Nicorandil

What it is and how it works

Nicorandil opens ATP-sensitive potassium channels in vascular smooth muscle, causing arterial dilatation, and its nitrate moiety relaxes venous smooth muscle via cyclic GMP, reducing both afterload and preload and dilating coronary arteries.

Indications

Prevention and long-term treatment of stable angina pectoris in adults inadequately controlled by or intolerant of first-line antianginal drugs (beta-blockers or calcium-channel blockers).

Dosage and administration (summary)

Oral: initially 10 mg twice daily (5 mg twice daily if prone to headache), usually 10–20 mg twice daily, up to 30 mg twice daily.

Contraindications

Cardiogenic shock, hypotension, left ventricular failure with low filling pressures, hypovolaemia, acute pulmonary oedema, and concomitant use of phosphodiesterase-5 inhibitors or riociguat.

Warnings and precautions

Can cause serious ulceration of the mouth, gastrointestinal tract (including anal and perianal), skin and eye; treatment should be withdrawn if ulceration occurs. Headache is common at the start of treatment. Hyperkalaemia has been reported, particularly in renal impairment.

Pregnancy

Avoid unless essential because data are limited.

Storage and supply

Store below 25 °C in the original blister to protect from moisture.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.