Ointments and Topical Preparations
GLYCERYL TRINITRATE (GTN) AND DILTIAZEM
Rectogesic is the most common brand name for glyceryl trinitrate ointment, whilst Anoheal is a brand name for diltiazem ointment.
These are ointments that are applied to the anal canal for a number of conditions, most commonly anal fissure. Anal fissure is a condition in which a split occurs in the skin at the opening of the anus. This can sometimes become chronic and cause symptoms including pain, itching and bleeding.
Whilst they are different drugs, each works by relaxing the sphincter muscle in the bottom, relieving pain and helping to heal the anal fissure. By relaxing the muscle, they improve the blood supply to the anal fissure to aid healing.
HOW DO I APPLY THEM?
Both these ointments need to be applied to the anus. You can use a glove or a piece of clingfilm to cover your finger when applying them.
The ointment can be applied to the skin around the anus over an area about the size of a 50 pence piece. There is no need to push the ointment into the anal canal if this is uncomfortable.
You should apply these ointments twice a day (and you can re-apply after each bowel movement) or as directed by your doctor. Always read the instructions about the amount and method of application that come with the medicine.
ARE THEY SAFE?
Generally, both of these ointments are very safe. GTN may cause headaches. This should not cause alarm. If this occurs, it is advisable to take simple pain killers such as paracetamol. Reducing the dose applied to the bottom is likely to reduce the severity and duration of headache.
If you are able to continue to use the medicine, then this side effect usually gets slowly better with time. If you find these intolerable, then you should see your GP and/ or surgeon to discuss alternatives.
GTN (Rectogesic) may make you feel light-headed or dizzy. Diltiazem (Anoheal) sometimes causes an itching or burning sensation around the anus. If this occurs, you should stop taking the medicine and consult your doctor.
DO THESE OINTMENTS INTERACT WITH OTHER DRUGS?
You should not take the ointments with sildenafil (Viagra) and its related drugs tadalafil and vardenafil. You should also use with caution if you are taking other nitrate drugs such as glyceryl trinitrate (GTN) spray or tablets and long acting nitrates such as isosorbide mononitrate.
HOW LONG SHOULD I USE THE OINTMENT FOR?
You should be guided by your doctor in this. However, generally, it is worth continuing to use the ointment for eight weeks, even if the symptoms resolve. The reason is that fissures commonly recur and by continuing to use the paste after symptoms resolve, there is better chance that the fissure will remain healed.
IS THERE ANYTHING ELSE I SHOULD DO?
It is important to avoid getting constipated. Passing a very hard stool when you have an anal fissure is both very uncomfortable and also carries a significant risk of re-opening the fissure itself. A laxative such as Movicol or Laxido may be suitable.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment