Nicorandil Rivopharm (Nicorandil)

Nicorandil is used in the management of coronary artery disease‑related angina, acting on the vascular smooth muscle to relieve chest pain.

• Stable angina pectoris: reduces the frequency and severity of angina attacks.
• Chronic angina: improves exercise tolerance and daily activity levels.
• Angina secondary to coronary artery disease: alleviates myocardial ischemia by decreasing preload and afterload.

• Nicorandil donates nitric oxide, activating guanylate cyclase and increasing cyclic GMP, which leads to vascular smooth‑muscle relaxation. Simultaneously, it opens ATP‑sensitive potassium channels in arterial and venous walls, causing hyperpolarisation and further vasodilation. The combined arterial and venous dilation reduces both cardiac preload and afterload, improving myocardial oxygen supply‑demand balance.

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

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 changes.
• Nausea: occasional gastrointestinal upset.
• Palpitations: awareness of heartbeat.
• Hypotension: mild blood pressure reduction.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Myocardial infarction: rare but reported in susceptible patients.
• Bronchospasm: respiratory difficulty, especially in asthmatic individuals.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Stevens‑Johnson syndrome: rare skin disorder.
• Hepatic dysfunction: abnormal liver enzymes or liver injury.

When prescribing Nicorandil, clinicians should consider several safety measures.

• Blood pressure monitoring: watch for hypotension, especially after dose initiation.
• Avoid in severe hypotension: contraindicated in patients with markedly low blood pressure.
• Caution in asthma: risk of bronchospasm may be heightened.
• Hepatic impairment: use with care in patients with liver disease.
• Pre‑operative use: discontinue before major surgery to avoid excessive vasodilation.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nicorandil can interact with other cardiovascular agents, altering its safety profile.

Major Interactions (Avoid)

• Sildenafil or other PDE5 inhibitors: additive vasodilation may cause severe hypotension.
• Other nitrates (e.g., nitroglycerin): combined effect can lead to dangerous blood pressure drops.
• Strong antihypertensives: may potentiate hypotensive response.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance blood pressure‑lowering effect.
• Beta‑blockers: can mask tachycardia, requiring careful monitoring.
• Calcium channel blockers: additive vasodilatory effect may need dose adjustment.