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Orally administered diltiazem may be titrated upward as tolerated and needed approximately every one to two days (tablets) or every one to two weeks (long-acting forms).

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The treatment of chronic anal fissure has shifted in the recent years from surgical to medical modalities because of disability and the risk of incontinence associated with surgery.

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Jawaid M, Masood Z, Salim M: Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure.

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The authors noticed a problem that is presumably unknown to gastroenterologists and surgeons: that compounded formulations of topical 2% diltiazem, recommended by the American Society of Colon and Rectal Surgeons for anal fissure therapy but not approved by the United States Food and Drug Administration, may be subpotent or suprapotent.

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