and reality. He was ten years older than his picture, shabby, every hair out of place, four foot tall, not wearing his confidence inspiring white coat ... dirty ripped jeans intead!, no friggin clipboard!! ... and a disagreeable scowl where his self assssured smile should have been!!!
Pffffft! It was just like the day Mum told me Santa wasn't real and DAD had been eating the beer and cookies! The beer should have been a give away I guess.
Anyway ... The pharmacist came out and had a chat to me when the ointment was ready and explained that she had not used Parafin as the script specified, or crushed Diltiazem granules because the ointment is "easier to use if it is in a petroleum base" and "using crushed Diltiazem granules will result in a gritty mixture, Diltiazem powder yelds a much better result". You don’t say!
So there you have it, common sense at last! Perfectly smooth and easy to apply ointment. I've used it a few times now, but the fissure and skin tag have been a bit angry lately, so it's a little hard to tell how good it's going to be. Fingers crossed though!
I think it's a concern that my CRS didn't know about this!