nicorandil at a glance
Medicine class
Potassium-channel activator and vasodilator with nitrate-like activity
Licensed role
Symptomatic treatment of stable angina in adults when first-line options are unsuitable or inadequate
Food
Tablets may be taken with or without food
Important warning
Persistent or painful ulcers affecting the mouth, eyes, skin or digestive tract require prompt assessment
What is nicorandil used for?
The selected UK product is licensed for:
Symptomatic treatment of stable angina in adults whose symptoms are inadequately controlled by first-line anti-anginal treatment, or who cannot tolerate or have a contraindication to those treatments.
How does nicorandil work?
Nicorandil opens potassium channels in arterial smooth muscle and increases cGMP through its nitrate component, particularly affecting veins. This reduces the heart’s preload and afterload while improving coronary blood flow and the balance between the heart muscle’s oxygen supply and demand.
nicorandil preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 20 mg
How to take nicorandil
Follow the prescription label and product leaflet.
Swallow the tablet with water; do not crush or chew it.
It can be taken with or without food.
Only divide a scored tablet if instructed by the prescriber or pharmacist.
Keep each tablet in its blister until needed because it is sensitive to moisture.
Do not swallow the separately marked silica-gel desiccant.
nicorandil side effects
Common or expected effects
- Headache, particularly when treatment is started
- Dizziness or weakness
- Nausea or vomiting
- Flushing
- Faster heartbeat
Get urgent medical advice
- Painful or persistent ulcers affecting the mouth, digestive tract, anus, genitals, skin or stoma
- Abdominal pain, gastrointestinal bleeding, perforation, fistula or abscess associated with ulceration
- Eye pain, light sensitivity, conjunctival or corneal ulceration
- Severe hypotension, fainting or collapse
- Angioedema or anaphylaxis
- Severe hyperkalaemia or liver injury
nicorandil in pregnancy
Nicorandil is not recommended during pregnancy because human data are limited. Anyone who is pregnant or planning pregnancy should ask the prescriber to review treatment rather than stopping it without advice.
nicorandil while breastfeeding
Nicorandil is not usually recommended while breastfeeding because it is unknown whether it enters human milk or affects the infant. A prescriber should weigh maternal benefit against potential infant risk and consider alternatives where appropriate.
nicorandil interactions
Check all prescribed, non-prescription and recreational medicines before use. Important interactions include:
PDE5 inhibitors, including sildenafil, tadalafil and vardenafil
Contraindicated because the combination can cause a serious fall in blood pressure.
Riociguat and other soluble guanylate-cyclase stimulators
Contraindicated because of the risk of a serious fall in blood pressure.
NSAIDs and aspirin
May increase the risk of severe gastrointestinal ulceration, bleeding or perforation.
Common questions about nicorandil
Answers are fully visible for fast scanning and source review.
Is nicorandil a nitrate?
Not solely. It has a nitrate component but also opens potassium channels, giving it a dual vasodilator mechanism.
Why is nicorandil prescribed after other angina treatments?
Its UK licence is for stable angina that remains inadequately controlled by first-line treatment, or when those treatments are contraindicated or not tolerated.
Can nicorandil cause ulcers after years of treatment?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.