What is FISURIN? Ingredients, protocol and what it can and cannot do

What exactly is FISURIN?

FISURIN is a topical treatment for anal fissures designed by the colorectal surgeons of Clínica Proctológica de Lima, a clinic in San Borja, Lima, that treats only anorectal conditions. It belongs to PROCTOANE, the anorectal care line of AQUINTFARMA S.A.C., the pharmaceutical company of AQUINT Health Group in Peru.

The idea came from daily practice. For years our surgeons prescribed nifedipine and lidocaine as two separate preparations. Patients got confused about which to apply when, stopped one of them early, or replaced both with a hemorrhoid cream from the pharmacy. FISURIN puts the two actives in one hydrogel and adds what was missing: a written protocol with a start, a check-up and an end point.

Regulatory status matters, so here it is plainly. In Peru, FISURIN is a magistral formula: a medicine prepared by an authorized pharmacy for a named patient, on a doctor’s prescription. It is not a mass-produced pharmacy product and it is not sold over the counter. If you want the general background on this kind of preparation, read Compounded fissure cream: what it is, how to get one and why it doesn’t travel.

What is inside FISURIN and what does each component do?

Why this pairing? A fissure stays open because of a loop: the tear hurts, the pain makes the internal sphincter contract, the tight muscle cuts blood flow to the tear, and the tear cannot heal. Nifedipine acts on the muscle; lidocaine acts on the pain. Colorectal guidelines (ASCRS 2023, ACPGBI 2023) recommend a topical calcium channel blocker such as nifedipine or diltiazem as first-line medical treatment for chronic fissure.

The evidence for the combination comes from published trials, not from FISURIN itself. In a randomized double-blind trial, nifedipine 0.3 % with lidocaine 1.5 % healed 94.5 % of chronic fissures at 6 weeks, against 16.4 % in the control group (Perrotti, 2002). The Italian SIUCP guideline of 2023 lists that same combination among first-line options for chronic fissure. We do not publish healing percentages of our own: our internal results are being compiled for publication and will be shown only once audited. The full evidence summary is on our evidence page.

How does the 6-week FISURIN protocol work?

FISURIN is never prescribed as "a cream and good luck". It comes with a schedule:

1. Week 0 – consultation. A surgeon confirms that it is a fissure (and not a hemorrhoid, abscess or something else), writes the prescription and sets up the fiber and sitz-bath plan.
2. Weeks 1–2. FISURIN three times a day, after bowel movements. Pain should fall clearly in this period.
3. Weeks 3–4. Two to three times a day. Check-up at week 4, in person or by message.
4. Weeks 5–6. Continue until the surgeon confirms closure. Do not stop when the pain disappears; that is when most fissures reopen.
5. Week 8. If the fissure is closed, a prevention plan. If it is not, the surgeon discusses botulinum toxin or surgery.

Around the ointment, the protocol includes psyllium or another soluble fiber twice a day with about 2 liters of water, a sitz bath after each bowel movement, a stool softener if stools are still hard after 3 days of fiber, and a footstool to raise the knees on the toilet. Step-by-step application is on our how to use FISURIN page, and the general technique for any fissure ointment is in How to apply anal fissure cream correctly: where, how much and when.

What can FISURIN do, and who is it for?

Used correctly within the protocol, FISURIN does two things: it lowers sphincter tone so the tear gets blood again, and it eases the pain of bowel movements so you stop avoiding the toilet. Those are the conditions under which a fissure can heal. Our surgeons prescribe it for:

• Acute fissures that still hurt after 1 to 2 weeks of soft stools.
• Chronic fissures, those lasting more than 6 to 8 weeks.
• Post-operative fissures and wounds after sphincterotomy or fissurectomy, the indication it was first formulated for.
• Recurrent fissures, as part of a prevention plan.

It also simplifies treatment: one product instead of two, one schedule, and a surgeon who follows you by message during the six weeks. That follow-up is often what keeps people from stopping at week 2.

What can FISURIN not do?

Being clear about limits is part of prescribing it well:

• It does not replace soft stools. No ointment wins against a hard stool every morning. Fiber, water and, if needed, a softener are part of the treatment, not extras; see All guides.
• It does not act in a few days. Pain usually falls in the first two weeks, but closure takes 6 to 8 weeks of regular use.
• It does not avoid surgery in every case. Some chronic fissures, especially old ones with a large sentinel pile or fibrosis, still need botulinum toxin or a lateral internal sphincterotomy.
• It is not for atypical fissures. A fissure off the midline, several fissures, or one with pus or a lump needs investigation for Crohn’s disease, infection or other causes, not an ointment. See Lateral or multiple anal fissures: when should you think of Crohn’s, HIV, syphilis, tuberculosis or cancer?.
• It is not for hemorrhoids. For hemorrhoids our surgeons prescribe a different product from the same line.
• It is not for everyone. Not for children without a pediatric indication; in pregnancy and breastfeeding only on prescription after weighing benefit and risk.

What side effects can FISURIN cause?

Topical nifedipine reaches the bloodstream in very small amounts, so in healthy adults it does not lower blood pressure in a noticeable way. The effects patients report are mostly local:

• Mild burning in the first applications, usually from the fissure itself, which tends to fade within days as the lidocaine works and the tear starts to settle.
• Rarely, flushing or a mild headache. Far fewer headaches than with nitroglycerin, which causes them in up to half of patients.
• Rash or intense irritation: stop and contact your surgeon.

Tell the doctor if you take other calcium channel blockers or blood-pressure medicines, if you have very low blood pressure, or if you are pregnant or breastfeeding. Our guide on Side effects of anal fissure creams and how to manage them covers how to handle each of these.

How can you get FISURIN, and can it be shipped abroad?

In Peru, FISURIN is obtained through a consultation, in person in San Borja or online, followed by a prescription and preparation by an authorized pharmacy with delivery in Lima. The pharmacy sets the price per jar and the consultation is charged separately; ask on WhatsApp for the current price and the 6-week package.

Outside Peru, the magistral formula is not shipped. Magistral preparations are made for a named patient under local pharmacy rules and cannot legally cross borders. Two other versions are in preparation:

If you live in the US, UK, Australia or India and need a sphincter relaxant now, your doctor can prescribe nifedipine or diltiazem from a compounding pharmacy, or nitroglycerin ointment (Rectiv in the US, Rectogesic in the UK and Australia). We compare those options in FISURIN or a pharmacy nifedipine ointment: what really changes?. To be notified when a version reaches your country, join the list on the Get FISURIN page; the full product sheet is on the FISURIN page and common questions are on our FAQ.

When should you see a doctor instead of waiting for the ointment?

Any fissure ointment, FISURIN included, is for a typical fissure confirmed by a doctor. Do not wait for it to work if you have:

The steps after a failed medical course are explained in All guides and on our surgery page.