Patient Drug Education for Nitroglycerin Ointment
Robert Wayne, MD FACS
Nitroglycerin ointment (NTG) is used to help heal anal fissures. The ointment relaxes the smooth muscle around the anus and promotes blood flow which helps heal the fissure (tear). The NTG reduces anal canal pressure, which diminishes pain and spasm. We use a diluted concentration of NTG (.125%) compared to the 2% that is typically used for heart patients, and this is why you need to obtain the medication from a pharmacy which will compound your prescription.
The NTG ointment should be applied 3 times per day, or as directed. A pea-sized drop should be placed on the tip of your finger and then gently placed inside the anus. The finger should be inserted 1/3 -1/2 its length and may be covered with a plastic glove or finger cot You may use Vaseline to help coat the finger or dilute the ointment If you are advised to mix the NTG with steroid ointment, Dmit the steroids to one to two weeks. The first few applications should be taken lying down, as mild light-headedness or a brief headache may occur.
It may take several weeks for the fissure to begin healing, and you will need to continue taking the medication after resolution of your symptoms. It is important to continue the treatment for the entire time period – up to 3 months or as directed. It takes up to two years for the healing tissue to regain the rtonnal skin strength. You will be advised to add fiber to your diet, increase water intake to 7-8 glasses per day, take relaxing baths or site baths, and avoid prolonged sitting and straining on the commode. Local anesthetic ointment may be added.
Initially, the anal fissure is very inflamed, which allows more of the NTG to get into the blood. This allows for a higher incidence of the most common side effect – a headache. It is usually brief and mad, but may require Tylenol or Advil0. You may dilute the NTG further with Vaseline9 to decrease the headaches. As the treatment progresses and the fissure begins to heat the headaches will tend to dissipate. Other side effects include lightheadedness, flushing, dizziness, nervousness, nausea, and vomiting. If any of these side effects persist or worsen, notify us promptly. Stop using the NTG and notify us immediately if you develop the rare side effects of severe dizziness, fainting, fast/pounding heartbeat paleness, sweating, blurred vision, dry mouth, dark urine, bluish lips/skin/nails, unusual tiredness, severe weakness, irregular heartbeat seizures, or chest pain. Serious allergic reactions are unusual, but seek immediate medical attention if you develop a rash, swelling, dizziness, or trouble breathing.
Tell us if you are allergic to nitrates, have severe anemia, low blood pressure, dehydration, chronic heart failure, cardiomyopathy, recent heart attack, increased pressure in the brain, or exposure to nitrates white on the job. Do not use NTG white driving or working around machinery if you are drowsy, dizzy, have lightheadedness, or blurred vision. Limit alcoholic beverages. To minimize dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. The elderly may be more prone to dizziness and falling. White there are not adequate studies to confirm the safety of NTG in pregnant or breast feeding women, it has been used without incident so far. We recommend waiting at least one hour after applying the NTG ointment before breast feeding.
Do not use NTG ointment if you are taking drugs for sexual problems [e.g., sildenafil (Viagra®), tadalaffl (Cteus9), vardenafil (Levrtra9)]. Use caution before taking cough-and-cold products, diet aids, or NSAIDs preparations because they may contain ingredients that could increase your blood pressure, cause a fast heartbeat or increase chest pain (e.g., pseudcephedrine, phenylephrine, chlorpheniramine, diphenhydramine, clemastine, ibuprofen, and naproxen). Tell us if you drink alcohol, take alteplase, migraine drugs (ergotamine). water pills/diuretics such as furosemtde or hydrochlorothiazide, or other drugs for high blood pressure (beta blockers, calcium channel blockers, ACE inhibitors).
Store the NTG at room temperature and keep away from light and moisture. Close the container tightly after each use. Do not store in the bathroom. Keep away from children and pets. If you have any questions or problems please call us at (503) 440 – 3104