This ointment is used to relieve pain associated with chronic anal fissures.

The main pharmacological effect of glyceryl trinitrate is mediated through the release of nitric oxide. When applied intra-anally, it relaxes the internal anal sphincter. Increased tone (hypertonicity) of the internal anal sphincter, but not the external sphincter, is a key contributing factor in the development of anal fissures.

Nitroglycerin 0.4% ointment should be inserted into the anal cavity with an applicator.The ointment must be inserted at least 1 cm into the anus.The dose is to be applied intra-anally every twelve hours. Treatment may be continued until the pain abates,up to a maximum of 8 weeks.

Medicines that may enhance the blood pressure–lowering effect of glyceryl trinitrate ointment include:

• Antidepressants
• Erectile dysfunction medicines
• Antihypertensive drugs
• Diuretics
• Sedatives or tranquillizers
• Cardiac medications

This ointment is generally not recommended in patients with severe conditions such as severe anemia, glaucoma, hypotension, or raised intracranial pressure.

Headache and dizziness are common side effects of Nitroglycerin 0.4% ointment. In rare cases, it may reduce control over bowel movements, leading to minor stool leakage.

There is insufficient data regarding the use of Nitroglycerin in pregnant women. Animal studies do not clearly confirm safety regarding pregnancy, fetal development, or postnatal effects. Therefore, this ointment should not be used during pregnancy. It is not known whether Nitroglycerin passes into breast milk, so its use during breastfeeding is not recommended due to potential risk to the infant.

Nitroglycerin 0.4% ointment should be used cautiously in patients with severe liver or kidney disease. It should be avoided in patients with severe anemia, glaucoma, low blood pressure, or increased intracranial pressure.

Pediatric use: Not recommended for children and adolescents under 18 years due to lack of safety and efficacy data.

Accidental overdose may cause low blood pressure and reflex tachycardia. Since this occurs due to dilation of blood vessels and reduced blood volume, treatment should focus on restoring fluid balance. Excessive doses may also cause methemoglobinemia, which may be treated with methylene blue infusion.

Drugs used in ano-rectal conditions

Store below 25°C. Do not freeze. Keep all medicines out of the reach of children.