Nictoris 10

Indications

Nicorandil is used to prevent and treat long-term (stable) angina, the chest pain caused by reduced blood flow to the heart muscle. It is usually used when other angina medicines such as beta blockers or calcium channel blockers are not suitable or do not control symptoms well enough. It does not stop an angina attack that has already started.

How It Works

Nicorandil has two actions. It opens potassium channels in blood vessel muscle and also acts like a nitrate, releasing nitric oxide. Both actions relax and widen the arteries and veins, including the coronary arteries that supply the heart. This reduces the heart's workload and improves its blood supply, which helps prevent angina.

Dosage and Administration

The usual adult starting dose is 10 mg twice a day, or 5 mg twice a day in people prone to headache. The doctor may increase it to 10 to 20 mg twice a day, up to 30 mg twice a day if needed. Swallow tablets with water, at about the same times each day, with or without food. Keep tablets in their blister until use. Use a fast-acting nitrate spray or tablet under the tongue for sudden angina attacks, as prescribed.

Interactions

Do not take nicorandil with Sildenafil, Tadalafil, Vardenafil or Riociguat, as blood pressure can fall dangerously. Other blood pressure medicines, nitrates, alcohol and some antidepressants increase the fall in blood pressure. Taking it with Aspirin, NSAIDs or steroids such as Prednisolone increases the risk of ulcers and bleeding in the gut. Medicines that raise potassium (such as Spironolactone) may increase potassium further.

Contraindications

Do not use nicorandil if you are allergic to it, have very low blood pressure, cardiogenic shock, acute heart failure or low blood volume, acute fluid on the lungs, or if you are taking a PDE5 inhibitor or Riociguat. It should be avoided in people with low potassium levels in some situations, as advised by a doctor.

Side Effects

The most common side effect is headache, especially in the first days; it usually eases with time. Others include dizziness, flushing, nausea, vomiting and weakness. Less common but important are ulcers in the mouth, gut, anus, skin or eye, which may heal only when the medicine is stopped, and high potassium levels.

Get urgent medical help if you develop mouth, anal or other ulcers, bleeding from the back passage or black stools, fainting or severe dizziness, chest pain that does not settle with your usual treatment, or signs of a serious allergic reaction such as swelling of the face or difficulty breathing.

Pregnancy and Lactation

There is little information on nicorandil in pregnancy, so it is best avoided unless a doctor decides it is needed. It is not known whether it passes into breast milk; it is not recommended while breastfeeding.

Precautions and Warnings

Tell your doctor about any ulcers or bleeding while taking it. Use with care in people with low blood pressure, heart failure, diverticular disease, low or high potassium, or G6PD deficiency. Dizziness can occur, so take care when driving until you know how it affects you. Do not stop taking it suddenly without medical advice.

Overdose

Overdose can cause very low blood pressure, a fast heartbeat, flushing and fainting. Lie the person down with legs raised and seek emergency medical help.

Therapeutic Class

Antianginal agent, potassium channel opener with nitrate activity.

Storage

Store below 25 to 30°C in a dry place, away from light and moisture, and out of the reach of children. Keep tablets in the original blister until use.