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Angina - stable - Management
Managing nicorandil
Who should avoid taking nicorandil?
- Nicorandil is contraindicated in people with:
- Left ventricular failure.
- Hypotension.
- The concomitant use of nicorandil and a phosphodiesterase inhibitor (sildenafil, tadalafil, or vardenafil) is contraindicated.
In depth
What are the adverse effects of 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 may occur, especially after high starting doses; it can be minimized by careful dose titration.
- Gastrointestinal ulceration (including aphthous ulcers and anal ulceration) has been reported with nicorandil.
- 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.
In depth
What drug interactions can occur with nicorandil?
- The concomitant use of nicorandil and a phosphodiesterase inhibitor (sildenafil, tadalafil, or vardenafil) is contraindicated.
In depth
What advice should I give to someone taking nicorandil?
- Advise people taking nicorandil that they should not drive or operate machinery until it is established that nicorandil does not impair their performance.
- Advise the person that if they develop symptoms suggestive of gastrointestinal ulceration, they should seek medical advice. Although these adverse effects are rare, they are frequently missed.
In depth
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