Nicorandil

• Nicorandil is employed in the management of coronary artery disease, particularly chronic stable angina.
• Chronic stable angina pectoris: reduces frequency of angina attacks and improves exercise tolerance.
• Stable angina: alleviates chest pain episodes during physical activity.
• Coronary artery disease: enhances myocardial oxygen balance by decreasing cardiac workload.

• Nicorandil donates nitric oxide, leading to vasodilation of arterial and venous vessels, and simultaneously opens ATP‑sensitive potassium channels in vascular smooth muscle. The combined effect reduces both preload and afterload, lowers myocardial oxygen demand, and improves coronary blood flow, thereby restoring the balance between myocardial oxygen supply and demand.

Common Side Effects

• Headache: mild to moderate intensity, often transient.
• Flushing: warmth and reddening of the skin, especially on the face.
• Dizziness or light‑headedness, particularly on standing.
• Nausea or mild gastrointestinal discomfort.
• Palpitations: awareness of heartbeat irregularities.
• Peripheral edema: swelling of the lower limbs.

Serious or Rare Side Effects

• Oral or gastrointestinal ulceration, which may be severe.
• Severe hypotension leading to fainting or shock.
• Allergic reactions such as rash, pruritus, or Stevens‑Johnson syndrome.
• Worsening angina or myocardial infarction in rare cases.
• Hepatic dysfunction presenting as jaundice or elevated liver enzymes.

• Precautions should be taken when initiating Nicorandil therapy and during ongoing treatment.
• Monitor blood pressure: watch for signs of hypotension, especially after dose changes.
• Assess for headache: advise patients to report persistent or severe headaches.
• Evaluate gastrointestinal health: monitor for ulcer symptoms and advise prompt reporting.
• Use with caution in severe hepatic impairment: dose adjustment may be required.
• Avoid in patients with known hypersensitivity to Nicorandil or its excipients.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Nicorandil may interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Concomitant nitrates (e.g., isosorbide dinitrate): risk of profound hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): additive vasodilatory effect leading to severe blood pressure drop.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents (e.g., ACE inhibitors, beta‑blockers): may enhance blood‑pressure‑lowering effect.
• Diuretics: can increase the risk of volume depletion and hypotension.
• Calcium channel blockers: may potentiate vasodilation, requiring blood pressure monitoring.
• Antiplatelet or anticoagulant therapy: monitor for increased bleeding tendency.