Treatment Non-Compliance due to Glyceryl Trinitrate Side Effects in Anal Fissure

Objective: Anal fissures generally respond very well to the glyceryl trinitrate (GTN) ointment. However, it is associated with side effects like headache and hypotension.  The objective was to evaluate the noncompliance of patients with topical glyceryl trinitrate due to its side effect in the management of anal fissure.  Methodology:  After taking ethical approval, a prospective case series was conducted at IIMCT-Pakistan Railway Hospital over a period from 1st March, 2023 to 31st August 2023. A sample size of 112 was calculated using WHO calculator 1.1 and these many patients were subsequently studied for side-effects of GTN and their compliance to the therapeutic regime. Results: Of 122 patients studied: 62 (55.4%) were males, mean age was 35.35±10.22 years and mean daily doses of GTN was 2.31±0.56. Sixty-five (53%) of the patients using topical GTN reported side effects. Headache and postural hypotension were the most commonly reported side effects: 29.5% and 21.4% reported these side effects, respectively. Non-compliance was noted in only 14 patients (12.5%). Headache contributed 78.6% whereas postural hypotension & palpations contributed 21.4% towards the non-compliant cases. Thus, these two side effects were the only ones contributing towards non-compliance and had statistically highly significant association with non-compliance at a p value of 0.001. 94% of the compliant patient completely healed completely whereas only 2% of non-compliant patients achieved healing till 3-month follow-up: these results were significant at p<0.001. Conclusion: Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing.