Rectiv (nitroglycerin 0.4% ointment) is difficult to find at pharmacies. Learn why there's a shortage and what you can do to get your prescription filled.
If you've been prescribed Rectiv (Nitroglycerin 0.4% rectal ointment) for anal fissure pain, you may have already discovered the frustrating reality: many pharmacies simply don't carry it. You're not imagining things — Rectiv has been one of the hardest prescription medications to find in recent years, and the problem has continued into 2026.
In this article, we'll explain exactly why Rectiv is so hard to find, what's behind the shortage, and what steps you can take to get your prescription filled.
Rectiv is the brand name for Nitroglycerin 0.4% rectal ointment. It's the only FDA-approved topical treatment specifically designed to relieve moderate-to-severe pain caused by chronic anal fissures.
An anal fissure is a small tear in the lining of the anus. It can cause intense pain, especially during and after bowel movements. Rectiv works by relaxing the internal anal sphincter muscle. This increases blood flow to the area, helps reduce spasm, and allows the fissure to heal.
Rectiv was approved by the FDA in 2011 and is manufactured by Allergan, which is now part of AbbVie. Despite being the only approved treatment in its category, Rectiv has faced ongoing supply problems.
Rectiv is made by only one manufacturer — Allergan (AbbVie). There is no FDA-approved generic version of Nitroglycerin 0.4% rectal ointment on the market. When there is only one company producing a drug, any disruption in their production process can lead to widespread shortages.
Chronic anal fissures are a relatively common condition, but the number of patients who specifically need Rectiv is small compared to blockbuster medications. This means pharmacies have less financial incentive to keep Rectiv on their shelves. Many retail pharmacies — including large chains — simply don't stock it at all.
Like many specialty medications, Rectiv has been affected by broader supply chain issues in the pharmaceutical industry. Manufacturing delays, raw material shortages, and distribution bottlenecks have all contributed to periods when Rectiv is simply unavailable through normal channels.
For most brand-name drugs, generic competition eventually brings prices down and increases supply. But as of 2026, there is no FDA-approved generic version of Rectiv. This means patients can't simply switch to a cheaper, more widely available alternative at their local pharmacy.
Even when Rectiv is technically in stock, insurance coverage can be a barrier. Many insurance plans require prior authorization before they'll cover Rectiv. Some plans don't cover it at all. These hurdles can delay treatment and push patients toward other options, which further reduces demand and makes pharmacies even less likely to stock it.
As of early 2026, Rectiv continues to experience intermittent supply issues. The FDA has periodically listed Rectiv on its drug shortage database. Availability varies by region — some areas of the country have better access than others, but overall, finding Rectiv remains a challenge for many patients.
For the latest updates on the Rectiv shortage, see our dedicated article: Rectiv shortage update: What patients need to know in 2026.
Instead of calling pharmacy after pharmacy, use a tool like MedFinder to check which pharmacies near you currently have Rectiv in stock. This can save you hours of frustrating phone calls.
While there is no FDA-approved generic Rectiv, compounding pharmacies can prepare Nitroglycerin ointment at various concentrations (typically 0.2% to 0.4%). This is often significantly cheaper than brand-name Rectiv and may be easier to obtain. Talk to your doctor about whether a compounded version is right for you.
For more details on alternatives, read our guide: Alternatives to Rectiv if you can't fill your prescription.
Large chain pharmacies often have the most limited stock of niche medications. Independent pharmacies and specialty pharmacies may be more willing and able to order Rectiv for you or offer a compounded alternative.
If Rectiv is truly unavailable, your doctor may recommend other treatments for anal fissures, including topical Diltiazem (a calcium channel blocker), Botox injections into the anal sphincter, sitz baths, stool softeners, or in severe cases, surgery (lateral internal sphincterotomy). These are not direct substitutes for Rectiv, but they may help manage your condition while you wait for supply to improve.
AbbVie (the parent company of Allergan) offers patient assistance programs that may help eligible patients access Rectiv at reduced cost or for free. You can also check resources like NeedyMeds and RxAssist for additional programs.
For tips on saving money, see: How to save money on Rectiv in 2026.
Rectiv is hard to find because it's a single-source brand-name medication with no FDA-approved generic, serving a relatively small patient population. Supply chain disruptions and low pharmacy stocking levels make the problem worse.
But you're not without options. Tools like MedFinder can help you locate pharmacies that have Rectiv in stock. Compounded alternatives, specialty pharmacies, and patient assistance programs can also help you get the treatment you need.
Don't give up — and don't suffer in silence. Anal fissures are a treatable condition, and there are paths to getting your medication even when supply is tight.
You focus on staying healthy. We'll handle the rest.
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