Rectiv (nitroglycerin)

For the treatment of moderate to severe pain associated with chronic anal fissures, the recommended adult dosage of nitroglycerin 0.4% rectal ointment is 375 mg (1 inch) of ointment, which is equivalent to 1.5 mg nitroglycerin, applied in the anal canal every 12 hours for up to 3 weeks. Improved outcomes (e.g., healing rates, reduction in pain) after extension of treatment duration to 6 weeks+ have been reported by some clinicians.

Nitroglycerin 0.4% ointment is applied rectally into the anal canal; the ointment should not be administered orally, vaginally, or topically to the eye. The ointment should be applied using a finger covering (e.g., plastic wrap, disposable surgical glove, finger cot). The tube of ointment should be squeezed until a line of ointment equaling the length of the measuring line on the dosage guide on the ointment carton is expressed onto the covered finger. The ointment should then be gently inserted into the anal canal no further than to the first finger joint using the covered finger. The ointment also should be applied around the side of the anal canal. If this cannot be achieved because of pain, the ointment should be applied directly to the outside of the anus. After application of the ointment, the finger covering should be discarded and the hands should be washed.

The tube of nitroglycerin 0.4% rectal ointment should be tightly closed when not in use and should be discarded 8 weeks after it is first opened.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

Nitroglycerin rectal ointment is contraindicated in patients with known hypersensitivity to nitroglycerin or other nitrates or nitrites or to any ingredient in the formulation.

Nitroglycerin rectal ointment is contraindicated in patients who are receiving selective phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil). (See Drug Interactions: Selective Phosphodiesterase Type 5 Inhibitors.) The drug also is contraindicated in patients with severe anemia or increased intracranial pressure.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

Adverse effects reported in at least 5% of patients receiving nitroglycerin 0.4% rectal ointment include headache and dizziness.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

Safety and efficacy of nitroglycerin 0.4% rectal ointment in pediatric patients younger than 18 years of age have not been established.

Category C. (See Users Guide.)

It is not known whether nitroglycerin is distributed into milk. Because many drugs are distributed into milk, nitroglycerin 0.4% rectal ointment should be used with caution in nursing women.

Clinical studies of nitroglycerin 0.4% rectal ointment did not include sufficient numbers of patients 65 years of age and older to determine whether geriatric patients respond differently than younger patients. Published clinical data indicate that geriatric patients have increased sensitivity to nitrates, which is manifested by more frequent or severe hypotension and related dizziness or fainting; this increased sensitivity may reflect the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.