At a glance
Anoheal is a brand name for diltiazem 2% ointment. It is one of the treatments UK clinicians use for anal fissures, usually when GTN ointment has caused headaches or not helped.
Key points people ask about:
- It is diltiazem. Anoheal and “diltiazem 2% cream” or “ointment” contain the same active medicine. The brand describes one manufacturer’s version.
- It is prescription only. It cannot be bought over the counter.
- It is often available on the NHS. But people describe GPs who have not heard of it, pharmacies that need to order it in, and some back-and-forth.
- Reactions are common. Itching and rash are the side effects most people mention.
This page covers the UK-specific practicalities. For how diltiazem works and the usual treatment course, see our diltiazem cream guide.
Where it fits in UK treatment
In the UK, the usual order people describe is:
- Stool softening, fibre, fluids and pain relief
- GTN ointment, often the licensed product Rectogesic. See our Rectogesic guide.
- Diltiazem, as Anoheal or another version, if GTN causes headaches or does not help
- Referral to discuss Botox or surgery if creams have not worked
Some colorectal teams start with diltiazem rather than GTN. This varies by area and by clinician.
Topical diltiazem is, at the time of writing, generally prescribed in the UK as an unlicensed medicine. That is normal for this use. It means the product has not been assessed by the medicines regulator for fissures, not that it is known to be unsafe. It does mean your prescriber takes on more responsibility for it, which is one reason some GPs are cautious.
Getting it: NHS or private
Through a hospital team. Many people are first prescribed Anoheal after seeing a colorectal surgeon. The hospital then writes to the GP asking them to continue it.
Through a GP directly. Some GPs prescribe it themselves. Others prefer a different diltiazem product on their local formulary. People describe being told “the NHS doesn’t do it”, then finding a different GP or a second call gets it prescribed.
Privately. Some people see a private colorectal surgeon and pay for a private prescription. A private prescription can be much more expensive than an NHS one. People often then ask their GP to take over prescribing on the NHS. GPs can decline, but many agree.
Prescription charges. In England, the standard charge applies unless you are exempt or have a prepayment certificate. Prescriptions are free in Scotland, Wales and Northern Ireland.
Collecting it. Pharmacies often need to order it in. Waits of a few days are common. Some people describe much longer waits. Things people find helpful:
- Calling the pharmacy before taking in the prescription to ask about stock
- Putting in repeat requests well before running out
- Asking if a smaller tube is possible, as some versions have a short use-by once opened
From abroad. People travelling to the UK to get it still need a UK prescription. Buying it from unregulated websites carries real risks. If you cannot get it where you live, ask your own clinician what the local alternatives are.
Why GPs may not know it
People describe GPs who look blank at the name Anoheal. Common reasons:
- It is often not listed by brand in day-to-day prescribing systems.
- Many GPs know it as “diltiazem 2% cream” or “ointment” rather than by brand.
- Unlicensed products are prescribed less often in general practice.
- Fissures are usually managed with GTN first, so a GP may rarely get to step three.
It can help to bring the hospital letter, or to ask for “diltiazem 2% ointment for anal fissure” rather than the brand name.
How it relates to other diltiazem products
Anoheal is one version. Others are made by specials manufacturers or local pharmacies.
What people notice:
- Same medicine, different feel. Bases differ. Some are greasier, some creamier.
- Different reactions. Some people react to one diltiazem product and not another. Some react to all of them.
- Storage. Some versions need to be kept in the fridge. Others do not. Some must be thrown away a set number of days after opening. Always follow the label on the product you have.
If you are switched between versions and notice a change, tell your prescriber.
Reactions people report
The most common side effects people describe with Anoheal and other diltiazem products:
- Itching around the anus, sometimes severe
- An irritated rash, sometimes appearing after weeks of no problems
- Burning or stinging on application
- Cramping or a pressure feeling after bowel movements, which some people link to the muscle changing
- Headaches, though usually far milder than with GTN
Some people describe sores or spots appearing in nearby areas. In some accounts this turned out to be a fungal infection rather than a reaction to the medicine. These need checking by a GP. Do not assume they are a normal side effect.
Our guides to the diltiazem rash and diltiazem side effects go into more detail. When diltiazem does not suit, people are often switched to another option. See nifedipine vs diltiazem.
When to seek care
Call 999 or go to A&E if you have:
- Heavy bleeding, or bleeding that will not stop
- Fever with pain, swelling or discharge around the anus
- Severe pain that is getting worse rather than better
- Fainting, or a very slow or irregular heartbeat
For anything you are not sure about, NHS 111 can advise.
See your GP soon if:
- Itching or a rash is getting worse
- Sores, blisters or spots appear, especially beyond where you apply it
- There is no improvement after the course you were given
- You cannot get your prescription filled and are running out
- Bleeding that is dark, mixed into the stool, or happens without pain
- A change in bowel habit lasting more than a few weeks, or narrower stools
- Unexplained weight loss, or a lump