What Is Rectiv?

Rectiv is the brand name for nitroglycerin 0.4% rectal ointment, the only FDA-approved topical medication specifically designed to treat moderate-to-severe pain associated with chronic anal fissures. It was approved by the FDA in 2011 and is manufactured by Allergan (now part of AbbVie).

If you've been dealing with the sharp, burning pain of an anal fissure that hasn't healed with basic home treatments, Rectiv may be the next step your doctor recommends. This guide covers everything patients need to know about Rectiv in 2026 — from how it works to how much it costs.

What Does Rectiv Treat?

Rectiv is indicated for one specific condition: moderate-to-severe pain caused by chronic anal fissures.

What Is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anus. These tears are surprisingly common and can cause intense, sharp pain during and after bowel movements, along with bright red bleeding. Common causes include:

• Passing hard or large stools (often due to constipation)
• Chronic diarrhea
• Childbirth
• Straining during bowel movements
• Inflammatory bowel disease (Crohn's disease)

Acute vs. Chronic Anal Fissures

Most anal fissures are acute — they heal on their own within 4-6 weeks with conservative measures like increased fiber intake, stool softeners, warm sitz baths, and topical pain relievers. When a fissure doesn't heal within 6-8 weeks, it's considered chronic. Chronic fissures often develop a cycle where the internal anal sphincter spasms, reducing blood flow to the area and preventing healing.

This is exactly where Rectiv comes in. By relaxing the internal anal sphincter, it breaks this cycle and promotes healing. For a deeper look at the science, see our guide on how Rectiv works.

How Does Rectiv Work?

Rectiv's active ingredient is nitroglycerin — the same compound used in heart medications, but in a much lower concentration and applied locally. When applied to the anal canal, nitroglycerin is converted to nitric oxide (NO), which:

• Relaxes the internal anal sphincter — reducing the spasm that causes pain and prevents healing
• Increases blood flow to the fissure — promoting tissue repair
• Reduces pain — both directly through sphincter relaxation and indirectly through improved healing

Think of it like this: the fissure can't heal because the muscle around it keeps squeezing tight. Rectiv tells that muscle to relax, giving the fissure the breathing room it needs to close up.

How to Use Rectiv: Dosage and Application

Standard Dosing

The standard Rectiv dosage is:

• Amount: 1 inch of ointment (approximately 375 mg of ointment, containing 1.5 mg of nitroglycerin)
• Frequency: Every 12 hours (twice daily)
• Duration: Up to 3 weeks
• Route: Intra-anal application

Application Instructions

1. Wash your hands thoroughly before and after application
2. Cover your finger with a finger cot or plastic wrap (included with the medication)
3. Squeeze 1 inch of ointment onto the covered finger — use the dosing line printed on the medication packaging as a guide
4. Gently insert the covered finger with ointment into the anal canal up to the first finger joint
5. Apply the ointment around the inside of the anal canal
6. Wash your hands again after application

Important Application Tips

• Apply at roughly the same times each day (e.g., morning and evening) to maintain consistent levels
• If you miss a dose, apply it as soon as you remember — unless it's almost time for the next dose, in which case skip the missed one
• Do not use more than 1 inch per application — more medication increases side effects without improving effectiveness
• Store at room temperature, away from heat and moisture

Rectiv Side Effects

Like all medications, Rectiv can cause side effects. The most common include:

• Headache (up to 64% of patients) — the most frequent side effect, caused by nitroglycerin dilating blood vessels throughout the body
• Dizziness and lightheadedness — related to blood pressure lowering effects
• Low blood pressure (hypotension) — especially when standing up quickly
• Flushing — warmth or redness in the face
• Nausea — typically mild
• Rapid heart rate (tachycardia) — the body's response to blood pressure changes

Most side effects are temporary and improve within the first week of treatment. For a complete guide on managing side effects and knowing when to seek help, read our detailed article on Rectiv side effects.

Who Should NOT Use Rectiv

Rectiv is not safe for everyone. You should not use Rectiv if you:

• Take PDE5 inhibitors — medications like Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil). Combining these with Rectiv can cause dangerous, life-threatening drops in blood pressure.
• Use other nitrate medications — such as isosorbide mononitrate or isosorbide dinitrate (used for chest pain/angina)
• Have severe anemia
• Have increased intracranial pressure
• Are allergic to nitroglycerin or other nitrates

Be sure to tell your doctor about all medications you take. For more details, see our guide on Rectiv drug interactions.

How Much Does Rectiv Cost?

Rectiv is not a cheap medication. Here's what to expect in 2026:

• Cash price (without insurance): $500 to $900+ per 30g tube
• With insurance: Coverage varies widely. Many insurance plans require prior authorization, and copays can still be significant.
• No FDA-approved generic: As of 2026, there is no generic version of Rectiv on the market, which keeps prices high.

Ways to Save on Rectiv

Don't let sticker shock stop you from getting treatment. There are several ways to reduce the cost:

• Manufacturer savings programs — AbbVie may offer patient assistance
• Prescription discount cards — Services like GoodRx, SingleCare, and RxSaver can sometimes reduce the cash price
• Compounded alternatives — A compounding pharmacy can prepare nitroglycerin ointment for $30-$100
• Insurance appeals — If your insurer denies coverage, your doctor can submit a prior authorization or appeal

For a complete breakdown of savings strategies, read our guide on how to save money on Rectiv.

Rectiv Availability in 2026

One of the biggest challenges patients face is simply finding Rectiv in stock. As a single-source brand medication for a niche condition, supply has been inconsistent. If you're struggling to locate Rectiv, use MedFinder to check pharmacy availability in real time.

Rectiv vs. Other Treatments for Anal Fissures

Rectiv is one of several treatment options for chronic anal fissures:

Rectiv is typically tried before more invasive options. If Rectiv is unavailable or not working, your doctor can discuss alternatives.

Key Takeaways

• Rectiv is the only FDA-approved topical treatment for chronic anal fissure pain
• Apply 1 inch of ointment intra-anally every 12 hours for up to 3 weeks
• Headache is the most common side effect (up to 64% of patients)
• Never use Rectiv with Viagra, Cialis, Levitra, or other nitrate medications
• Cost ranges from $500-$900+ without insurance — savings programs and compounded alternatives are available
• Use MedFinder to check real-time availability at pharmacies near you