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Active Ingredients
Important Disclaimer
These statements have not been evaluated by the Food and Drug Administration (FDA). Compounded products are not FDA-approved and are not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. The information provided is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting any new treatment.
Clinical Information
Evidence-based details for healthcare providers
Use as directed by your healthcare provider. Apply a small amount to the affected area 3 to 4 times a day, using the supplied finger cot or a clean glove. Wash hands before and after use. If you miss a dose, apply it when you remember unless it is almost time for your next dose. Do not double up.
Diltiazem is a calcium channel blocker. When placed on the skin around the anus, it relaxes the ring muscle (anal sphincter) and widens tiny blood vessels. This lowers pressure, improves blood flow, and lets tears or swollen veins heal faster. Lidocaine is a local anesthetic. It blocks pain signals in the nerves of the skin, giving numbness within 5–10 minutes that lasts about 1–2 hours. Together, the ointment reduces pain quickly and supports healing over days to weeks.
Do not use if you are allergic to diltiazem, lidocaine, other amide-type anesthetics, or any ingredients in this ointment (can cause severe rash or swelling). Do not use if you have a complete heart block, very low heart rate, or very low blood pressure unless your doctor tells you it is safe (small amounts can absorb into the body). Avoid if you have severe liver disease without medical supervision. Do not apply to open, actively bleeding, or infected wounds. Not for use inside the mouth, eyes, or vagina. Ask your doctor before use if you are pregnant, planning pregnancy, breastfeeding, or under 18 years old.
Because only a tiny amount enters the bloodstream, interactions are uncommon, but caution is still advised. Tell your healthcare provider if you take beta blockers (such as metoprolol), other calcium channel blockers (like verapamil), blood pressure medicines, digoxin, or anti-arrhythmia drugs, as added effects on heart rate or blood pressure could occur. Large amounts of lidocaine can interact with certain heart medicines (e.g., amiodarone) or antiseizure drugs. Avoid applying other topical numbing products or using hemorrhoid creams with phenylephrine at the same time unless advised. Limit alcohol—it can widen blood vessels and may increase dizziness.
Very common (more than 1 in 10): mild burning or stinging for a few minutes after application—usually fades quickly. Common (1–10 in 100): itching, redness, or swelling at the site; headache; light-headedness when standing. Uncommon (1–10 in 1,000): dizziness, low blood pressure, slow pulse, mild nausea. Rare but serious: severe allergic reaction with rash, hives, or swelling of face; irregular heartbeat; bluish skin or lips (sign of methemoglobinemia). Most local side effects improve within 15–30 minutes; systemic effects resolve after stopping the ointment. Seek medical help right away if you notice trouble breathing, chest pain, or severe dizziness.
Store at room temperature (68-77°F, 20-25°C). Keep the tube tightly closed and protect from moisture, heat, and direct sunlight. Do not freeze. Do not store in the bathroom. Keep out of reach of children and pets. Discard any unused ointment 90 days after first opening or by the expiration date, whichever comes first. Use a pharmacy take-back program for disposal when possible or mix leftover ointment with coffee grounds in a sealed plastic bag before throwing it in household trash.
Frequently Asked Questions
How long will it take before I feel relief?
Most people feel numbing from lidocaine within 5–10 minutes. Pain relief from muscle relaxation may take a few days of regular use. Full healing of a fissure can take several weeks.
Can I use the ointment right before a bowel movement?
It is best to apply after cleaning the area, usually after a bowel movement. If you need pain relief before going, you can apply a small amount, but you may need to reapply afterward for continued benefit.
Is it safe to use during pregnancy or while breastfeeding?
Small amounts of the medicine are absorbed, but safety in pregnancy and breastfeeding has not been firmly established. Use only if your obstetric provider believes the benefit outweighs any risk.
What should I do if the ointment burns or irritates my skin?
A brief mild sting is normal. If burning lasts more than 10–15 minutes, wash the area with mild soap and water, stop using the ointment, and call your healthcare provider.
Can I use other hemorrhoid creams or wipes at the same time?
Check with your healthcare provider first. Using many products together can increase irritation or change how well the medicine works. If allowed, space applications at least 30 minutes apart.
How should I apply the ointment hygienically?
Wash your hands, put on the provided finger cot or a disposable glove, apply a pea-sized amount to the fingertip, and gently spread a thin layer around the anus. Discard the finger cot and wash hands again.
Related Products
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Gabapentin, amitriptyline, and lidocaine transdermal cream is a compounded topical medication used for certain types of nerve-related pain on the skin. It is applied to a specific painful area to help reduce burning, tingling, and sensitivity. Because this is a compounded medication, it is made for an individual patient based on a prescriber’s order and is not FDA-approved as a combined product.
Diltiazem Ointment
Diltiazem topical ointment is a compounded prescription medicine used to help relieve pain and promote healing of anal fissures (small tears near the anus). It may also help reduce anal muscle spasm that can worsen pain during and after bowel movements. This product is made by a compounding pharmacy based on a prescriber’s instructions and is not FDA-approved as a finished, commercially manufactured drug product.
Ketamine Rapid Dissolve Tablets
Compounded rapid-dissolve tablets that contain ketamine hydrochloride. The tablets melt under the tongue for quick absorption. Your healthcare provider may prescribe them to manage certain conditions when other treatments have not worked. Use only under close medical supervision because ketamine is a controlled substance with important safety rules.
Hydrocortisone | Lidocaine | Nifedipine Rectal Rocket
This compounded suppository (often called a "rectal rocket") combines hydrocortisone 3%, lidocaine 2%, and nifedipine 0.3% to help ease pain, swelling, and itching caused by hemorrhoids or anal fissures. The special shape lets part of the suppository stay outside the anus while the rest sits inside, giving medicine to both internal and external areas at the same time. Your healthcare provider may choose this product when creams or over-the-counter treatments are not enough.