The Scottish Medicines Consortium (SMC) has rejected Glyceryl Trinitrate 0.4% Ointment (Rectogesic)® for use on the NHS in Scotland for a second time.
The SMC accept that this product is associated with a very small decrease in pain the economic case has not been demonstrated. The economic case is based on a comparison to Anacal, Anusol and Xyloproct all of which are licensed for the relief of pain associated with anal fissures. Rectogesic is about 10 times more expensive than these products.
Action: First line treatment of anal fissures 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.