Nicorandil Biogaran (Nicorandil)

Nicorandil is indicated for conditions involving myocardial oxygen supply‑demand mismatch within the angina disease family.

• Chronic stable angina: reduces the frequency of angina attacks and improves exercise tolerance.
• Angina pectoris: alleviates chest pain episodes associated with coronary artery disease.
• Ischemic heart disease: helps maintain myocardial oxygen balance during physical stress.

• Nicorandil activates ATP‑sensitive potassium channels in vascular smooth muscle, leading to hyperpolarisation and vasodilation. Concurrently, it releases nitric oxide, which stimulates guanylate cyclase, increasing cyclic GMP and further relaxing coronary and peripheral vessels. The combined actions lower both preload and afterload, improving myocardial oxygen supply while reducing cardiac workload.

Nicorandil may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Headache: mild to moderate intensity, often transient.
• Flushing: warm sensation with reddening of skin.
• Dizziness or light‑headedness, especially on standing.
• Nausea or gastrointestinal discomfort.
• Palpitations or tachycardia.
• Mild hypotension.

Serious or Rare Side Effects

• Severe hypotension leading to syncope.
• Myocardial infarction or worsening ischemia.
• Bronchospasm, particularly in asthmatic patients.
• Anaphylactic or severe allergic reactions.
• Stevens‑Johnson syndrome or other severe skin eruptions.
• Hepatic dysfunction or elevated liver enzymes.

When prescribing Nicorandil, clinicians should consider several safety measures.

• Blood pressure monitoring: watch for excessive hypotension, especially after dose initiation.
• Severe hypotension: avoid use in patients with markedly low blood pressure.
• Asthma or reactive airway disease: use with caution due to potential bronchospasm.
• Hepatic impairment: dose adjustment may be required; monitor liver function.
• Pre‑operative use: discontinue according to surgical guidelines to reduce intra‑operative hypotension.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Nicorandil can interact with other medications that affect vascular tone or blood pressure.

Major Interactions (Avoid)

• Nitrates (e.g., nitroglycerin): additive vasodilation may cause severe hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): risk of profound blood pressure drop.
• Other potent vasodilators (e.g., hydralazine): may lead to uncontrolled hypotension.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents (ACE inhibitors, beta‑blockers): additive blood pressure‑lowering effect.
• Antiplatelet or anticoagulant drugs: increased risk of bleeding.
• Diuretics: potential electrolyte disturbances and enhanced hypotensive response.