Nicorandil Zentiva (Nicorandil)

• Nicorandil is indicated for conditions involving myocardial oxygen supply‑demand mismatch, primarily within the angina spectrum.
• Angina pectoris: reduces the frequency and severity of chest pain episodes.
• Stable chronic angina: improves exercise tolerance and delays onset of symptoms.
• Ischemic heart disease: helps alleviate myocardial ischemia by decreasing cardiac preload and afterload.

• Nicorandil donates nitric oxide, activating guanylate cyclase and increasing cyclic GMP, leading to vascular smooth‑muscle relaxation. Simultaneously, it opens ATP‑sensitive potassium channels in arterial and venous walls, causing arterial and venous dilation, which lowers cardiac preload and afterload and improves myocardial oxygen balance.

Nicorandil may cause a range of adverse reactions, most of which are dose‑related and reversible.

Common Side Effects

• Headache: mild to moderate, often transient.
• Flushing: warm sensation, usually short‑lived.
• Dizziness or light‑headedness.
• Nausea or abdominal discomfort.
• Peripheral edema: mild swelling of lower limbs.
• Palpitations: occasional awareness of heartbeat.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure.
• Tachycardia: rapid heart rate requiring medical review.
• Gastrointestinal ulceration or perforation.
• Stevens‑Johnson syndrome or severe skin reactions.
• Hepatic dysfunction: elevated liver enzymes.
• Anaphylactoid reactions: rare but potentially life‑threatening.

• When prescribing Nicorandil, clinicians should consider patient‑specific factors and monitor for adverse events.
• Avoid use in patients with severe hypotension: risk of further blood pressure decline.
• Monitor hepatic function: rare liver enzyme elevations.
• Caution in patients with active peptic ulcer disease: risk of ulcer exacerbation.
• Use carefully in the elderly: increased sensitivity to vasodilatory effects.
• Avoid concomitant use with other potent vasodilators without supervision.
• Store at ambient temperature below 25 °C: keep in original container, protect from moisture and direct sunlight.

Nicorandil can interact with several drug classes, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Nitrates (e.g., nitroglycerin): additive hypotensive effect.
• PDE5 inhibitors (e.g., sildenafil): risk of severe hypotension.
• Antihypertensives (e.g., ACE inhibitors, beta‑blockers): may potentiate blood pressure lowering.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance orthostatic hypotension.
• Antiplatelet agents (e.g., aspirin, clopidogrel): monitor for increased bleeding risk.
• CYP450 modulators: potential impact on Nicorandil metabolism, though clinical relevance is limited.