• See Also
  1. Anal Fissure
  2. Nitroglycerin
  • Indications
  1. Anal Fissure
  • Preparations
  1. Glyceryl Trinitrate ointment 0.2% to 0.4% (Compounded by pharmacies)
  2. Nitroglcycerin ointment 0.4% (Rectiv)
  • Dosing
  1. Apply twice daily for 6 weeks
  • Mechanism
  1. Chemical sphincterotomy
    1. Reduces maximal anal resting pressure
  • 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
  • Drug Interactions
  1. Phosphodiesterase Inhibitors (e.g. Viagra)
    1. Contraindicated in combination
  • 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]
  • References
  1. (2012) Presc Lett 19(1): 3