Rectogesic

Rectogesic is a topical rectal ointment containing glyceryl trinitrate (GTN) at a concentration of 0.4%, prescribed for the relief of pain associated with chronic anal fissure.

An anal fissure is a small tear in the lining of the anal canal that causes sharp pain, particularly during and after bowel movements, and may also bleed.

Glyceryl trinitrate works by relaxing the smooth muscle of the internal anal sphincter, which is often in spasm in patients with chronic fissures.

By reducing sphincter pressure, GTN improves blood flow to the fissure, promoting healing and relieving the intense pain caused by the spasm.

This conservative approach can be effective for many patients and may help avoid the need for surgical intervention.

Rectogesic is applied directly to the anal canal and surrounding perianal skin. Treatment is typically continued for six to eight weeks, during which time the fissure is expected to heal.

Concurrent measures such as dietary fibre supplementation and adequate fluid intake are recommended to keep stools soft and reduce straining.

Apply a pea-sized amount of ointment (approximately 2.5 cm squeezed from the tube, equivalent to roughly 375 micrograms of GTN) to the anal margin using a finger, twice daily, morning and evening.

Do not insert the ointment into the anal canal. Wash your hands thoroughly before and after application. Wearing a disposable glove or finger cot may be preferred.

Combine treatment with measures to keep stools soft, such as increasing dietary fibre and fluid intake. Avoid straining during bowel movements.

Apply approximately 375 micrograms of glyceryl trinitrate (a 2.5 cm strip of ointment) to the perianal skin every twelve hours.

Treatment should continue for a minimum of six weeks and up to eight weeks. If the fissure has not healed after eight weeks, surgical options should be discussed with your doctor.

Do not exceed the recommended dose or frequency.

The most common side effect is headache, which affects a significant proportion of patients and results from the vasodilatory action of glyceryl trinitrate.

Headaches are often worst during the first week of treatment and tend to diminish with continued use. Over-the-counter paracetamol may help manage them.

Other common effects include dizziness and light-headedness, particularly on standing. Local perianal burning or irritation may also occur.

Uncommon effects include flushing, nausea, and a drop in blood pressure. Severe hypotension is rare at the recommended dose.

Rectogesic can cause headaches and dizziness, especially at the start of treatment. Rise slowly from sitting or lying positions to reduce the risk of light-headedness.

Do not use Rectogesic concurrently with phosphodiesterase-5 inhibitors (such as sildenafil, tadalafil, or vardenafil), as the combination may cause a dangerous drop in blood pressure.

Avoid alcohol in excess, as it may enhance the hypotensive effect. Inform your prescriber if you have low blood pressure, anaemia, or a history of migraine.

Rectogesic is contraindicated in patients with hypersensitivity to glyceryl trinitrate or other nitrate compounds, severe hypotension, hypovolaemia, marked anaemia, raised intracranial pressure, constrictive pericarditis, and concurrent use of PDE5 inhibitors or soluble guanylate cyclase stimulators.

It should not be used in children.