Nicorandil, serious side effects (ulceration)

Some patients who take nicorandil tablets have developed ulcers - particularly mouth, eye or skin ulcers....
Abdelwahab Ward, BS Pharm, PharmD

Angina is chest pain originating from reduced blood flow to the heart muscle, often due to coronary artery narrowing, which restricts oxygen delivery, particularly during exertion.

Nicorandil (Adancor, Randil), a potassium-channel opener with nitrate properties, serves as a vasodilator for treating angina when first-line options fail. It reduces cardiac preload and afterload while improving coronary blood flow.

  • Usual dosing is 10–20 mg twice daily, with adjustments to minimize side effects like headache. Absorbed rapidly, Nicorandil peaks within 30-60 minutes, metabolizes primarily via denitration, and has a short half-life of about one hour.
  • Adverse effects include headache, flushing, and potential ulceration, particularly in the gastrointestinal tract.
  • Monitor patients for ulcers, as they may be non-healing and require discontinuation of Nicorandil.
  • Contraindications include cardiogenic shock, severe hypotension, and use with vasodilators like sildenafil due to the risk of extreme hypotension.

References

  1. Patient.info. Nicorandil for Angina - Treatments. Side effects and dosage. [online] Available at: https://patient.info/medicine/nicorandil-for-angina-ikorel.
  2. Nicorandil and mouth ulcer - General Practice Notebook. [online] Available at: https://gpnotebook.com/simplepage.cfm.
Abdelwahab Ward, BS Pharm, PharmD