Nitroglycerin Rectal

Nitroglycerin Rectal is a prescription medication used to treat moderate-to-severe pain associated with chronic anal fissures. 

• Nitroglycerin Rectal is available under the following different brand names: Rectiv

Common side effects of Nitroglycerin Rectal include:

• Headache, and
• Dizziness

Serious side effects of Nitroglycerin Rectal include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Pounding heartbeats,
• Fluttering in your chest,
• Slow heart rate,
• Lightheadedness,
• Chest pain or pressure,
• Pain spreading to the jaw or shoulder,
• Nausea, and
• Sweating

Rare side effects of Nitroglycerin Rectal include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Ointment, intra-anal

• 0.4 % (4 mg nitroglycerin/1 g of ointment)

Chronic Rectal Fissure Pain

Adult dosage

• Cover the finger with plastic wrap, a disposable surgical glove, or a finger cot and measure 1-inch (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) length of ointment using the dosing line provided with packaging
• The covered finger is then gently inserted into the anal canal no further than to the first finger joint and applied circumferentially to the anal canal
• If this cannot be achieved due to pain, application of the ointment should be made directly to the outside of the anus
• May be applied intra-anally every12 hour until pain abates, not to exceed a treatment duration of 3 weeks

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Nitroglycerin Rectal has severe interactions with the following drugs:
  • avanafil
  • sildenafil
  • tadalafil
  • vardenafil
• Nitroglycerin Rectal has severe interactions with no other drugs.
• Nitroglycerin Rectal has moderate interactions with at least 87 other drugs.
• Nitroglycerin Rectal has minor interactions with the following drugs:
  • acetylcysteine
  • acetylcysteine (Antidote)

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to nitroglycerin or any of the excipients or idiosyncratic reactions to other organic nitrates
• Use within a few days of selective PDE-5 inhibitors (. g, sildenafil, tadalafil, vardenafil); as these may potentiate hypotensive effects of organic nitrates; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life
• Increased intracranial pressure (. g, head trauma, cerebral hemorrhage) or inadequate cerebral circulation
• Severe anemia

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Nitroglycerin Rectal?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Nitroglycerin Rectal?”

Cautions

• Caution with existing cardiovascular disorders; venous and arterial dilatation may occur and decrease venous blood return to the heart and reduce arterial vascular resistance and systolic pressure
• Caution with blood volume depletion, existing hypotension, cardiomyopathies, CHF, acute MI, or poor cardiac function for other reasons
• Headache: Nitroglycerin produces dose-related headaches which may be severe
• Additive hypotensive effects may occur when coadministration with nitric oxide (NO) donors (.g, long-acting nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, amyl nitrite, butyl nitrite), antihypertensive drugs, beta-adrenergic blockers, and calcium channel blockers
• Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects
• Coadministration with aspirin may increase nitroglycerin maximum serum concentration and AUC
• Alcohol may enhance nitroglycerin’s vasodilating effects
• Avoid use in patients with hypertrophic cardiomyopathy
• Caution when coadministration with tPA, heparin, and ergotamine
• May precipitate or aggravate intracranial pressure

Pregnancy and Lactation

• Use with caution if the benefits outweigh the risks during pregnancy.
• Lactation
  • Unknown whether distributed in the breast milk/use caution