{ "schema_version": 1, "kind": "condition", "id": "anal-fissure", "name": "Acute anal fissure", "category": "chronic", "sources": "ASCRS Clinical Practice Guideline for Anal Fissure 2017 · Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883)", "review_status": "reviewed", "verified_against": "ASCRS Clinical Practice Guideline for Anal Fissure 2017 · Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883) · Acute anal fissure - disease-level clinical article (anal-fissure-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 158, "generic": "Glyceryl trinitrate", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 0.4% ointment intra-anally every 12 hours", "adult_duration": "up to 8 weeks", "dose_source": "ASCRS Clinical Practice Guideline for Anal Fissure 2017", "rationale": "Topical nitrate that relaxes the internal anal sphincter and improves local blood flow, breaking the spasm-ischemia cycle that keeps a fissure from healing; used alongside fiber, stool softeners, and sitz baths rather than instead of them.", "cautions": [ "Headache is very common due to systemic nitrate absorption.", "Advise high-fiber diet, stool softeners, and warm sitz baths concurrently.", "Contraindicated with PDE-5 inhibitors (sildenafil)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric surgical referral required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "GLYCEROTONE 0.4 % RECTAL OINT. 50 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > MISR", "price_egp": 32.5, "pack_count": null, "unit_price": null, "strength_mg": 50000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RECTOSWAB RECTAL OINT 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNISWAB", "price_egp": 12.9, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "anal-fissure" }, { "id": 160, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Acute anal fissure - disease-level clinical article (anal-fissure-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - An atypical (nonmidline) fissure location requires investigation for secondary underlying causes (Crohn disease, infection, malignancy)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "anal-fissure" }, { "id": 159, "generic": "Lidocaine", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 5% ointment topically to anal verge prior to defecation", "adult_duration": "up to 2 weeks", "dose_source": "Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883)", "rationale": "Topical local anesthetic that numbs the anal verge to ease the pain of defecation; provides symptomatic relief only and does not address the sphincter spasm that perpetuates the fissure.", "cautions": [ "Symptomatic pain relief option; does not heal internal sphincter spasm.", "A fissure is broken mucosa and lidocaine crosses it. Stay under about 6 g of ointment a day; past that the drug reaches the blood, and in children that has caused seizures.", "Discontinue if local sensitization occurs." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric surgical referral required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FARCO-CAINE 5% OINT. 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.25, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOSINE 5% TOPICAL OINT. 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 4.4, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOGED 5% TOPICAL GEL 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ULTRACAINE 5% GEL 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XYLOTOP 4% TOP. CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 4.25, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XYLOTOP 4% TOPICAL GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIDOCAINE 2% GEL. 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 6.75, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XYLOCAINE JELLY 2% 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASPEN PHARMA > PHOENIX GROUP", "price_egp": 30.8, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "anal-fissure" } ] }