The Medical Letter on Drugs and Therapeutics
Nitroglycerin Ointment (Rectiv) for Anal Fissure
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The FDA has approved the use of nitroglycerin ointment 0.4% (Rectiv – ProStrakan/Aptalis) for treatment of moderate to severe pain associated with chronic anal fissure; the same drug is marketed as Rectogesic in Europe. Nitroglycerin ointment 2% (Nitro-Bid) is available in the US for prevention of angina.

MECHANISM OF ACTION — Nitroglycerin is a vasodilator that relaxes smooth muscle. Applied topically, it causes relaxation of the anal sphincter.1

STANDARD TREATMENT — The most effective treatment for chronic anal fissure is a lateral internal anal sphincterotomy, which can be done under local anesthesia and results in a cure in about 95% of patients, but can cause varying degrees of fecal incontinence; a recent review found that this complication, which may persist, occurred in 9% of patients. ... more      

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Title: Nitroglycerin Ointment (Rectiv) for Anal Fissure
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