Nifedipine Ointment

Nifedipine ointment is a medicated rectal ointment, commonly compounded at 0.2%, 0.3%, or 0.5% strength when prescribed. It is one smooth-muscle relaxant option used in anal fissure care plans. Patients and prescribers sometimes call it nifedipine cream or topical nifedipine — for this use these names refer to the same kind of compounded preparation; the ointment base is chosen for how and where it is applied.

Diltiazem 2% may be prescribed instead of nifedipine. These are alternative active ingredient approaches, not ingredients that are normally combined together unless the prescription specifically says so.

Taché Pharmacy prepares these prescriptions in St. Boniface, Winnipeg, and explains the label, application routine, storage, and refill timing after the prescription is written.

Anal fissures are often associated with internal anal sphincter spasm and reduced blood flow to the irritated area. Smooth-muscle relaxant ointments are prescribed to reduce sphincter tone and support the healing environment.

The prescriber chooses the active ingredient, strength, base, directions, and length of treatment. The pharmacy prepares the prescription and explains practical use.

Prescriptions may specify one of these active ingredient options:

• Nifedipine 0.2%, 0.3%, or 0.5%
• Diltiazem 2%

Optional add-ons may include lidocaine 1% or 2% for local numbing, or hydrocortisone 1% or 2% when a corticosteroid is part of the prescriber's plan. Vaseline is the default base unless the prescription requests a different base.

1. Wash hands before and after application
2. Apply the amount directed on the prescription label
3. Apply as directed to the affected rectal area
4. Many prescriptions are written for use 2–3 times daily and after each bowel movement
5. Continue for the treatment period written by the prescriber unless told otherwise

Ask the care team before changing the dose, stopping early, or combining with other rectal products.

Side effects are very uncommon and usually occur only at the start of therapy:

• Perianal itching or soreness
• Headache
• Light-headedness or flushing

Nifedipine and diltiazem are also used orally for blood pressure, but the amount absorbed from a rectal ointment is small. Mention any blood-pressure medications you take so the pharmacist can review the combination, and contact the care team if light-headedness persists.

There is no commercially manufactured nifedipine or diltiazem rectal ointment approved in Canada — that is exactly why it is compounded. When a prescriber writes for one, a compounding pharmacy prepares it from the raw ingredients at the strength and quantity on the prescription.

This also means the preparation is not interchangeable at a non-compounding pharmacy: if a pharmacy cannot prepare it, the prescription can be transferred to one that can.

Prescribers sometimes include a smooth-muscle relaxant ointment in hemorrhoid care plans, alone or alongside other measures. The same nifedipine or diltiazem options apply, and lidocaine or hydrocortisone add-ons are more common in this setting when the prescriber wants numbing or inflammation control in the same preparation.

For combined approaches, see also rectal rockets — a suppository format some prescribers use for hemorrhoid symptoms.

Store at room temperature away from direct heat unless your label says otherwise, and keep the tube tightly closed. Compounded ointments carry a beyond-use date on the label that is shorter than a manufactured product's expiry, because the preparation is made fresh per prescription. Discard after that date and ask about a refill if treatment is continuing.

Price depends on the active ingredient, strength, add-ons, and quantity, so there is no single price — the pharmacy can quote a specific prescription before it is filled. Many private drug plans cover compounded prescriptions when the formula meets the plan's rules, and eligible costs can count toward the Manitoba Pharmacare deductible. The pharmacy team can check a specific plan at the time of filling.

A printable anal fissure preparations template lists the common nifedipine and diltiazem options, strengths, add-ons, and directions fields. Nifedipine 0.2% in Vaseline is the most commonly stocked starting point and is often available same day.

For a variation not on the template — a different base, strength, or combination — call the compounding lab to discuss what can be prepared.