Kent and Medway
Joint Medicines Formulary

Anal fissures

Drug Safety update

 December 2014: Botulinum toxin products: rare but serious risks

Following conservative treatment failure:

  • Glyceryl trinitrate or Diltiazem can be used. Maximum 8 weeks treatment only. Needs medical review if problem persists beyond this time.
  • Botulinum A toxin can be used for chronic anal fissure as an unlicensed indication.
  • Botulinum A toxin can be used for a number of indications. Please refer to internal trust guidelines and information.

Glyceryl trinitrate

Go to the EMC website for more information and guidance.

Diltiazem

Unlicenced Drug Go to the EMC website for more information and guidance.

Botulinum A toxin

Go to NICE for more information and guidance. Go to the EMC website for more information and guidance.
  • On Formulary Preferred
  • On Formulary Second Line
  • On Formulary Third Line
  • Specialist Initiation
  • Secondary Care Only
  • Not Approved for Formulary