Rectiv ointment contains nitroglycerin, a nitrate that dilates (widens) blood vessels.

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

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

You should not use Rectiv ointment 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).

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

Before using Rectiv, tell your doctor if you have congestive heart failure, low blood pressure, glaucoma, liver disease, migraine headaches, or a history of heart attack, stroke, or circulation problems.

Do not use Rectiv without the advice of a doctor 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.

Rectiv can cause severe headaches, which may occur each time you use the medication. Your doctor may recommend treating fever and pain with an aspirin free pain reliever such as acetaminophen (Tylenol). Follow the label directions or your doctor's instructions about how much of this medicine to use.

Use Rectiv ointment exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Rectiv 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 Rectiv.

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

Apply 1 inch of Rectiv ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra-anally every 12 hours for up to 3 weeks. A finger covering, such as plastic-wrap, disposable surgical glove or a finger cot, should be placed on the finger to apply the ointment. To obtain a 1.5 mg dose of nitroglycerin, the covered finger is laid alongside the 1 inch dosing line on the carton.

The tube is gently squeezed until a line of ointment the length of the measuring line is expressed onto the covered finger. The ointment is gently inserted into the anal canal using the covered finger no further than to the first finger joint and the ointment is applied around the side of the anal canal. If this cannot be achieved due to pain, application of the ointment should be made directly to the outside of the anus. Treatment may be continued for up to three weeks.

Rectiv ointment is not for oral, ophthalmic, or intravaginal use. Hands should be washed after application of the ointment.

You should not use Rectiv ointment if you are allergic to nitroglycerin, or if you have:

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

• increased pressure inside the skull; or

• if you also use erectile dysfunction medicine such as Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil, or vardenafil.

Do not use Rectiv 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.

Tell your doctor if you have ever had:

• congestive heart failure;

• heart attack;

• a blood vessel disorder;

• low blood pressure; or

• headaches.

Tell your doctor if you are pregnant or breastfeeding.

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

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of nitroglycerin can be fatal.

Overdose symptoms may include a severe throbbing headache, confusion, fever, fast or pounding heartbeats, dizziness, vision problems, vomiting, bloody diarrhea, trouble breathing, cold or clammy skin, fainting, and seizures.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Drinking alcohol can increase certain side effects such as dizziness, drowsiness, feeling light-headed, or fainting.

Avoid getting this medicine in your eyes, mouth, or vagina.

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

Call your doctor at once if you have:

• pounding heartbeats or fluttering in your chest;

• slow heart rate;

• a light-headed feeling, like you might pass out; or

• heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Nitroglycerin can cause severe headaches. These headaches may gradually become less severe as you continue to use Rectiv. Do not stop using this medicine. Ask your doctor before using any headache pain medication.

Common Rectiv 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.

Tell your doctor about all your current medicines, especially:

• aspirin or heparin;

• medicine used to treat blood clots;

• blood pressure medication;

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

• other nitroglycerin medication.

This list is not complete and many other drugs may interact with nitroglycerin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.