When Rectiv Isn't Available: Your Options for Anal Fissure Treatment

If you've been prescribed Rectiv (Nitroglycerin 0.4% rectal ointment) and can't find it at your pharmacy, you're not alone. Rectiv has been in short supply for years, and many patients are left wondering what else they can use to treat their chronic anal fissure pain.

The good news is that there are several alternatives worth discussing with your doctor. In this guide, we'll cover the most common options — from compounded versions of the same active ingredient to entirely different treatment approaches.

Important: Never switch medications or stop treatment without talking to your doctor first. The right alternative depends on your specific situation.

Alternative #1: Compounded Nitroglycerin Ointment

This is the closest alternative to brand-name Rectiv. Compounding pharmacies can prepare Nitroglycerin ointment in concentrations ranging from 0.2% to 0.4%, which is the same active ingredient found in Rectiv.

Pros:

• Same active ingredient as Rectiv
• Much more affordable — typically $30 to $100 per tube
• More widely available than brand-name Rectiv
• Concentration can be customized to your needs

Cons:

• Not FDA-approved (compounded medications are regulated differently)
• Quality may vary between compounding pharmacies
• Insurance may not cover compounded medications

To find a compounding pharmacy, ask your doctor for a recommendation or search through the Professional Compounding Centers of America (PCCA) directory.

Alternative #2: Topical Diltiazem

Topical Diltiazem is a calcium channel blocker that, like Nitroglycerin, relaxes the internal anal sphincter muscle. It's commonly prepared by compounding pharmacies at a concentration of 2%.

Pros:

• Lower incidence of headaches compared to Nitroglycerin (headaches are the most common Rectiv side effect, affecting up to 64% of patients)
• Available through compounding pharmacies
• Well-studied for anal fissure treatment
• Often more affordable than brand-name Rectiv

Cons:

• Not FDA-approved for anal fissures (used off-label)
• Must be compounded — not available as a standard prescription
• May be slightly less effective than Nitroglycerin for some patients

Many colorectal specialists consider Diltiazem a first-line alternative when Rectiv is unavailable. If you're experiencing significant headaches with Nitroglycerin, Diltiazem may actually be a better option for you.

For more about Rectiv side effects, see: Rectiv side effects: What to expect and when to call your doctor

Alternative #3: Topical Nifedipine

Nifedipine is another calcium channel blocker that can be compounded into a topical ointment for anal fissure treatment. It works similarly to Diltiazem by relaxing the anal sphincter.

Pros:

• Effective at promoting fissure healing
• Fewer headaches than Nitroglycerin
• Available through compounding pharmacies

Cons:

• Not FDA-approved for this use
• Less commonly prescribed than Diltiazem in the United States
• Must be compounded

Alternative #4: Botox (Botulinum Toxin) Injections

For patients who don't respond to topical treatments or who can't tolerate them, Botox injections into the internal anal sphincter are another option. This is an in-office or outpatient procedure performed by a colorectal specialist.

Pros:

• No daily application required
• Can be effective when topical treatments fail
• Effects last several months

Cons:

• Requires a procedure — not a simple prescription
• Can be expensive, especially without insurance
• Small risk of temporary fecal incontinence
• May need repeat injections

Alternative #5: Conservative Treatments

While not direct replacements for Rectiv, several conservative measures can help manage anal fissure symptoms and support healing:

• Sitz baths — Soaking in warm water for 10-15 minutes several times daily can reduce pain and promote blood flow
• Stool softeners — Products like docusate sodium help prevent hard stools that aggravate fissures
• Fiber supplements — Psyllium husk or methylcellulose increase stool bulk and softness
• Adequate hydration — Drinking plenty of water supports softer stools
• Topical lidocaine — Over-the-counter numbing ointments can provide temporary pain relief

These measures are often recommended alongside Rectiv or its alternatives, not as complete replacements. But they can make a real difference in your comfort level while you work to find a more targeted treatment.

Alternative #6: Surgery (Lateral Internal Sphincterotomy)

For chronic anal fissures that don't respond to medical treatment, surgery may be recommended. Lateral internal sphincterotomy (LIS) involves making a small cut in the internal anal sphincter muscle to permanently reduce spasm.

Pros:

• Highest success rate of any anal fissure treatment (over 90%)
• One-time procedure with lasting results

Cons:

• Invasive — requires anesthesia and recovery time
• Small risk of fecal incontinence (typically minor and temporary)
• Usually reserved for fissures that haven't healed with other treatments

Surgery is typically considered a last resort after topical treatments and Botox have been tried.

How to Talk to Your Doctor About Alternatives

If you can't find Rectiv, schedule an appointment or call your doctor's office. Here are some helpful questions to ask:

1. "Can you prescribe compounded Nitroglycerin ointment as an alternative to Rectiv?"
2. "Would topical Diltiazem be appropriate for my situation?"
3. "Do you know of any pharmacies that currently have Rectiv in stock?"
4. "Should I be considering other treatment approaches if Rectiv remains unavailable?"

Your doctor can help you weigh the pros and cons of each option based on your medical history and the severity of your fissure.

You can also use MedFinder to check whether Rectiv has become available in your area. For tips on finding it, see: How to find Rectiv in stock near you

The Bottom Line

Rectiv may be hard to find, but you have options. Compounded Nitroglycerin ointment is the closest direct alternative and is usually more affordable and easier to obtain. Topical Diltiazem is another well-established option with fewer headaches. For tougher cases, Botox and surgery are available.

Don't let a medication shortage keep you from getting treatment. Talk to your doctor, explore your alternatives, and use tools like MedFinder to stay on top of Rectiv availability.