Your Patients Can't Find Rectiv — Here's How You Can Help

As a healthcare provider, you've likely had patients return to your office frustrated and in pain because they couldn't fill their Rectiv (Nitroglycerin 0.4% rectal ointment) prescription. The ongoing Rectiv shortage has made this a common scenario, and your patients are looking to you for guidance.

This guide provides practical, actionable steps you can integrate into your workflow to help patients access Rectiv — or appropriate alternatives — as efficiently as possible.

Understanding the Scope of the Problem

Rectiv is the only FDA-approved topical Nitroglycerin product for chronic anal fissure pain. It's manufactured exclusively by Allergan (AbbVie), and there is no FDA-approved generic. This single-source, niche-market reality means:

• Most retail pharmacies don't routinely stock Rectiv
• Supply is intermittent and regionally variable
• Patients often need to contact multiple pharmacies before finding stock
• Many patients give up and go untreated

For a detailed analysis of the shortage, see: Rectiv shortage: What providers and prescribers need to know in 2026

Step 1: Check Availability Before Prescribing

One of the most impactful things you can do is verify pharmacy stock before sending a prescription. This prevents the frustrating cycle of patients going to a pharmacy only to be told the drug isn't available.

Use MedFinder for Providers

MedFinder for Providers is designed for exactly this situation. It allows you to:

• Search for pharmacies near your patient that have Rectiv in stock
• Check real-time availability across multiple pharmacy locations
• Send prescriptions to pharmacies where the drug is actually available

Integrating a quick MedFinder check into your prescribing workflow can save your patients significant time and frustration.

Direct Patients to MedFinder

You can also direct patients to medfinder.com so they can check availability themselves. This empowers patients to be proactive and reduces the volume of pharmacy-related calls to your office.

Step 2: Establish Compounding Pharmacy Relationships

Given the unreliability of brand-name Rectiv supply, having a compounding pharmacy in your network is essential. Compounded Nitroglycerin ointment (0.2%-0.4%) is the most direct alternative and is reliably available.

Identifying Quality Compounding Pharmacies

When selecting a compounding pharmacy partner, look for:

• PCCA membership: Professional Compounding Centers of America members have access to standardized formulations and quality ingredients
• ACHC or URAC accreditation: Third-party accreditation indicates adherence to quality standards
• State licensure: Verify the pharmacy is properly licensed in your state
• Experience with rectal/topical formulations: Not all compounding pharmacies have equal expertise in all dosage forms

Streamlining the Compounding Process

To make prescribing compounded medications as smooth as possible:

• Keep the compounding pharmacy's fax number and phone number readily available in your EHR or prescribing system
• Create a template prescription for compounded Nitroglycerin ointment with your preferred concentration, quantity, and directions
• Establish a process for your staff to contact the compounding pharmacy directly when Rectiv is unavailable
• Consider maintaining a list of 2-3 compounding pharmacies in your area as backups

Step 3: Develop a Standard Protocol for Rectiv Unavailability

Rather than addressing each case individually, create a standardized approach for your practice:

Recommended Protocol:

1. First attempt: Prescribe Rectiv and check MedFinder for availability
2. If unavailable at nearby pharmacies: Contact your preferred compounding pharmacy and prescribe compounded Nitroglycerin 0.4% ointment
3. If patient can't tolerate Nitroglycerin (e.g., severe headaches): Consider topical Diltiazem 2% (also compounded)
4. If topical therapy fails after 6-8 weeks: Consider Botulinum toxin injection or surgical referral

This protocol ensures that no patient falls through the cracks and that alternatives are offered proactively.

Step 4: Proactive Patient Communication

Setting expectations at the time of prescribing can prevent a lot of downstream frustration:

What to Tell Patients When Prescribing Rectiv:

• "Rectiv can sometimes be difficult to find at pharmacies. If your pharmacy doesn't have it, don't worry — we have backup plans."
• "You can check medfinder.com to see which pharmacies near you have it in stock."
• "If you can't find it within a day or two, call our office and we'll switch you to a compounded alternative."
• "The most important thing is that you start treatment. We have several options that work well."

Patient Handout Suggestion

Consider creating a simple handout for patients prescribed Rectiv that includes:

• Link to MedFinder
• Names of 2-3 local compounding pharmacies
• Your office phone number for follow-up if they can't find the medication
• A brief explanation of why the shortage exists

Step 5: Address Cost Barriers

Even when patients can find Rectiv, cost can be a significant barrier. Brand-name Rectiv can cost $500-$900+ per tube without insurance, and many insurance plans require prior authorization.

Cost-Reduction Strategies for Your Patients:

• Compounded alternatives: $30-$100 (dramatically cheaper than brand)
• AbbVie patient assistance programs: For eligible uninsured or underinsured patients
• Pharmacy discount programs: GoodRx, SingleCare, and other coupon services may reduce brand-name cost
• Insurance appeals: If prior authorization is denied, consider appealing with clinical documentation

For comprehensive cost information to share with patients: How to save money on Rectiv in 2026

For provider-specific cost strategies: How to help patients save money on Rectiv

Step 6: Document and Report

Clinical Documentation

When the shortage forces a change in treatment plan, document it clearly in the patient's chart:

• Note that brand-name Rectiv was unavailable
• Document the alternative prescribed and clinical rationale
• Record any patient education provided about alternatives
• Note any adverse effects from the alternative (for future reference)

Report to the FDA

Provider reports to the FDA carry significant weight. Reporting the shortage helps the FDA:

• Assess the scope and severity of the problem
• Prioritize engagement with the manufacturer
• Consider expedited review of generic applications

Report shortages through the FDA Drug Shortage Program.

Key Reminders for All Nitroglycerin Formulations

Whether prescribing brand-name Rectiv or compounded Nitroglycerin, remember:

• Absolute contraindication: Concurrent use with PDE5 inhibitors (Sildenafil, Tadalafil, Vardenafil) — risk of severe hypotension
• Drug interactions: Screen for other nitrates, antihypertensives, and alcohol use
• Most common side effect: Headache (up to 64% of patients) — counsel patients in advance
• Duration of therapy: Typically up to 3 weeks; reassess if fissure doesn't heal
• Application: 1 inch of ointment (approximately 375mg of ointment) applied intra-anally every 12 hours

For detailed interaction guidance: Rectiv drug interactions: What to avoid

Summary: A Provider's Checklist

• ☐ Bookmark MedFinder for Providers and check before prescribing
• ☐ Establish relationships with 2-3 local compounding pharmacies
• ☐ Create a standard protocol for when Rectiv is unavailable
• ☐ Prepare patient communication (verbal and written) about the shortage
• ☐ Know the cost-reduction options available to patients
• ☐ Document treatment changes in the chart
• ☐ Report the shortage to the FDA

Your proactive approach can make the difference between a patient getting effective treatment and one who suffers unnecessarily. The shortage is frustrating, but with the right systems in place, you can ensure your patients continue to receive the care they need.