Generic
Nicorandil
7 brands available in the market
At a glance
Nicorandil is a vasodilator used for prevention and long-term treatment of angina pectoris. It opens potassium channels to dilate arterioles and stimulates guanylate cyclase causing venous vasodilatation, reducing preload and afterload and improving coronary blood flow.
Description
Nicorandil dilates arterioles and large coronary arteries by opening potassium channels, and stimulates guanylate cyclase causing venous vasodilatation. It reduces preload and afterload, and improves coronary blood flow.
Indications
- Prevention and long-term treatment of angina pectoris
Therapeutic class
Potassium-channel Activator
Pharmacological class
Vasodilator
Pharmacology
Nicorandil opens potassium channels to dilate arterioles and coronary arteries, and stimulates guanylate cyclase to cause venous vasodilatation, reducing preload and afterload and improving coronary blood flow.
Mechanism of action
Dilates blood vessels to reduce heart workload and prevent chest pain.
Dosage
Adult Dose (Oral):
- Initial: 10 mg twice daily; may increase to 20 mg twice daily
- For patients prone to headache: 5 mg twice daily
- Max dose: 30 mg twice daily
Administration
- Swallow tablet whole; do not chew, crush or break
- Take at the same time each day
- May be taken with or without food
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Headache (especially on initiation, usually transitory)
- Cutaneous vasodilation with flushing
- Nausea, vomiting
- Dizziness, weakness
- Rare: oral ulceration, myalgia
- At high dosage: reduction in blood pressure and/or increase in heart rate
- Angioedema
Precautions & warnings
- Caution in hypovolaemia, low systolic BP, acute pulmonary oedema, glaucoma
- May impair ability to drive or operate machinery
- Discontinue if mouth ulceration or stomatitis appears
- Avoid alcohol
Contraindications
- Cardiogenic shock
- Hypotension
- Left ventricular failure with low filling pressure
- Patients taking phosphodiesterase-5 inhibitors
- Lactation
Drug interactions
- Hypotensive interaction with alcohol, TCAs, antihypertensives and other vasodilators
- Enhanced hypotensive effect with sildenafil and other PDE-5 inhibitors
Food interactions
Alcohol may increase hypotensive effect.
Use in pregnancy
Use in Pregnancy: Nicorandil may be unsafe during pregnancy; animal studies show evidence of fetal harm.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Information not available; consult doctor.
Pediatric use
Not recommended for children.
Geriatric use
Elderly should use lowest effective dose.
Renal / hepatic impairment
Renal Impairment: Safe in kidney disease; dose adjustment may not be needed.
Hepatic Impairment: Safe in liver disease; dose adjustment may not be needed; caution in severe hepatic dysfunction.
Overdose effects
Overdose: Peripheral vasodilation, fall in blood pressure and reflex tachycardia; monitor cardiac function, supportive measures, fluid replacement, vasopressors.
Storage conditions
Store in a cool and dry place, protected from light; keep out of reach of children.
Chemical structure
Nicorandil