botulinum toxin type a + diltiazem hydrochloride

This is a combination therapy consisting of botulinum toxin type A, a neurotoxin protein that inhibits acetylcholine release at neuromuscular junctions to induce temporary muscle relaxation, and diltiazem hydrochloride, a calcium channel blocker that relaxes smooth muscle by inhibiting calcium influx. The combination has been studied primarily for the treatment of chronic anal fissure, with the aim of reducing internal anal sphincter tone and promoting fissure healing. Botulinum toxin type A is typically administered via local injection into the internal anal sphincter, while diltiazem hydrochloride is applied topically as an ointment or gel. Clinical studies indicate that this combination does not provide superior efficacy compared to botulinum toxin alone in terms of healing rates or recurrence prevention[1][2][3]. Both agents are approved drugs individually but their combined use for this indication remains off-label.