Monograph: |
Nicorandil
Adverse Effects and Precautions
Adverse effects reported with nicorandil arc headache which
is usually transitory and occurring at the start of therapy, cu-
taneous vasodilatation and flushing, nausea, vomiting, dizzi-
ness. and weakness. A reduction in blood pressure and/or an
increase in heart rate may occur with high doses.
Nicorandil is contra-indicated in patients with cardiogenic
shock, left ventricular failure with low filling pressures, and
hypotension. It should be avoided, or used only with caution,
in patients with hypovolaemia. low systolic blood pressure, or
acute pulmonary oedema.
Oral ulceration. Painful, large aphthous ulcers on the
tongue and oral mucosa have been reported in patients re-
ceiving nicorandil for angina. The ulcers were resistant to
treatment but healed when nicorandil was withdrawn.
Pharmacokinetics
Nicorandil is absorbed from the gastro-intestinal tract and
maximum plasma concentrations are achieved 30 to 60 min-
utes after administration by mouth. Metabolism is mainly by
denitration and approximately 20% of an administered dose
is excreted in the urine mainly as metabolites. The elimina-
tion half-life is about one hour. Nicorandil is only slightly
bound to plasma proteins.
Uses and Administration
Nicorandil is a nitrate derivative of nicotinamide and
acts as a vasodilator. It is a potassium-channel opener
providing vasodilatation of arterioles and large coronary ar-
teries and its nitrate component produces venous vasodilata-
tion through stimulation of guanylale cyclase. It is used in
angina pectoris . The usual initial dose by mouth is
10 mg twice daily (or 5 mg twice daily in patients susceptible
to headache), increased as necessary to a maximum of 30 mg
twice daily; the usual therapeutic dose is in the range of 10 to
20 mg twice daily.
|