Nicorandil Almus (Nicorandil)

• Nicorandil acts on the coronary circulation and peripheral vasculature to relieve angina symptoms.
• Chronic stable angina pectoris: reduces the frequency of angina attacks and improves exercise capacity.
• Effort‑induced angina: provides symptomatic relief during physical activity.
• Refractory angina: offers an additional therapeutic option when conventional treatments are insufficient.

• Nicorandil exerts a dual mechanism: it donates nitric oxide, producing nitrate‑like vasodilation, and it opens ATP‑sensitive potassium channels in vascular smooth muscle, causing hyperpolarisation and relaxation. The combined effect dilates coronary and peripheral arteries, lowering both preload and afterload, which improves myocardial oxygen balance and alleviates anginal pain.

Common Side Effects

• Headache: mild to moderate intensity, often transient.
• Flushing: warmth and redness, usually short‑lived.
• Dizziness or light‑headedness: related to blood pressure reduction.
• Nausea or abdominal discomfort: may occur after dosing.
• Peripheral edema: swelling of lower limbs in some patients.
• Palpitations: sensation of irregular heartbeat.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Myocardial infarction: rare but possible, especially with overdose.
• Ulceration of the mouth or genital area: painful sores that need evaluation.
• Stevens‑Johnson syndrome or toxic epidermal necrolysis: life‑threatening skin reactions.
• Anaphylaxis or severe allergic reactions: immediate medical emergency.

Precautions for Nicorandil Almus include careful patient assessment and monitoring.

• Cardiovascular status: monitor blood pressure and heart rate regularly.
• Renal impairment: use with caution; adjust therapy based on renal function.
• Hepatic impairment: consider dose adjustment or close monitoring.
• Concomitant nitrates or PDE5 inhibitors: risk of additive hypotension; avoid combined use.
• Pregnancy and lactation: safety not established; avoid unless benefit outweighs risk.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Nicorandil may interact with several drug classes.

Major Interactions (Avoid)

• Other nitrates (e.g., nitroglycerin): additive vasodilation can cause severe hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): risk of profound blood pressure drop.
• Strong antihypertensives (e.g., ACE inhibitors, ARBs): may lead to excessive blood pressure reduction.

Moderate Interactions (Monitor Closely)

• Diuretics: monitor electrolytes and blood pressure for additive effects.
• Beta‑blockers: observe heart rate and angina control.
• Calcium channel blockers: may enhance vasodilatory response, requiring dose adjustments.