Nicorandil Zentiva Pharma Uk (Nicorandil)

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

• Stable angina pectoris: decreases the frequency of angina attacks and improves exercise tolerance.
• Chronic angina: provides sustained symptom relief for patients with long‑term angina.
• Ischemic heart disease: alleviates chest discomfort associated with reduced myocardial oxygen supply.

• Nicorandil donates nitric oxide, activating guanylate cyclase and increasing cyclic GMP, which relaxes vascular smooth muscle. Simultaneously it opens ATP‑sensitive potassium channels in arterial and venous walls, causing vasodilation that lowers both preload and afterload, thereby reducing myocardial oxygen demand and relieving angina.

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

Common Side Effects

• Headache: mild to moderate pain often occurring after the first dose.
• Flushing: transient warmth and redness of the skin.
• Dizziness: sensation of light‑headedness, especially when standing quickly.
• Nausea: mild gastrointestinal upset.
• Palpitations: awareness of irregular or rapid heartbeats.
• Hypotension: modest drop in blood pressure.

Serious or Rare Side Effects

• Severe hypotension: marked blood pressure fall requiring medical attention.
• Myocardial infarction: rare occurrence of heart attack.
• Bronchospasm: difficulty breathing, particularly in patients with asthma.
• Stevens‑Johnson syndrome: severe skin reaction.
• Anaphylaxis: life‑threatening allergic response.

When prescribing Nicorandil, clinicians should consider several safety measures.

• Blood pressure monitoring: check for hypotension before and during therapy.
• Nitrate tolerance assessment: evaluate for reduced response over time.
• Hepatic and renal function: adjust use if significant impairment is present.
• Concomitant PDE5 inhibitors: avoid due to risk of profound hypotension.
• Asthma caution: use carefully in patients with reactive airway disease.
• Store at room temperature: keep in the original pack, protect from moisture and direct sunlight.

Nicorandil interacts with several drug classes; awareness helps prevent adverse events.

Major Interactions (Avoid)

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

Moderate Interactions (Monitor Closely)

• Antihypertensives: may enhance blood‑pressure‑lowering effect, requiring dose adjustment.
• Diuretics: monitor electrolytes and volume status.
• Antacids: may alter Nicorandil absorption, observe therapeutic response.
• Calcium channel blockers: observe for excessive vasodilation.
• Beta‑blockers: watch for additive heart‑rate effects.