Nicorandil

Question 1

What are the main indications for the use of nicorandil?

Answer 1

Treatment and prevention of chest pain with stable angina - patients who don’t tolerate B-blockers or CCBs

Question 2

What is the mechanism of action of nicorandil?

Answer 2

Causes both arterial and venous vasodilatation through its actions as a nitrate and by activating K+-ATP channels (hyperpolarising the cell membrane and subsequently inactivating voltage-gated Ca2+ channels). This causes relaxation and vasodilatation.

The effect is to reduce cardiac preload and systemic and coronary vascular resistance. This improves myocardial perfusion, and decreases myocardial work and oxygen demand.

Question 3

What are adverse effects of nicorandil?

Answer 3

• Flushing, dizziness
• Headache.
• Nausea, vomiting
• Hypotension.
• GI, skin or mucosal ulceration

Question 4

When would you use nicroandil with caution?

Answer 4

• Poor LV function
• Hypotension
• Pulmonary oedema

Question 5

What are important interactions to be aware of when using nicorandil?

Answer 5

Phosphodiesterase inhibitors

Question 6

What dose of nicorandil would prescribe initially?

Answer 6

10 mg twice daily - can go up as far as 30 mg twice daily