Drug reference

Nicorandil

Vasodilator · Antianginal

VasodilatorAntianginal

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

1 major

incl. contraindicated

PREGNANCY

—

not curated

Top interactions

SildenafilContraindicatedDatabase

Mechanism

Nicorandil has a unique dual mechanism: it opens ATP-sensitive potassium channels (K-ATP) in vascular smooth muscle, causing hyperpolarization and vasodilation of arterioles (reducing afterload), and it possesses a nitrate moiety that releases nitric oxide, dilating capacitance veins (reducing preload) and epicardial coronary arteries. This combination of arteriolar and venodilator effects reduces both preload and afterload while improving coronary blood flow. The IONA trial demonstrated that nicorandil reduces major adverse coronary events in stable angina.

Indications

Prophylaxis and treatment of stable anginalittle use in heart failureStable anginaVasospastic anginaAcute MI (during angioplasty)Prevention of recurrent episodes of vasospastic angina

Dosing

Adult: Initially 5–10 mg twice daily by mouth, then increased if tolerated to 40 mg twice daily; usual dose 10–20 mg twice daily, use lower initial dose regimen if patient susceptible to headache.
Max dose: 80 mg/day (40 mg twice daily)

Pharmacokinetics

Onset

well absorbed orally

Half-life

initial rapid phase t½ is 1 hour and later slow phase t½ is 12 hours

Metabolism

nearly completely metabolized in liver

Excretion

in urine

Contraindications

Acute pulmonary oedema
Hypovolaemia
Left ventricular dysfunction with low ﬁlling pressure

Side effects

Common

Oral ulcerationHeadacheflushingpalpitationweaknessdizzinessnauseavomitinglarge painful aphthous ulcers in the mouth

Drug interactions

Sildenafil

Contraindicated

Database

Extreme hypotension, potentially life-threatening.

PDE5 inhibitors should not be prescribed to patients receiving any form of nitrate. Patients should be warned not to use PDE5 inhibitors and nitrates concurrently. No PDE5 inhibitor should be used in the 24 hours prior to initiating nitrate therapy. If significant hypotension occurs, fluids and α adrenergic receptor agonists may be used for support.

11 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.