North East and North Cumbria
ICS Formulary
 
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1 Gastro-intestinal system
01-07-04 Management of anal fissures

Glyceryl Trinitrate 0.4% ointment  Rectogesic®
First Choice
  • 0.2% also available unlicensedunlicensed.

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Botulinum toxin type A
Formulary
  • Approved for use by specialists as an alternative to surgery in patients failing other treatments. Also approved for use in paediatrics but there must be documented informed consent from patients/carers.
Link  MHRA DSU (July 2026): Botulinum toxin type A products: updated warnings regarding risk of iatrogenic botulism

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Diltiazem 2%
Formulary
  • The most effective formulation is to be prescribed

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