At a glance
Nifedipine and diltiazem are both calcium channel blockers. As creams or ointments, both aim to relax the internal sphincter and improve blood flow to a fissure. Neither is a cure, and neither works for everyone.
The main differences people describe are not about how they work. They are about:
- Where you live. In the UK, diltiazem is the common alternative to GTN. In the US, both are made up by compounding pharmacies, and nifedipine is widely used.
- Side effects. Itching and rash come up more often in diltiazem accounts. Headache and flushing come up a little more in nifedipine accounts. Both are usually milder than GTN headaches.
- How each one suits you. Many people react to one and get on fine with the other.
This page compares them side by side. For each one on its own, see our guides to nifedipine cream and diltiazem cream.
How they compare
| Nifedipine | Diltiazem | |
|---|---|---|
| Drug family | Calcium channel blocker | Calcium channel blocker |
| Main aim | Relax the sphincter, improve blood flow | Relax the sphincter, improve blood flow |
| UK availability | Uncommon; specially made if at all | Common NHS alternative to GTN |
| US availability | Compounded; widely used | Compounded; widely used |
| Often mixed with | Lidocaine | Sometimes lidocaine or other ingredients |
| Side effects people mention most | Headache, flushing, burning, rash | Itching, rash, burning |
The percentages on the labels look very different. Diltiazem creams are often 2%. Nifedipine creams are usually well under 1%. That does not make nifedipine weaker. They are different medicines, and the strengths are not comparable. Your prescriber chooses the strength.
Availability by country
UK. GTN ointment is usually offered first. When it causes bad headaches or does not help, diltiazem is the usual next step. It is often supplied as a ready-made branded product, Anoheal, or as a specially made version. See our guide to Anoheal in the UK. Topical nifedipine is rarely prescribed on the NHS, and people asking for it are often told it is not available.
US. Neither is sold as a standard, mass-produced cream. Both are mixed by compounding pharmacies, often with lidocaine. Which one you get often comes down to what your surgeon is used to. Some clinics have a strong preference for one over the other.
Elsewhere. Accounts from other countries describe patchy access. Some people are offered only GTN. Some can get one calcium channel blocker but not the other. The quality of specially made creams also varies. A gritty texture can mean the medicine has not been mixed in evenly, and it is fair to raise it with the pharmacy before using it.
Side effects compared
Both creams act mostly where they are applied, but some of the medicine is absorbed into the body.
Things people report with both:
- Stinging or burning on application, often easing after the first days
- Itching and redness around the area
- Mild headache or light-headedness, usually less than with GTN
Mentioned more with diltiazem:
- An itchy, sore rash, sometimes appearing after weeks of trouble-free use
- Some describe needing to stop because of it
Mentioned more with nifedipine:
- Headaches and flushing, especially for people who apply higher up
- A small number describe palpitations or chest discomfort, which needs urgent attention
Also worth knowing:
- Some reactions are to the base or to added lidocaine, not the main medicine.
- Two versions of the same drug can feel very different. People describe reacting to one pharmacy’s diltiazem and not another’s.
More detail is in our diltiazem side effects guide.
What people say about effectiveness
There is no clear winner in people’s accounts, and studies have not shown one to be reliably better than the other.
Patterns people describe:
- Some notice less pain within days. Others feel nothing for two or three weeks, then gradual change.
- Some feel one relaxes the muscle more noticeably. For others it is the reverse.
- Some describe both helping with pain but neither fully healing a long-standing fissure.
That last group often moves on to discuss Botox or surgery with their clinician. Our decision guide lays those options out.
Switching between them
Switching is common. The usual reasons:
- A rash or itch from one cream
- Side effects like headaches that do not settle
- No change after a fair trial, often six to eight weeks
People commonly ask their prescriber:
- Should there be a gap between stopping one and starting the other?
- If I reacted to the first, how will we know if I react to the second?
- How long should I give the new one before we review?
- Should lidocaine be left out this time?
Do not use the two together, or alongside GTN, unless your prescriber has said so. Combining them can drop blood pressure and cause dizziness or fainting. Our guide to switching between GTN and diltiazem covers the transition in more detail.
When to seek care
Get urgent help (go to A&E or an emergency department, or call 999 in the UK or 911 in the US) 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
- Chest pain, a racing heartbeat or fainting after using either cream
See your GP or prescriber soon if:
- A rash, sores or itching spread beyond where the cream goes
- Side effects are affecting daily life
- There has been no improvement after the course you were given
- You want to talk about switching, or about next steps beyond creams
- 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