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Rectal Nitroglycerin

Aka: Rectal Nitroglycerin, Glyceryl Trinitrate, Rectiv

Indications
1. Anal Fissure
Preparations
1. Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies)
2. Nitroglcycerin ointment 4% (Rectiv)
Dosing
1. Apply twice daily for 6 weeks
Mechanism
1. Chemical sphincterotomy
  1. Reduces maximal anal resting pressure
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
Drug interactions
1. Phosphodiesterase inhibitors (e.g. Viagra)
  1. Contraindicated in combination
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
References
1. (2012) Presc Lett 19(1): 3

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 1/12/2012 and last published on 5/9/2012.

This is one of 5737 pages in the Family Practice Notebook