Clinical Information
Use as directed by your healthcare provider. Apply a small, pea-sized amount to the affected area, usually 3 to 4 times a day. If you forget a dose, apply it when you remember unless it is almost time for your next dose. Do not use two doses at the same time.
After you rub the ointment on, nitroglycerin is absorbed through the skin and changes into nitric oxide. Nitric oxide tells nearby blood vessels and the anal sphincter muscle to relax. This lowers pressure inside the anus, improves blood flow, and lessens pain from spasms. Relief of pain often starts within 15–30 minutes, but full healing of fissures may take several weeks of regular use. The relaxing effect usually lasts about 4–6 hours per application.
Do not use if you are allergic to nitroglycerin, nitrates, or any ingredients in this ointment. Do not use if you have very low blood pressure, severe anemia, increased pressure in the head (such as recent head injury or bleeding in the brain), or if you are taking medicines for erectile dysfunction or pulmonary hypertension like sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). Avoid use if you recently had a heart attack unless your doctor says it is safe. Talk to your doctor before use if you are pregnant, plan to become pregnant, or are breastfeeding.
Serious low blood pressure can happen if this ointment is used with PDE-5 inhibitors such as sildenafil, tadalafil, or vardenafil—do not combine them. Use caution with other blood pressure medicines (beta-blockers, ACE inhibitors, diuretics) because dizziness or fainting may increase. Alcohol can add to the blood-pressure-lowering effect. Ergot drugs for migraines (for example, dihydroergotamine) may work less well when taken with nitroglycerin. Tell your healthcare provider about all prescription drugs, over-the-counter medicines, and herbal products you use.
Very common (more than 1 in 10 people): headache, especially during the first few days; often eases with continued use or acetaminophen. Common (1–10 in 100 people): dizziness, light-headedness, flushing, burning or tingling at the application site. Uncommon (1–10 in 1,000 people): rapid heartbeat, nausea, blurred vision. Rare but serious: severe drop in blood pressure causing fainting, allergic skin rash, or chest pain. Most mild side effects pass within 30–60 minutes. Stop use and seek medical help if you faint, feel chest pain, or notice swelling of the face or throat.
Store at room temperature 68–77°F (20–25°C). Keep the tube tightly closed and protect from heat, moisture, and direct light. Do not freeze. Keep out of reach of children and pets. Check the beyond-use date on the label and discard any leftover ointment after that date. Dispose of unused product through a pharmacy take-back program or place it in a sealed plastic bag mixed with coffee grounds before throwing it in the household trash.
Frequently Asked Questions
Q:How much ointment should I apply each time?
A:A pea-sized amount (about 0.1 inch of ointment) is usually enough. Spread it gently on the inside and just outside of the anus as your provider showed you.
Q:When will my pain get better?
A:Many people feel less pain within 15–30 minutes after each dose, but healing the fissure can take 2–6 weeks. Keep using it as directed even if symptoms improve early.
Q:What if the headache is too strong?
A:Headaches are common at first. Try using the smallest amount that still helps, resting in a dark room, or taking acetaminophen if your doctor approves. If headaches remain severe or stop you from using the medicine, call your healthcare provider.
Q:Can I drink alcohol while using this ointment?
A:Limit alcohol because it can widen blood vessels even more and make dizziness or fainting more likely. If you choose to drink, do so in moderation and stand up slowly.
Q:Is it safe during pregnancy or while breastfeeding?
A:Safety data in pregnancy and breastfeeding are limited. Use only if your provider decides the benefits outweigh the risks. Discuss all options with your obstetrician before starting.
Q:Can I use a hemorrhoid cream at the same time?
A:Ask your provider first. Some over-the-counter creams may be fine, but using too many products can irritate the skin. Apply different products at least one hour apart unless told otherwise.
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