Nitroglycerin (Ointment)
Indications
The ointment will help to relieve the symptom of pain caused by chronic anal fissures.
Pharmacology
The principal pharmacologic action of glyceryl trinitrate is mediated via the release of nitric oxide. When glyceryl trinitrate ointment is applied by the intra-anal route,the internal anal sphincter becomes relaxed.Hypertonicity of the internal but not the external anal sphincter is a predisposing factor in the formation of anal fissures.
Dosage & Administration
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.
Interaction
The following medicines may increase the blood pressure lowering effect of glyceryl trinitrate ointment-
- Medicines for depression
- Medicines for erectile dysfunction
- Medicines for high blood pressure
- Diuretics
- Commonly used tranquillizers
- Medicines used to treat heart problems
Contraindications
Headache and dizziness is a common side effect experienced with Nitroglycerin 0.4% ointment. A possible side effect is reduced control over bowel movements and leaking of bowel motions although this is expected to be a rare event.
Side Effects
Headache and dizziness is a common side effect experienced with Nitroglycerin 0.4% ointment. A possible side effect is reduced control over bowel movements and leaking of bowel motions although this is expected to be a rare event.
Pregnancy & Lactation
There are no adequate data from the use of Nitroglycerin in pregnant women. Animal studies are inconclusive with respect to effects on pregnancy embryonal/foetal parturition and postnatal development. This ointment should not be used during pregnancy. It is not known whether Nitroglycerin is excreted in human milk. Due to the potential harmful effects on the breast fed child, the use of this ointment is not recommended during breast feeding.
Precautions & Warnings
Nitroglycerin 0.4% ointment should be used with caution in patients who have severe hepatic or renal disease.It should not be used if patient suffers from severe anemia, glaucoma, hypotension, increased intracranial pressure.
Use in Special Populations
Pediatric Use: It is not recommended for use in children and adolescents below 18 years of age due to lack of data on safety and efficacy
Overdose Effects
Accidental overdose may result in hypotension and reflex tachycardia. Because the hypotension associated with nitroglycerin overdose is the result of venodilation and arterial hypovolaemia, prudent therapy in this situation should be directed toward increasing central fluid volume. Excessive dosage may also give rise to methaemogiobinaemia. This should be treated with methylene blue infusion.
Therapeutic Class
Drugs used in Ano-rectal region
Storage Conditions
Store below 25°C. Do not freeze. Keep all medicines out of reach of the children.
