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nitroglycerin

Pronunciation

Generic Name: nitroglycerin (rectal) (NYE troe GLIS er in)
Brand Name: Rectiv

What is nitroglycerin rectal?

Nitroglycerin is a nitrate that dilates (widens) blood vessels.

Nitroglycerin rectal is used to treat moderate to severe pain caused by chronic anal fissures (tears in the skin lining your rectum).

Nitroglycerin rectal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nitroglycerin rectal?

You should not use nitroglycerin rectal if you have: severe anemia (a lack of red blood cells), or a brain injury, hemorrhage, or tumor.

You also should not use this medicine if you are using medicine to treat pulmonary arterial hypertension (PAH), such as riociguat, (Adempas), sildenafil (Revatio), or tadalafil (Adcirca).

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Do not take erectile dysfunction medicine (Viagra, Cialis, and others) while you are using nitroglycerin rectal, or you could have a sudden and serious decrease in blood pressure.

What should I discuss with my healthcare provider before using nitroglycerin rectal?

You should not use this medicine if you are allergic to:

  • isosorbide dinitrate;

  • isosorbide mononitrate; or

  • other forms of nitroglycerin (pill, spray, or skin ointment, or skin patch).

Do not take erectile dysfunction medicine (Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil, vardenafil) while you are using nitroglycerin rectal. Using erectile dysfunction medicine with nitroglycerin can cause a sudden and serious decrease in blood pressure.

You also should not use nitroglycerin rectal if you have:

  • severe anemia (a lack of red blood cells); or

  • a brain injury, hemorrhage, or tumor.

Do not use nitroglycerin rectal if you have early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling). Seek emergency medical attention if you have symptoms of a heart attack.

To make sure nitroglycerin is safe for you, tell your doctor if you have:

  • congestive heart failure;

  • a history of heart attack, stroke, or circulation problems;

  • low blood pressure;

  • migraine headaches; or

  • liver disease.

FDA pregnancy category C. It is not known whether nitroglycerin rectal will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether nitroglycerin rectal passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Nitroglycerin rectal is not approved for use by anyone younger than 18 years old.

How should I use nitroglycerin rectal?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Nitroglycerin rectal can cause severe headaches. Ask your doctor before using any headache pain medication.

It may take up to 3 weeks before your symptoms improve. Keep using as directed and tell your doctor if your symptoms do not improve or if they get worse while using nitroglycerin rectal. Do not use this medicine for longer than 3 weeks unless your doctor tells you to.

Store at room temperature away from moisture and heat. Keep the tube tightly closed when not in use. Throw away any nitroglycerin rectal ointment you have not used within 8 weeks after you first opened the tube.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using nitroglycerin rectal?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. It can increase some of the side effects of nitroglycerin, such as dizziness, drowsiness, feeling light-headed, or fainting.

Nitroglycerin rectal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a light-headed feeling, like you might pass out.

Common side effects may include:

  • headache; or

  • dizziness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Nitroglycerin dosing information

Usual Adult Dose for Angina Pectoris:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and beta-blockers.


LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue every 5 minutes as needed, up to 3 sprays in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.

Use: Acute relief of an anginal attack.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting down due to rapid onset.
-Advise patient not to chew or swallow this medication.

Use: Acute relief of an anginal attack.

Usual Adult Dose for Angina Pectoris Prophylaxis:

LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue 5 to 10 minutes prior to activity that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to chew or swallow this medication.


TOPICAL OINTMENT:
1/2 inch (7.5 mg) topically upon rising and 1/2 inch (7.5 mg) 6 hours later; titrate as needed and tolerated

Comments:
-Clinical trial doses have ranged from 1/2 to 2 inches (7.5 to 30 mg) applied to 36 square inches of truncal skin.
-Ointment should be applied to a dry and hairless area of the trunk.


TRANSDERMAL PATCH:
0.2 to 0.4 mg/hr patch applied topically once a day for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr

Comments:
-Patch should be applied to a dry and hairless area of the upper arm or body; rotate application sites to avoid skin irritation.
-Doses between 0.4 and 0.8 mg/hr have shown continued effectiveness for 10 to 12 hours daily for at least 1 month of intermittent administration.


EXTENDED RELEASE CAPSULE:
2.5 to 6 mg orally 3 to 4 times a day; titrate as needed and tolerated

Comments:
-Subjects were titrated up to 26 mg four times a day in one clinical trial.

Usual Adult Dose for Myocardial Infarction:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Control of congestive heart failure in the setting of acute myocardial infarction.

Usual Adult Dose for Hypertension:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Uses:
-Treatment of perioperative hypertension.
-Induction of intraoperative hypotension.

Usual Adult Dose for Anal Fissure and Fistula:

RECTAL OINTMENT:
1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra-anally every 12 hours for up to 3 weeks

Comments:
-A finger covering such as plastic wrap, a disposable surgical glove, or a finger cot should be placed on the finger to apply ointment.
-Insert finger no further than first finger joint and apply around side of anal canal; if unable to insert finger due to pain, apply directly to outside of anus.

Use: Treatment of moderate to severe pain associated with chronic anal fissure.

What other drugs will affect nitroglycerin rectal?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with nitroglycerin rectal, especially:

  • aspirin or heparin;

  • blood pressure medication;

  • ergot medicine--dihydroergotamine, ergotamine, ergonovine, methylergonovine;

  • medicine to treat a blood clot--alteplase, streptokinase, urokinase, tenecteplase); or

  • nitroglycerin used in a pill form or spray under the tongue, or as a skin patch or skin ointment.

This list is not complete. Other drugs may interact with nitroglycerin rectal, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about nitroglycerin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01. Revision Date: 2014-11-17, 11:02:16 AM.

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