Potassium channel activator with nitrate component Pregnancy: There are no or limited data in pregnant women; as a precautionary measure it is preferable to avoid use during pregnancy. Not recommended during breast-feeding (excreted in small amounts into animal breast milk; human excretion unknown). Insufficient fertility data to estimate human risk.

Nicorandil

Brand names: Ikorel

Nicorandil is a potassium-channel-activator anti-anginal used when standard agents are insufficient or not tolerated.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg twice daily (usual starting dose); usual therapeutic range 10 to 20 mg twice daily

Route: Oral — swallow whole with a glass of water; do not crush or chew (the tablet can be divided into equal doses). Administration is independent of food intake

Frequency: Twice daily, preferably in the morning and in the evening

Max: 40 mg twice daily

eMC §4.2. It is recommended that the dose be titrated upwards in accordance with the patient's needs, response and tolerance, up to 40 mg twice daily if necessary. A lower starting dose of 5 mg twice daily may be used in patients particularly prone to headache (headache occurs in more than 30% of patients, particularly in the first days of treatment; progressive dose titration may reduce its frequency). Elderly: no special dose requirements, but as with all medicines use of the lowest effective dose is recommended. Liver and/or renal impairment: no special dosage requirements. Paediatric population: not recommended in paediatric patients since safety and efficacy have not been established in this group — no paediatric dose is given; refer to a children's formulary. Safety warning from §4.4: nicorandil-induced gastrointestinal, skin, mucosal and eye ulcerations may occur at different locations in the same patient, are refractory to treatment and mostly respond only to withdrawal — if ulceration develops, nicorandil should be discontinued. Onset ranges from shortly after initiation to several years later.

Dose adjustments

Renal

No special dosage requirements for patients with liver and/or renal impairment; however, use with care in combination with other products that may increase potassium levels, especially in moderate to severe renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to nicorandil or to any of the excipients
Shock (including cardiogenic shock), severe hypotension, or left ventricular dysfunction with low filling pressure, or cardiac decompensation
Use of phosphodiesterase 5 inhibitors (risk of a serious drop in blood pressure)
Use of soluble guanylate cyclase stimulators (such as riociguat) — risk of a serious fall in blood pressure
Hypovolaemia
Acute pulmonary oedema

Side effects

Very common: headache (reported in more than 30% of patients in clinical trials, particularly in the first days of treatment)
Common: dizziness; cutaneous vasodilation with flushing; nausea and vomiting; feeling of weakness; decrease in blood pressure; heart rate increased
Gastrointestinal ulcerations (stomatitis, aphthosis, mouth, tongue, small intestinal, large intestinal and anal ulcers), gastrointestinal haemorrhage and diverticulitis — may progress to perforation, fistula or abscess formation
Skin and mucosal ulcerations (mainly peri-anal, genital and parastomal), rash, pruritus; angioedema (rare)
Eye disorders: corneal ulcer, conjunctival ulcer, conjunctivitis; diplopia; ophthalmoplegia and IIIrd/VIth nerve paralysis (often associated with headache)
Hyperkalaemia; myalgia; liver disorders such as hepatitis, cholestasis or jaundice

Interactions

Phosphodiesterase 5 inhibitors — contraindicated; serious drop in blood pressure
Soluble guanylate cyclase stimulators e.g. riociguat — contraindicated; serious fall in blood pressure
Acetylsalicylic acid or NSAIDs — increased risk of severe complications such as gastrointestinal haemorrhage secondary to nicorandil-induced ulceration; caution advised
Corticosteroids — gastrointestinal perforations reported with concomitant use; caution advised
Other medicinal products with a blood-pressure-lowering effect — caution advised
Other medicinal products that may increase potassium levels — risk of severe hyperkalaemia, especially in moderate to severe renal impairment
NOTE: eMC §4.5 was not captured in this bundle — the interactions above are taken from §4.3 and §4.4, which cross-refer to §4.5. Clinician to review the full §4.5 before publication.

Clinical monograph

How it works

It combines nitrate-like venodilation with arterial dilation through potassium-channel opening, reducing cardiac preload/afterload and improving coronary blood flow.

Prescribing in practice

It can cause serious ulceration of skin, mucosa and the gastrointestinal tract (mouth, anal and gastrointestinal ulcers, fistulae or perforation) — investigate any ulceration and usually stop the drug.
Headache is common early in treatment.
It is contraindicated with phosphodiesterase-5 inhibitors (e.g. sildenafil) and in significant hypotension.

Monitoring

Review for ulceration at any site and for blood pressure/headache.

Counselling the patient

Report any persistent mouth, skin, anal or gut ulcers — they can be caused by this medicine.
Do not take erectile-dysfunction drugs such as sildenafil with it.
Headaches at the start often settle.

Evidence & guidelines

An add-on anti-anginal in stable angina (NICE NG185 pathway), with an important ulceration warning.

Reference: NICE CG126; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways