Glyceryl Trinitrate 0.4% (nitroglycerine) Rectal prep

Introduction: Glyceryl Trinitrate 0.4% (nitroglycerine) Rectal prep is used for the treatment of anal fissure. It is applied as a rectal ointment which relaxes the sphincter muscle and helps in healing of the fissure.

How it works: Glyceryl trinitrate acts on the enzyme nitric oxide stimulating guanylate cyclase in the vascular smooth muscle cells resulting in the relaxation of smooth muscles. Rectal application relaxes the sphincter muscle, relieves pain from anal fissure and promotes healing.

Important Information: Apply 1.5 mg 12 hourly up to 8 weeks to the anal canal. Do not use with phosphodiesterase type-5 inhibitors (sildenafil, tadalafil).

• Anal fissure

Topical Vasodilator

Nitrate Vasodilator

Glyceryl trinitrate acts on the enzyme nitric oxide stimulating guanylate cyclase in the vascular smooth muscle cells resulting in the relaxation of smooth muscles. Rectal application relaxes the sphincter muscle, relieves pain from anal fissure and promotes healing by improving blood flow.

Glyceryl trinitrate releases nitric oxide which relaxes the sphincter muscle, relieving pain from anal fissure and improving blood flow for healing.

Adult Dose (Rectal):

• As 0.4% ointment for anal fissure: Apply 1.5 mg 12 hourly
• Up to 8 weeks

For rectal use only. Apply a small amount of ointment to the anal canal. Use as directed by your doctor.

If you miss a dose, apply it as soon as you remember. If it is almost time for your next dose, skip the missed dose and follow your regular schedule.

Common Side Effects:

• Headache (common)

Precautions:

• Headache usually goes away after a few days - inform doctor if it persists.
• May cause dizziness or sleepiness - do not drive.
• Avoid alcohol (increases dizziness).
• Do not use with sildenafil or tadalafil (may cause hypotension).

Contraindications:

• Allergy to glyceryl trinitrate or similar medicines
• Low blood pressure
• Heart or blood vessel disorders
• Closed-angle glaucoma
• Migraine or recurrent headaches
• Increased intracranial pressure
• Anaemia
• Taking sildenafil citrate, tadalafil, vardenafil

Drug Interactions:

• Enhances bioavailability of dihydroergotamine
• May reduce efficacy of heparin, alteplase and noradrenaline
• Aspirin and other NSAIDs may reduce therapeutic response
• Alcohol may cause severe hypotension and collapse

Food Interactions:

• Alcohol may cause flushing, increased heart beat, nausea, thirst, chest pain and hypotension (Disulfiram reaction)

Use in Pregnancy: Generally considered safe during pregnancy. Animal studies have shown low or no adverse effects.

Use in Lactation: Probably safe during breastfeeding. Limited data suggests the drug does not represent significant risk to the baby.

Pediatric Use: Safety and efficacy in children have not been established.

Geriatric Use: No specific dosage adjustment is necessary for elderly patients. Use with caution.

Renal Impairment: Probably safe in kidney disease. Dose adjustment may not be needed.

Hepatic Impairment: Limited information available. Please consult your doctor.

Overdose: Overuse may cause severe headache, dizziness, hypotension. Discontinue use and seek medical attention.

Storage: Keep below 30°C, away from light. Keep out of reach of children.

Glyceryl Trinitrate 0.4% Rectal Ointment