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Potassium channel activator with nitrate component

Nicorandil

Brand names: Ikorel

Adult dose

Dose: 5–10mg BD, increase to 20mg BD (max 30mg BD)
Route: PO
Frequency: BD

Clinical pearls

  • Adjunct in chronic stable angina when standard therapy insufficient
  • MHRA: ulceration is a class effect — counsel patients to report any ulcer; STOP nicorandil and review

Contraindications

  • Cardiogenic shock
  • Severe hypotension
  • LV dysfunction with low filling pressures
  • Concurrent PDE-5 inhibitors / riociguat

Side effects

  • Headache (common, often improves)
  • Flushing
  • GI/oral/anal/skin ulceration (MHRA — sometimes severe; STOP if occurs)
  • Hypotension

Interactions

  • PDE-5 inhibitors (severe hypotension)
  • Riociguat
  • Antihypertensives

Monitoring

  • Mucosal/skin ulceration

Reference: BNF; NICE CG126; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/nicorandil/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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