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Angina - stable - Management
What are the adverse effects of nicorandil?
- Headache is the most common adverse effect, occurring in 22–48% of people taking nicorandil.
- Headache is usually seen during the first 2 weeks of treatment; it is dose related and tends to diminish with continued use.
- Careful dose titration can reduce the incidence of headache and the number of people who stop treatment because of it.
- Hypotension has been occasionally reported with nicorandil, especially after high starting doses. However, long-term treatment of stable angina with oral nicorandil has not been associated with significant changes in blood pressure or heart rate.
- Hypotension can be minimized by careful dose titration.
[Micromedex, 2009]
- Gastrointestinal ulceration (including aphthous ulcers and anal ulceration) has been reported with nicorandil. Advice from the Medicines and Healthcare products Regulatory Agency states that [MHRA, 2008]:
- GPs and other healthcare professionals should consider nicorandil treatment as a possible cause in people who present with symptoms of gastrointestinal ulceration.
- Ulcers that result from nicorandil are usually refractory to treatment; they respond only to withdrawal of nicorandil.
- Nicorandil withdrawal should take place only under the supervision of a cardiologist.
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