Products
Nicorandil is commercially available in tablet form (Dancor). It has been approved in many countries since 1993.
Structure and properties
Nicorandil (C8H9N3O4, Mr = 211.2 g/mol), like nitroglycerin, is an organic nitrate. It is a combination of the vitamin nicotinamide with an ethyl nitrate.
Effects
Nicorandil (ATC C01DX16) has vasodilator, antihypertensive, and cardioprotective properties. It lowers preload and afterload, unloads the heart, and increases coronary vessel blood flow. The effects are based on a dual mechanism of action. Nicorandil opens potassium channels on the one hand and acts as a nitrate on the other.
Indications
For the treatment of angina pectoris.
Dosage
According to the drug label. The maximum daily dose is 40 mg.
Contraindications
- Hypersensitivity
- Cardiovascular shock
- Severe hypotension
- Acute myocardial infarction
- Hypovolemia
- Concurrent use of phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil, and vardenafil.
Full precautionary information under Interactions can be found in the drug label.
Interactions
Because of the antihypertensive properties of nicorandil, concomitant use of phosphodiesterase-5 inhibitors is contraindicated because they may also cause a drop in blood pressure. Other antihypertensive agents may also increase the risk of a drop in blood pressure.
Adverse effects
The most common adverse effects include headache, especially early in treatment, dizziness and weakness, fatigue, an increase in heart rate, vasodilatation, flushing, a drop in blood pressure, and nausea and vomiting. Rarely, mucosal ulcerations, some severe and deep, occur, e.g., aphthae, gastrointestinal ulcers, and tongue ulcers. Other, less frequent adverse effects are possible. If ulcerations occur, the drug must be discontinued or possibly the dose reduced.
