The Scottish Medicines Consortium has rejected Glyceryl Trinitrate 0.4% Ointment (Rectogesic) for use in Scotland.
The advice issued by the Consortium agrees that this product lowers pain scores more than a placebo ointment but they felt the effect was small and that an economic case for use was not demonstrated. This economic case was made based up healing rates compared to surgery, but rectogesic is not licensed to heal anal fissures.
Action: Symptomatic treatment of anal fissures at presentation should be based on lifestyle advice about diet and bowel habit. Prescriptions for products containing topical steroids or anaesthetics may be appropriate for management of pain and inflammation.