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Glyceryl trinitrate (rectal)

Also known as Rectogesic

Key points about Rectogesic

Rectogesic is an ointment used for the treatment and relief of symptoms of anal fissure.
Rectogesic is also called glyceryl trinitrate rectal ointment.
Find out how to use it safely and possible side effects.

Rectogesic is an ointment used mainly for the treatment and relief of symptoms of anal fissure (tear). It may also be used for relief of pain and discomfort associated with haemorrhoids and haemorrhoidectomy (operation to remove haemorrhoids). The ointment relaxes the anal muscles and allows more blood flow into the skin around the fissure, to enable the fissure to heal. Read more about anal fissure (tear).

Apply the ointment 3 times daily; don't use it more than this.

Cover your finger with a finger cot (available from pharmacies), or a piece of cling film, or use a disposable glove.
Then use 1 to 1.5 cm of the ointment from the tube on to your finger (there is a measuring line on the packaging to help you).
Then, using your finger, gently insert the ointment just inside your anus (bottom).
To make sure that the ointment gets to the correct place, insert your finger to the first finger joint.

Note: It's important not to apply too much of ointment – using too much causes headache (dilates the blood vessels in the brain).

Tips when applying Rectogesic

Keep your hands clean: Before applying the ointment, wash and dry your hands. Wear disposable gloves or use a finger cot or cling film over the finger you are using. Wash your hands after you have used Rectogesic.
If the tube is difficult to squeeze: Warm the tube between your hands or in a glass of lukewarm water. Don't warm the ointment in the microwave.
Missed dose: If you forget to apply the ointment, apply the next dose at the usual time. Don't use a double dose to make up for a forgotten dose.
Keep using Rectogesic regularly. It's important to continue treatment as directed for 4 to 6 weeks for a fissure to allow it to heal. If you are using Rectogesic for haemorrhoids, you may only need to use it for 2 to 4 weeks. Your doctor may ask to see you every 2 weeks to check progress.

Do not use Rectogesic if you are pregnant or breastfeeding.

Do not use Rectogesic if you are taking medicines used to treat erection problems, such as:

sildenafil (Viagra, Avigra, Vedafil, Silvasta)
tadalafil (Cialis)
vardenafil (Levitra).

Using erectile dysfunction medicine with Rectogesic can cause a sudden decrease in blood pressure, which can be life threatening.

If you have low blood pressure, heart failure, migraines or regular headaches, talk to your doctor before starting Rectogesic.

Limit alcohol or avoid alcohol while you are using Rectogesic

Alcohol can increase your chance of side effects such as headaches and making you feel dizzy and faint.

Rectogesic can affect your ability to drive or operate machinery

Rectogesic may cause dizziness, light headedness, blurred vision, headaches or tiredness in some people, especially when you first start to use it. Be careful driving a car or operating machinery until you know how Rectogesic affects you.

Taking other medicines and supplements

Rectogesic can interact with some medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting Rectogesic and before starting any new products. If you are also taking other nitrate medicines as patches or tablets, talk to your doctor or pharmacist about the best times to take them.

Like all medicines, Rectogesic can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Headache	This is quite common when you first use Rectogesic and should settle within 30 minutes of application. If headaches are troublesome, try using a smaller amount of ointment for a few days, and then gradually increase the amount back to normal over several days. Tell your doctor if it is ongoing.
Dizziness Feeling lightheaded Feeling faint when you stand up	This is quite common when you use Rectogesic and usually goes away with time. Don't use any more ointment for at least 8 hours, then continue treatment by reducing the amount of ointment by half. Avoid alcohol. Tell your doctor if this continues.
Burning or itch or bleeding in the area where the ointment was applied	Tell your doctor.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)