Medical References
Nitroglycerin Ointment 0.2%


I was not aware of the Nitroglycerin ointment when I had a fissure. From what I have read since I started these pages, I would have certainly tried it. From what I can tell, Dr. Gorfine is a big proponent of this treatment and an early adopter of prescribing it to his patients. This is understandable considering the good experience he has had in using it as a treatment. He reports on these experiences in his papers. I have traded several email messages with Dr. Gorfine and he has given me the text of one of his papers that I have included. Dr. Gorfine has offered to help with email questions. So if you have a question for him, he can be reached at I don't think Dr. Gorfine answers email questions any more. 9/19/01 Jack.

Note that I think that the GTN ointment and NGT ointment both refer to glyceryl trinitrate. I do not know why there are two names for it.

From Tue Jan 7 19:18:12 1997
Subject: NTG

Dear Jack,

Your page is most useful. A number of my patients have "visited" your page prior to seeing me.

The use of NTG ointment as the initial treatment of anal fissures has become more popular as evidence of the effectiveness of this therapy accumulates in the medical literature. The most recent article was published last Saturday in the Lancet (Lund and Scholefield. A randomized, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate in treatment of anal fissures. Lancet 1997;349:11-14). This very elegant study showed that NTG healed 68% of fissures in 8 weeks or less whereas placebo healed only 8% in the same time. Headache was the only side effect.

I am a bit disturbed to see that some patients writing to you have been given NTG 2% by their doctors. The dosage used in the medical reports is 0.2%, ten times less concentrated. Headache with NTG 2% is a virtual certainty. I believe that the problem results from the fact that NTG 0.2% is not commercially available, whereas NTG 2% (for cardiac usage) is. Use of NTG 2% for fissures is NOT recommended! The pharmacy must compound the lower strength. The NTG 2% is diluted with white petrolatum 10:1. It must be used within the anal canal for maximal benefit.

I continue to use NTG 0.2% for my fissure patients with very gratifying results. Keep up the good work!

Stephen R. Gorfine, MD

From Sat Jan 11 05:49:49 1997

Dear Jack,

I would be honored to have you post my paper on your home page. The one you picked is a review which was prepared for a course entitled Controversies in General Surgery. You may post the paper without revision.

If you want, I can offer some help with the email questions that you get. If you forward them to me (Dr. Gorfine), I can send you an answer that may be of some help. I don't think Dr. Gorfine answers email questions any more. 9/19/01 Jack.


Date: Sun, 26 Jan 1997 12:20:37

Just a short note to let you know of my progress. I have been in touch with Dr. Gorfine and he truly is a remarkable man. I will foward you some valid information regarding the correct usage of NTG ointment. It seems my doctor's intructions were quite contradictory and therefore not as effective as it could have been. I think one very important element is time. My doctor was ready to operate after only 2 weeks on NTG therapy. If you read Dr. Gorfine's letter to me it is clear that most people given enough time will resolve the situation.

I am now 80% better and still have some occasional discomfort. My life for the mostpart has returned to normal. Thanks mostly to the advice of patient 6. I will now try and complete my recovery with the correct usage of NTG therapy as well as baths, metamusil, stool softeners and a diet with fiber and lots and lots of water. I also plan on fowarding Dr. Gorfine my file and seeing him instead of my local specialist. Luckily I live near enough to do that.

I spoke to Dr. Gorfine today at length. He is a rare and wonderful physician. I have an appointment with him on the 11th of Feb. He was incredibly helpful and supportive. Its very important that the ointment be used the correct way for maximum results. I now feel that I am well on my way to 100% cure. Just using the ointment 3 days correctly has already made a difference.

Mon, 8 Jul 96 04:40:09

This was emailed to me on: Mon, 8 Jul 96 04:40:09 UT, many thanks to the anonymous donor of this information. I have not read these references, but I would like to get them someday and read them.

There is a new non-surgical treatment for anal fissures. Nitroglycerin ointment 0.2% applied to the anal canal has been shown to heal fissures within 6 to 8 weeks. see:

  1. Gorfine SR. Treatment of benign anal disease with topical nitroglycerin. Dis Colon Rectum 1995;38:453-457.
  2. Gorfine SR. Topical nitroglycerin therapy for anal fissures and ulcers [letter]. N Engl J Med 1995;333:1156-1157.
  3. Schouten WR, Briel JW, Auwerda JJ, Boerma MO, Graatsma BH, Wilms EB. [Intra-anal application of isosorbide dinitrate in chronic anal fissure]. Ned Tijdschr Geneeskd 1995 Jul 15 1995;139:1447-1449.
  4. Lund JN, Armitage NC, Scholefield JH. Use of glyceryl trinitrate ointment in the treatment of anal fissure. Br J Surg 1996;83:776-777.
  5. There are many more references in my web version of Dr. Gorine's paper.

Joe is going to try this approach. I hope it works for him and that he lets us know how everything comes out.

Wed Aug 28 22:19:35 1996

Another source sent me this information:

Here's the info you asked for regarding the Dr. Gorfine study: The study was found in NEJM Home October 26, 1995 - - Volume 333, Number 17. Topical Nitroglycerin Therapy for Anal Fissures and Ulcers.

My husband actually spoke with Dr. Gorfine yesterday and he said that since the case study, he's treated over 250 patients with nitro with a 80% success rate. He has lowered the dosage from .3% to .2% to decrease the headaches. So there is hope. Although I just E-mailed a Dr. Brendler who calls himself the Butt Dr. He doesn't know much about the nitro, but he was concerned about unhealing ulcers ie. cancer. Yikes!

How to participate in Clinical Trials of Nitroglycerin drug.

From: Michael Crowley
Subject: Clinical trial for pain relief of chronic anal fissures with nitroglycerin ointment
Date: Aug 10, 2000

This trial is no longer available. - Jack

Dear Jack,

I wanted to let you and your readers know that Cellegy Pharmaceuticals is conducting a clinical trial to assess pain relief of chronic anal fissures using it's nitroglycerin ointment, Anogesic. This study will also assess healing of anal fissures as a result of treatment with nitroglycerin ointment. The study is being conducted in approximately 15 study centers nationwide. Further information, including study center locations, can be found at the following web site:

Thanks for passing on the news.

Yours truly,
Mike Crowley

This trial is no longer available. - Jack

Michael P. Crowley, Ph.D.
Cellegy Pharmaceuticals, Inc.
349 Oyster Point Boulevard, Suite 200
South San Francisco, CA 94080
(650) 616-2227

Date: Mon, 14 Aug 2000 20:15:20 EDT
Subject: Anal fissure

Nitroglycerin -(.2%) for those wanting to try this - you can order it yourself WITHOUT a prescription from:

Pharmacydirect in Australia
Phone: Sydney (02) 9648 8888 (have to get out of counrty first then dial this number - they take credit card)
FAX: Sydney Same number

It comes under the name rectogesic and costs about $25.00 - $30.00 U.S. dollars. It states on the box for Anal fissure. Only use a drop because any more can cause headaches. Directions are on the package. I didn't find this that useful. You have to get it inside which is very painful and it did not take away pain for me.

This is the visit to this page since 27 Jan 97.
Last modified: 3 Dec 11, removed note on new clinical trial because it has been a long time and the link is dead.
Last modified: 2 Aug 07, added note on new clinical trial.
Last modified: 6 Jun 05, added note on GTN and NGT being the same thing.
Last modified: 9 Jan 04, Changed mail link.
Last modified: 21 Aug 00
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