Cardiovascular Medicine Book


Rectal Nitroglycerin

Aka: Rectal Nitroglycerin, Glyceryl Trinitrate, Rectiv
  1. Indications
    1. Anal Fissure
  2. Preparations
    1. Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies)
    2. Nitroglcycerin ointment 0.4% (Rectiv)
  3. Dosing
    1. Apply twice daily for 6 weeks
  4. Mechanism
    1. Chemical sphincterotomy
      1. Reduces maximal anal resting pressure
  5. Adverse effects
    1. Severe Headache (25%)
      1. Apply with glove or finger cot to prevent absorption
      2. Start at 25-50% of typical dose and advance
  6. Drug Interactions
    1. Phosphodiesterase Inhibitors (e.g. Viagra)
      1. Contraindicated in combination
  7. Efficacy
    1. Study of 80 patients over 8 weeks
      1. Fissures healed in 68% using glyceryl ointment
      2. Adverse effects: Headache
      3. Only 8% healed with standard delivery
    2. Lund (1997) Lancet 349-11-4 [PubMed]
  8. References
    1. (2012) Presc Lett 19(1): 3
Medication Costs
rectiv (on 1/1/2017 at Medicaid.Gov Pharmacy Drug pricing)
RECTIV 0.4% OINTMENT $17.99 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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