Rectogesic Special Precautions

Concomitant use with other nitrates: Concurrent treatment with Rectogesic and anti-anginal products containing nitrates may interfere with 'nitrate free period' dosage arrangements for the anti-anginal drug. If a patient is already using glyceryl trinitrate or other nitrates for cardiac disease then using Rectogesic could potentially cause tachyphylaxis by eliminating the nitrate free interval. Where another nitric oxide donor anti-anginal drug is used concurrently, Rectogesic should not be used during the nitrate-free dosage arrangements for that product.
Use in renal/hepatic impairment: No specific information concerning the usage of Rectogesic in renal or hepatic impairment is available.
Other precautions: GTN can interfere with the measurement of catecholamines and vanilmandelic acid in the urine, as it increases the excretion of these substances.
Treatment should be stopped if anal bleeding increases.
Patients should be advised to change position slowly when changing from lying or sitting to upright to minimise postural hypotension, especially in patients with low blood volume and under diuretic treatment.
Paradoxical bradycardia and increased angina pectoris may accompany GTN induced hypotension.
If the physician elects to use GTN in patients with acute myocardial infarction or congestive heart failure, careful monitoring should be undertaken to avoid hypotension and tachycardia.
Effect on ability to drive or operate machinery: As patients may experience faintness and/or dizziness, particularly the elderly, reaction time when driving or operating machinery may be impaired especially at the start of treatment.
Use in Pregnancy & Lactation: See USE IN PREGNANCY & LACTATION section for further information.
Use in Children: The safety and effectiveness of glyceryl trinitrate in children have not been established.
Use in the Elderly: No specific information concerning the usage of Rectogesic in the elderly is available.