Anal Fissure Drug Summary

Last updated: 09 March 2026
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Anaesthetics - Local & General

Drug Available
Strength		 Dosage Remarks
Lidocaine
(Lignocaine)		 5% ointment, cream Apply to affected area up to 6x daily as needed
Max dose: 20 g/day 		Adverse Reactions
  • Local reaction, skin irritation, rarely allergic reaction
Special Instructions
  • Use with caution in debilitated patients, excessive and prolonged use
50 mg suppository Insert 1 suppository rectally as single dose
Max dose:
200 mg/day

Anorectal Preparations (Oral)

Drug Dosage Remarks
Lysozyme Cl/Phytomenadione/Pluronic F-68/Rutoside/Vit E
succinate 		1-2 cap PO 8 hourly Special Instructions
  • Prior to use, report any allergies to medicines, diarrhea, pregnancy or intention to become pregnant, or current medical treatment
  • Discontinue use and consult physician if skin rash, redness, loss of appetite, nausea/vomiting, or diarrhea develops

Anorectal Preparations (Topical)

Drug Available
Strength		 Dosage Remarks
Glyceryl trinitrate
(Nitroglycerin)		 0.2% ointment Apply 1-1.5 cm strip into the anal canal 8 hourly x 2-4 weeks Adverse Reactions
  • CNS effects (headache, dizziness); CV effects (hypotension, tachycardia); Other effects (nausea/vomiting, pruritus, anal burning and itching)
Special Instructions
  • Avoid in patients with hypotension, increased ICP, migraine or recurrent headache, hypertrophic obstructive cardiomyopathy, constrictive pericarditis, aortic or mitral stenosis
  • Discontinue treatment if anal bleeding increases
  • Monitor patients with acute MI or CHF to avoid hypotension and tachycardia
0.4% ointment Apply 2.5 cm strip into the anal canal 12 hourly for up to 8 weeks
Combination Products
Benzocaine/Zn oxide1 Benzocaine 1%/Zn oxide 2% suppository Insert 1 suppository up to 3x daily Adverse Reactions
  • Contact dermatitis
Cinchocaine/Hydrocortisone/Framycetin sulfate/Aesculin Cinchocaine 0.5%/Hydrocortisone 0.5%/Framycetin sulfate 1%/Aesculin 1% rectal ointment Apply ointment on affected area morning and evening, and after each stool Adverse Reactions
  • Dermatologic effects (itching, pain, rash); Other effect (blurred vision)
Special Instructions
  • Avoid in patients with untreated viral, bacterial, tuberculous, parasitic or fungal infections; long-term continuous therapy
  • Risk of growth retardation, visual disturbances
  • Exclude any potential malignancy prior to therapy
Cinchocaine 5 mg/Hydrocortisone 5 mg/Framycetin sulfate 10 mg/Aesculin 10 mg suppository Insert 1 suppostiory morning and evening, and after each stool
Fluocortolone pivalate/Lidocaine Fluocortolone pivalate 1 mg/Lidocaine 20 mg rectal cream Apply cream up to 3x daily for first few days, then twice daily
Max duration of treatment:
Not >4 weeks		 Adverse Reactions
  • Burning sensation
Special Instructions
  • Avoid in patients with TB or syphilitic processes in the area to be treated, viral diseases (eg vaccinia, chickenpox)
  • Avoid contact with eyes
  • Antimycotic therapy may be required in the event of fungal involvement
Fluocortolone pivalate 1 mg/Lidocaine 40 mg suppository Insert 1 suppository 12 hourly
Severe: Insert 3 suppositories for first 3 days, then decrease to 1 suppository daily or every other day
Max duration of treatment:
Not >4 weeks
Hydrocortisone acetate/Benzocaine/Benzalkonium Cl/Bismuth subgallate Hydrocortisone acetate 5 mg/Benzocaine 25 mg/Benzalkonium Cl 100 mg/Bismuth subgallate 20 mg rectal cream Apply cream to the anal area 12-24 hourly Adverse Reactions
  • Dermatologic effects (acne, irritation, dryness, folliculitis, hypopigmentation, secondary infection or allergic contact dermatitis); Other effects (edema, decreased glucose tolerance, psychic disorders, increased gastric acid secretion, osteoporosis, increased BP in hypertensive patients, mucosal atrophy)
Special Instructions
  • Avoid in patients with rectal and anal TB, infectious diseases, mycosis, PUD, osteoporosis, psychosis, severe psychoneurosis, diabetes, CHF, chronic renal failure, liver failure; concurrent administration of live virus vaccines
  • Avoid prolonged use of >7 days
Hydrocortisone acetate/Lidocaine1 Hydrocortisone acetate 0.25%/Lidocaine 5% rectal ointment
Hydrocortisone acetate 2.5 mg/Lidocaine 50 mg rectal ointment		 Apply ointment thinly onto affected area 2-4x daily
Max dose: 6 g/day 		Adverse Reactions
  • Dermatologic effects (local skin atrophy [in prolonged use >4 weeks], allergic reactions [very rare], urticaria, edema, anaphylactoid reactions)
Special Instructions
  • Avoid in patients with skin TB, viral and fungal infection on the affected area
  • Avoid prolonged use of >4 weeks
  • Discontinue if rectal irritation or bleeding occurs
Policresulen/Cinchocaine Policresulen 50 mg/Cinchocaine 10 mg rectal ointment Apply ointment 2-3x daily Adverse Reactions
  • Mild local discomfort (eg burning or itching)
Special Instructions
  • Avoid in patients with hypersensitivity to soya or peanut
Policresulen 100 mg/Cinchocaine 2.5 mg suppository Insert 1 suppository 2-3x daily
Sucralfate/Calendula extract/Matricaria extract/Hamamelis extract 25 g rectal ointment Apply ointment on anal periphery or use applicator into rectum possibly after defecation or sitz bath 12-24 hourly Adverse Reactions
  • Hypersensitivity reactions (burning sensation itching, pain or erythema)
Special Instructions
  • Avoid in patients with bleeding hemorrhoids
  • Recommend to use pantyliners as it may soil underclothing
2.5 g suppository Insert 1 suppository possibly after sitz bath 12-24 hourly
Trimebutine/Ruscogenins Trimebutine 5.8 g/Ruscogenins 0.5 g rectal cream Apply cream 1-2x daily Adverse Reactions
  • Dermatologic effect (rash); CNS effects (presyncope, syncope)
Special Instructions
  • Perform proctological exam and review treatment if symptoms are not relieved rapidly
Trimebutine 120 mg/Ruscogenins 10 mg suppository Insert 1-2 suppository daily
1Various combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

