What is Rectogesic® (glycerol trinitrate)?
Rectogesic® is a unique rectal ointment with the active ingredient glycerol trinitrate (GTN, also known as nitroglycerol) in a concentration of 0.4%. It is the only authorized drug that specifically relaxes the inner anal muscle and is used primarily for treating chronic anal fibrosis.
Unlike other hemorrhoid preparations, Rectogesic® contains neither a corticosteroid nor a local anesthetic. Instead, glycerol trinitrate releases nitric oxide (NO), which relaxes the smooth muscle of the closing muscle and improves local circulation.
This promotes the healing of analfissures and alleviates the associated pain. Rectogesic® can replace or delay surgical treatment (shincterotomy) in many cases.
Active Ingredients & Mechanism of Action
Active ingredient: Glyceroltrinitrat (Nitroglycerin)
Rectogesic® acts on the release of nitric oxide (NO):
Active mechanism:
- Glycerol trinitrate is locally converted into nitrogen monoxide (NO)
- NO activates the guanylate cyclase in the smooth muscle
- Increased cGMP level
- Relaxation of the smooth muscles of the inner anal phinkter
Therapeutic effects:
- Reducing the rest pressure in the anal canal (by 20-30 %)
- Relaxation of the inner anal closing muscle
- Improving anodermal blood circulation
- Promoting wound healing in analfissures
- Pain relief due to reduced sphincter spasm
Initiation of action:
- Sphinkterrelaxation: Within 15-30 minutes
- Pain relief: often after the first application
- Fissurenheilung: 6–8 weeks with regular application
Who is it suitable for?
Rectogesic® is suitable for:
- Adults with chronic anal fissure
- Painful sphincter spasm (closed muscle cramp)
- In addition to hemorrhoids with accompanying fissure
Especially recommended at:
- Chronic anal fissures (> 6 weeks)
- If conservative measures (seat baths, chair regulation) are not sufficient
- As an alternative to surgical sphincterotomy
- Painful stool-associated complaints by sphincterspasmus
Not suitable:
- Children and youth under 18 years
- Simultaneous intake of PDE-5 inhibitors (Sildenafil, Tadalafil)
- Heavy hypotension (low blood pressure)
- Known hypersensitivity to nitrate
Available Dosages
Dosing:
- 375 mg ointment (corresponding to about 1.5 mg glycerol trinitrate) every 12 hours rectal
- 2 × daily (morning and evening)
- 375 mg corresponds to an ointment strand of about 2.5 cm length
Dosing aid:
- The tube has a special dosing device
- An ointment line from the fingertip to the middle of the first finger member = approx. 375 mg
Application duration:
- Maximum 8 weeks
- Healing Fissur in 40–60 % of cases within this time
- For non-response: discuss surgical options
Available strength:
- 0.4% glycerol trinitrate recectal ointment (30 g tube)
How to Take
Application:
- Press an ointment strand of about 2.5 cm on the finger
- Apply the ointment carefully perianal (around the after)
- The ointment must NOT be introduced into the after
- Wash your hands thoroughly (headache!)
Important notes:
- HÄNDE GREEN WASCHEN after application (nitroglycerol is absorbed via the skin)
- Use disposable gloves when available
- If gloves are not possible: wrap your finger in a freshening foil
- Application 2 × daily at a distance of 12 hours
- headaches are common – usually leave after a few days after
Application tip: Apply ointment best in the morning and evening after the stool and gentle cleaning. No rubbing – just carefully tap.
Contraindications
**Rectogesic® must not be used at:* *
- hypersensitivity to glycerol trinitrate or other nitrates
- Simultaneous intake of PDE-5 inhibitors (Sildenafil, Tadalafil, Vardenafil) – life-threatening blood pressure drop!
- At the same time taking Riociguat
- Heavy anaemia
- Increased brain pressure
- Hypovolaemia (volume deficiency)
- Heavy hypotension (low blood pressure)
- Constrictive pericarditis
Preview at:
- Migraine or headache tendency (head pain most common side effect)
- Orthostatic hypotension (blood pressure drop when standing up)
- cardiovascular diseases
- Simultaneous intake of low blood pressure medications
pregnant and breastfeeding: No sufficient data. Only with strict indication after medical weighing.
Possible Side Effects
**Very common (> 10 %):* *
- headaches (the most common side effect, with more than 50% of patients!)
Family (1–10 %):
- Squeeze
- Blood pressure drop
- nausea
- Burn at the application site
- Anal Pruritus (Juckreiz)
** Occasionally (0.1-1 %):* *
- rectal bleeding
- Tachycardia (Herzrasen)
- Flush (face redness)
- Skin redness at application site
** Headaches occur in over half of the patients, since nitroglycerol also expands the blood vessels in the head. They are the most common reason for the decommissioning. In most patients, the headaches after 3–7 days after the body is used to the effect (tolerance development).
Interactions
Contraint with:
- PDE-5-Hemmer (Sildenafil, Tadalafil, Vardenafil) → life-threatening blood pressure drop!
- Riociguat → increased blood pressure reduction
Preview at:
- Other blood pressure sinks (ACE inhibitors, sartans, beta blockers, calcium channel blockers) → increased blood pressure drop
- Alcohol → increased blood pressure reduction
- Tricyclic antidepressants → enhanced hypotension
- Heparin → reduced heparin action under nitrates
- Ergotamine → Strengthening Ergotamine Effect
Important: Although the rectal application has a lower systemic absorption than oral, interactions with blood pressure-lowering drugs can occur. Contraindication with PDE-5 inhibitors is absolutely valid – even with rectal application.
Frequently Asked Questions
Similar Medications
Is Rectogesic® (glycerol trinitrate) right for you?
A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.
Important Notice
This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor. Read the package leaflet before use.