Rectogesic ointment (Glyceryl trinitrate)
Rectogesic (glyceryl trinitrate) 0,4 % ointment is approved for treatment of chronic pain from chronic anal fissure. Three double blinded placebo controlled randomized trials showed that the relative efficacy of treatment of the average pain-intensity during 24 hours was respectively 17,2 %, 10,6 % and 5,1 % after 21 days of treatment, and 21,1 %, 10,9 % and 1,5 % after 56 days of treatment. A Cochrane metanalysis described the ointments healing effect on anal fissures and found a marginal, but statistic significant improved effect in using 0,2 % - 0,4 % glyceryl trinitrate ointment than placebo. The most frequent adverse effect is headache, which occurs in about 50 % of the patients. 20-25 % of the patients experienced severe headache.The price for 30 g of Rectogesic 0,4 % is 486,75kr.
IRF states that Rectogesic 0,4% can be used in patients with chronicle anal fissure, where conservative treatment, for instance warm baths, use of laxantive and dietary instructions, do not have any pain reducing efficiency. Furthermore there is another option in using Rectogesic in patients that are not having an operation, to cure the anal fissure.
Rectogesic 0,4% ointment was marketed on 22 December 2007. Rectogesic 0,4 % is not covered under the rules of general reimbursement.