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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Nicorandil now firmly second line

The manufacturer of nicorandil (Ikorel®) has written to healthcare professionals advising of new restrictions to the licensed indication and additional contraindications and warnings.

Nicorandil is now recommended for the treatment of stable angina in patients whose angina is inadequately controlled by first line treatments or who have a contraindication or intolerance to first line treatments. First line treatments include beta blockers and calcium channel blockers.

It is also noted that nicorandil can cause serious skin, mucosal and eye ulceration that persists unless treatment is stopped. Treatment must be stopped if any ulceration develops and cardiologist advice sought if angina symptoms worsen.

Patients with diverticular disease may be at increased risk of fistula formation or bowel perforation. Patients taking aspirin, NSAIDs or corticosteroids are at increased risk of gastrointestinal ulceration.

Nicorandil is now contraindicated in hypovolaemia, acute pulmonary oedema and in combination with guanylate cyclase stimulators. It should be used cautiously in combination with medicines that increase potassium levels, especially in patients with moderate to severe renal impairment.

Action: Clinicians should be aware of these new restrictions and remain vigilant for ulceration in patients taking nicorandil.

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2 Comments to “Nicorandil now firmly second line”

  1. I have been prescribed Nicorandil but am very wary of taking this medication alongside Aspirin which I am also prescribed. When I initially took Nicorandil I developed a rash and irritation on the scalp. I am also very concerned about ulceration. I am finding it difficult to balance the benefits of Nicorandil against those of Aspirin. Your comments would be most welcome thank you.

    Comment by RKMorrell — May 8, 2019 #

    1. @RKMorrell,

      Nicorandil and aspirin are not really equivalents or even similar. Aspirin thins the blood, nicorandil opens up blood vessels to relieve angina symptoms. All medicines have side effects, and there must always be a balance between benefits and side effects. If you are getting side effects and are unsure, speak to your doctor as there may be other options for you.

      Comment by Matthew Robinson — May 8, 2019 #

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