Formulary
Nicorandil: Indications, Dosing, Side Effects and Interactions
Nicorandil clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Nicorandil: Indications, Dosing, Side Effects and Interactions
Nicorandil clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis and treatment of stable angina (second-line)**
- **Adult** (By Mouth): Initially 5-10 mg twice daily, 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.
Cautions
Diverticular disease (risk of fistula formation or bowel perforation); G6PD deficiency; heart failure (class III-IV); hyperkalaemia
Contraindications
Acute pulmonary oedema; hypovolaemia; left ventricular dysfunction with low filling pressure or cardiac decompensation; severe hypotension; shock (including cardiogenic shock)
Side effects
Common or very common Asthenia; dizziness; haemorrhage; headache (more common on initiation, usually transitory); nausea; vasodilation; vomiting Rare or very rare Abdominal pain; angioedema; conjunctivitis; eye disorders; gastrointestinal disorders; genital ulceration; hepatic disorders; hyperkalaemia; mucosal ulceration; myalgia; oral disorders; skin reactions; skin ulcer Frequency not known Diplopia Side-effects, further information Nicorandil can cause serious skin, mucosal, and eye ulceration; including gastrointestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.
Interactions
**Severe interactions:**
- The metabolism of nicorandil is not significantly affected by cimetidine (a CYP inhibitor), or rifampicin (a CYP3A4 inducer).
**Other interactions (6):**
- Therapeutic doses of nicorandil may lower the blood pressure of hypotensive patients.
- If nicorandil is used concomitantly with antihypertensive agents or other medicinal products with blood pressure lowering effect (e.g.
- Dapoxetine should be prescribed with caution in patients taking nicorandil due to possible reduced orthostatic tolerance.
- Gastrointestinal perforations in the context of concomitant use of nicorandil and corticosteroids have been reported.
- Caution is advised when nicorandil is used in combination with other medical products that may increase potassium levels (see sections 4.4 and 4.8).
- Nicorandil does not affect the pharmacodynamics of acenocoumarol.
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk-no information available.
Breast feeding
No information available-manufacturer advises avoid.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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