Crema Gel
Crema Gel (Diltiazem 2 percent topical, 30 g tube) — calcium channel blocker for chronic anal fissure. Lower headache rate than nitroglycerin ointment. WHO-GMP certified manufacturer. Worldwide shipping from MedsBase.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Crema Gel?
Crema Gel is topical diltiazem 2 percent w/w (30 g tube) — a calcium channel blocker formulated for chronic anal fissure. Applied two to three times daily into the anal canal, it relaxes the internal anal sphincter, lowers resting anal pressure, and improves blood flow to the fissure base, allowing healing without surgery. Healing rates are 65–75 percent over 6–8 weeks. It is the preferred topical agent over nitroglycerin (GTN) because it causes far fewer headaches. Manufactured under WHO-GMP standards.
📦 Every order is covered by our Reshipment Assurance Policy — if your parcel does not arrive within 20 business days, we reship it.
Why order from MedsBase
Our generic medications are sourced from WHO-GMP certified manufacturers and shipped worldwide in discreet, plain packaging — no medication name on the parcel exterior. Card payments are routed through a regulated processor (statement descriptors include a regulated card-payment processor — never “MedsBase” or any medication name). Crypto and SEPA bank transfer are also accepted. Every order is backed by our Reshipment Assurance Policy.
Why order from MedsBase
Crema Gel is supplied from a WHO-GMP certified manufacturer. Every order ships discreetly worldwide and is covered by our Reshipment Assurance Policy — if it does not arrive within 20 business days, we reship at no cost. Topical diltiazem is preferred over GTN ointment because of a much lower headache rate (5–15 percent vs 35–50 percent for GTN) while delivering similar healing rates.
Mechanism
Diltiazem is a non-dihydropyridine calcium channel blocker. Topically applied in the anal canal, it relaxes the internal anal sphincter (smooth muscle), reducing resting anal pressure (a key driver of fissure pain and ischaemia) and improving capillary perfusion of the posterior midline mucosa. Lower sphincter pressure allows the fissure to heal. Systemic absorption from a 2 percent topical preparation is small (~10 percent), so the systemic CCB effects (low BP, bradycardia, leg oedema) are minimal at standard doses.
Indications
- Chronic anal fissure (defined as > 6 weeks)
- Acute anal fissure that has not healed with sitz baths, fibre, and topical analgesia
- Post-haemorrhoidectomy painful sphincter spasm (off-label)
How to apply
- Wash hands; finger cot or glove on index finger if preferred.
- Squeeze a pea-sized amount onto the fingertip.
- Insert ~1 cm into the anal canal and spread on the fissure area; or apply to the fissure margin if internal application is too uncomfortable.
- Apply two to three times daily, ideally after a bowel motion and a sitz bath.
- Continue for 6–8 weeks. Stop once the fissure has healed (no pain, no bleeding) for at least 1–2 weeks.
Side effects
- Local: itching, burning, contact dermatitis (5–10 percent)
- Systemic (uncommon): headache (5–15 percent — far less than GTN), light-headedness, palpitation
- Caution in heart block (rare with topical), severe hypotension
Adjuncts — without these, the gel will not heal the fissure
- High-fibre diet: 25–35 g/day from psyllium, vegetables, fruit, whole grains.
- Adequate water intake (2 L/day).
- Sitz baths 10–15 minutes after each bowel motion.
- Stool softener (PEG, lactulose) if hard stools persist.
- No straining, no phone scrolling on the toilet.
Frequently Asked Questions
How long until it works?
Pain often improves within 1–2 weeks. Complete healing of the fissure takes 6–8 weeks. Continue applying for at least 2 weeks after symptoms resolve to prevent recurrence.
Why does it hurt to apply?
The gel itself is not painful, but the fissure area is. Applying after a sitz bath relaxes the sphincter and reduces application pain. Topical anaesthetic (lidocaine 2 percent jelly) before the diltiazem can help in the first week.
Can I use it with GTN ointment?
No — both are vasodilators and stacking them increases the risk of hypotension and severe headache without improving healing rates.
What if it doesn’t heal in 8 weeks?
Refer to colorectal surgery. Options include a higher concentration, switching to topical nifedipine, botulinum toxin injection, or lateral internal sphincterotomy (gold-standard surgery, 95 percent cure but ~5 percent risk of long-term incontinence).
Is it safe in pregnancy?
Limited data. Topical absorption is small but caution is advised. Try sitz baths, fibre, lactulose, and topical anaesthetic first. Discuss with obstetric prescriber.
Can I have sex while using it?
The gel can transfer to a partner during anal contact and produce mild local effects. Wait at least 1–2 hours after application or use a barrier.
Why does my partner complain of headache?
Transferred topical CCB can cause a mild headache. Wash hands and the perianal area thoroughly before intimate contact.
Will it stain underwear?
A thin oily film may transfer. Use a panty liner during the first 30 minutes after application.
Storage
Below 25°C, do not refrigerate. Keep tube tightly closed. Discard 4 weeks after first opening.
What if I miss a dose?
Apply when you remember and continue the schedule. Missing one or two doses does not undo healing — consistency over weeks is what matters.
Other Gastro Health Medications
- Anovate — Beclomethasone + phenylephrine + lignocaine cream
- Movicol — PEG osmotic laxative
- Duphalac — Lactulose
- Cremalax — Bisacodyl
- Dulcolax — Bisacodyl
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Ranked by recent MedsBase order volume — what other customers in this category are picking.
| Strength | 2% w/w 30 g |
|---|---|
| Quantity | 1 Tube/s, 2 Tube/s, 3 Tube/s, 6 Tube/s |
Crema Gel
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Crema Gel
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