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Nicorandil

Nicorandil

Description

Nicorandil is used to prevent or reduce the pain and strain on the heart caused by certain cardiovascular disorders. It is used in patients who cannot take certain other cardiovascular drugs called beta-blockers. It is also used for patients in whom the pain is not adequately controlled by other agents. This medicine is not recommended for use in children.

Missed Dose

If a dose of the oral form (tablet) of this medicine is missed, take the dose as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not double your dose to make up for the missed one. Since the injection form of this medicine is administered in the hospital/clinical setting by a qualified healthcare professional, the likelihood of missing a dose is very low.

Overdose

Oral forms: Seek emergency medical treatment or contact the doctor in case of an overdose with this medicine. Injections: Since the injection form of this medicine is administered in the hospital/clinical setting by a qualified healthcare professional, the likelihood of an overdose is very low. However, emergency medical treatment will be initiated by the doctor if an overdose is suspected.

How it works

Nicorandil works by improving the blood flow through the blood vessels of the heart, reducing the workload on the heart and relieving the symptoms of pain.

Abstract

Around 2 million people in the UK have angina pectoris and are therefore at high risk of severe coronary events such as myocardial infarction (MI) or sudden death.1 Conventional management of patients with stable angina includes glyceryl trinitrate, a beta-blocker, aspirin and a statin, with the aim of controlling symptoms and reducing the risk of a coronary event. For patients unable to tolerate a beta-blocker, the choice is less clear but calcium channel blockers and long-acting nitrates provide effective symptom control. Another option is nicorandil (Ikorel - Rhône-Poulenc Rorer), a potassium channel activator licensed for the "prevention and long term treatment of chronic stable angina pectoris".2 In our review of nicorandil 8 years ago, we concluded that it provided symptom control that was as good as, but no better than, other less expensive anti-anginal drugs.3 Since then, new data have suggested that nicorandil might reduce the frequency of coronary events in patients with stable angina.4 Here, we consider these findings and reassess the place of nicorandil for patients with angina.

How to take nicorandil

Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about nicorandil and will also provide you with a full list of side-effects which you could experience from taking it.

Take nicorandil exactly as your doctor tells you to. It is usual to take one tablet (either 10 mg or 20 mg) twice daily, in the morning and evening. When starting your treatment your doctor may give you a smaller dose (such as half a tablet) and then increase it after a short while. This will help avoid any unwanted side-effects, particularly headache. Your doctor will tell you what dose is right for you, and this information will be printed on the label of the pack of tablets to remind you about what the doctor said to you.

Try to take your tablets at the same times each day, as this will help you to remember to take your doses regularly. You can take nicorandil tablets either before or after meals. Swallow the tablet with a drink of water.

Conclusion

Nicorandil and long-acting nitrates are effective drugs for the treatment of chronic stable angina in patients with effort-induced symptoms arising from epicardial coronary artery stenoses, as well as coronary vasospasm and microvascular angina.

The success of any pharmacological angina therapy hinges on selecting the appropriate drug regimen tailored to individual patient factors and the prevailing underlying angina mechanism(s). Vasodilator drugs, such as nicorandil and long-acting nitrates, are most useful in patients who are unaffected by the haemodynamic side effects of these medications, and in those who have contraindications to rate-limiting anti-angina drugs. Further work is needed to better understand the long-term implications of these drugs on cardiovascular risk.

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