II. Indications

III. Preparations

  1. Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies)
  2. Nitroglcycerin ointment 4% (Rectiv)

IV. Dosing

  1. Apply twice daily for 6 weeks

V. Mechanism

  1. Chemical sphincterotomy
    1. Reduces maximal anal resting pressure

VI. 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

VII. Drug interactions

  1. Phosphodiesterase Inhibitors (e.g. Viagra)
    1. Contraindicated in combination

VIII. 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]

IX. References

  1. (2012) Presc Lett 19(1): 3

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Cost: Medications

rectiv (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
RECTIV 0.4% OINTMENT $17.99 per gram