Makindo Medical Notes

Always check the BNF link here before prescribing.

• 💊 Nicorandil is an anti-anginal agent with dual action: nitrate-like vasodilation and potassium channel activation.
• Used as a second-line option when angina is not controlled by first-line therapies (beta-blockers, calcium channel blockers).

⚙️ Mode of Action

• Opens K⁺ ATP channels → arteriolar vasodilation → ↓ afterload.
• Acts as a NO donor → venodilation → ↓ preload.
• Overall: ↓ myocardial oxygen demand + ↑ coronary perfusion.

📋 Indications

• 🫀 Prophylaxis of stable angina (chronic angina pectoris).
• Used in patients intolerant of, or inadequately controlled with, standard first-line therapy.

💊 Dose

• Initial: 5–10 mg BD.
• Titrate to 10–30 mg BD according to response (max 30 mg BD).
• Take regularly for prophylaxis (not for acute angina relief).

🔄 Interactions

• ⚠️ Severe hypotension risk if combined with PDE-5 inhibitors (sildenafil, tadalafil, vardenafil).
• Additive hypotension with other nitrates or vasodilators.

⚠️ Cautions

• Low baseline blood pressure or left ventricular failure (risk of hypotension).
• Use with caution in acute coronary syndrome (not first-line).
• Can exacerbate existing GI ulceration.

⛔ Contraindications

• Severe hypotension or shock.
• Concomitant use with PDE-5 inhibitors.
• Recent ACS where alternatives are available (specialist advice required).

⚠️ Side Effects

• ⬇️ Hypotension, dizziness, flushing.
• 🤕 Initial headache (common, usually settles).
• 🤢 Nausea, vomiting.
• 🩹 Gastrointestinal, oral, and anal ulceration (rare but serious; may require drug withdrawal).
• 🦠 Angioedema (rare).
• 💪 Myalgia, malaise.

📚 References

• BNF: Nicorandil
• NICE Clinical Knowledge Summaries: Stable Angina