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Nicorandil
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
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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