Nicorandil Eg (Nicorandil)

Nicorandil is indicated for conditions involving myocardial oxygen demand and supply imbalance, primarily chronic stable angina.

• Chronic stable angina: reduces frequency of angina attacks and improves exercise tolerance.
• Variant (Prinzmetal) angina: helps prevent coronary artery spasm.
• Post‑myocardial infarction angina: may aid in symptom control when other therapies are insufficient.

• Nicorandil acts as a nitrate‑like vasodilator while simultaneously opening ATP‑sensitive potassium channels in vascular smooth muscle. The combined effect leads to coronary and peripheral vasodilation, lowering both preload and afterload, which improves myocardial oxygen balance and relieves anginal symptoms.

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

Common Side Effects

• Headache: mild to moderate, often transient.
• Flushing: warmth and redness of the skin.
• Dizziness or light‑headedness, especially on standing.
• Nausea or abdominal discomfort.
• Palpitations: sensation of rapid or irregular heartbeat.
• Hypotension: mild drop in blood pressure.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Exacerbation of angina or myocardial infarction.
• Ulceration or severe gastrointestinal irritation.
• Allergic reactions such as rash or Stevens‑Johnson syndrome.
• Syncope: sudden loss of consciousness.
• Cardiogenic shock in extreme cases.

Before initiating Nicorandil therapy, several safety considerations should be observed.

• Blood pressure monitoring: check baseline and periodic readings.
• Concomitant nitrates: avoid combined use to prevent excessive vasodilation.
• Hepatic impairment: use with caution in patients with liver dysfunction.
• Severe hypotension: discontinue if symptomatic low blood pressure occurs.
• Pregnancy and lactation: assess risk‑benefit; generally avoid unless clearly needed.
• Store at below 25°C: keep in the original container, protect from moisture and direct sunlight.

Nicorandil can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Other nitrate preparations: risk of profound hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): may cause severe blood pressure fall.
• Potent vasodilators (e.g., hydralazine): additive hypotensive effect.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents (ACE inhibitors, ARBs, beta‑blockers): may enhance blood pressure lowering.
• Diuretics: monitor electrolytes and volume status.
• Calcium channel blockers: watch for additive vasodilatory response.
• Oral hypoglycemics: possible alteration of glucose control.
• Antiplatelet or anticoagulant drugs: monitor for bleeding tendency.