Calcium Antagonists (Topical)

Drug Available
Strength		 Dosage Remarks
Diltiazem 2% cream, gel, ointment Apply intra-anally
12 hourly x 6-12 weeks		 Adverse Reactions
  • Headache, flushing; less commonly symptomatic hypotension
Special Instructions
  • Avoid in patients with acute MI, pulmonary edema, severe hypotension or cardiogenic shock, wide QRS complex ventricular tachycardia
  • Use with caution in patients with hepatic or renal failure
Nifedipine 0.2-0.5% gel or ointment
with or without Lidocaine		 Apply with fingertip
to the anus and anal
canal 12 hourly x
21-42 days		 Adverse Reactions
  • Headache, flushing; less commonly symptomatic hypotension
Special Instructions
  • Use with caution in patients with hypotension, heart failure or poor cardiac reserve

Laxative

Drug Dosage Remarks
Ispaghula husk 7-11 g/day PO divided in 1-3 doses Adverse Reactions
  • GI effects (flatulence, abdominal distention, intestinal or esophageal obstruction, fecal impaction); Other effects (exanthem, pruritus, rhinitis, conjunctivitis, bronchospasm)
Special Instructions
  • Should be taken after meals and with sufficient fluid
    • Mix 1 sachet or 2 tsp of powder with 150 mL cool water, milk, fruit juice or other drinking liquid
  • Avoid in patients with sudden change in bowel habits persisting for >2 weeks, undiagnosed rectal bleeding, failure to defecate after laxative use, fecal impaction, abnormal constrictions in the GI tract, ileus, DM which is difficult to regulate
  • Use with caution in elderly or debilitated patients

Peripherally Acting Muscle Relaxant

Drug Dosage Remarks
Botulinum toxin A Exact dose, number of injection
and precise site of administration have yet to be determined 		Adverse Reactions
  • Injection site reactions (bruising, transient burning sensation, pain, stinging, edema); Hypersensitivity effects (skin rashes, flu-like symptoms)
Special Instructions
  • Contraindicated in patients with myasthenia gravis or Eaton-Lambert syndrome, should not be used in patients with amyotrophic lateral sclerosis or other disorders that produce a depletion of acetylcholine at the neuromuscular junction
  • Adrenaline and other precautions should be available in case of anaphylaxis

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.