Nicorandil

What is nicorandil?

Nicorandil is a prescription-only medicine used to treat chest pain (angina). It belongs to a group of medicines called potassium-channel activators. It is often prescribed when other angina treatments, such as beta-blockers or rate-limiting calcium-channel blockers, are not suitable or effective[1]. 

What is nicorandil used to treat?

Nicorandil is used for several heart-related conditions, particularly[1]: 

• Symptomatic treatment of stable angina, a type of chest pain caused by reduced blood flow to the heart 

How does nicorandil work?

Nicorandil has a dual action that helps relieve and prevent angina symptoms. It dilates arteries and veins, relaxing blood vessels and improving blood flow to the heart and it reduces the workload on the heart by lowering the pressure it has to pump against. This helps reduce the oxygen demand of the heart and eases chest pain[1]. 

Who can take nicorandil?

Most adults aged 18 and over can take nicorandil. However, it may not be suitable if you[1]: 

• Have low blood pressure 

• Have heart failure or pulmonary oedema 

• Have low blood potassium levels and are taking potassium supplements 

• Recently had a heart attack or been told you have heart failure 

• Have a genetic condition called glucose-6-phosphate dehydrogenase deficiency 

• Have low blood volume or certain digestive conditions like diverticular disease 

• Are allergic to nicorandil or any of its ingredients 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

What is the typical dosage of nicorandil?

Nicorandil comes as 10mg tablets. The usual dose of nicorandil is 10mg or 20mg twice daily. Some people may start on 5mg twice daily to reduce side effects such as headaches. Your doctor or pharmacist will advise on the right dose for you and may adjust it if needed[1]. 

How do you take nicorandil?

Nicorandil should be taken consistently each day[1]: 

• One tablet in the morning and one in the evening 

• Can be taken with or without food 

• Swallow the tablets whole with water 

• Tablets can be split if necessary, as they have a score line 

Can you stop taking nicorandil?

You should not stop taking nicorandil suddenly without medical advice. Stopping the medication can cause angina to return or worsen. If you are experiencing side effects, your doctor may adjust the dose or suggest an alternative treatment[1]. 

What do you do if you take too much nicorandil?

The amount of nicorandil that can lead to an overdose varies from person to person. Symptoms of an overdose may include dizziness, weakness, fast or irregular heartbeat. Call NHS 111 or go to A&E immediately. Take the medicine packaging with you[1]. 

What do you do if you forget to take nicorandil

If you miss a dose of nicorandil, you should[1]: 

• Take it as soon as you remember 

• If it’s nearly time for your next dose, skip the missed one 

• Do not double up to make up for a missed dose 

How do you store nicorandil?

Keep in a safe place out of reach of children. Nicorandil should be stored out of direct heat and light in a dry, cool place. Keep in original packaging as this protects the tablets from moisture[1]. 

What medicines can’t you take with nicorandil?

Some medicines can interact with nicorandil. Speak to your doctor and do not take with the following[1]: 

• Erectile dysfunction drugs (e.g. sildenafil, tadalafil) 

• Riociguat, a medicine used for pulmonary hypertension 

Use caution or check with your doctor before combining with[1]: 

• Medicines that are used to treat high blood pressure (hypertension) 

• Antidepressants such as amitriptyline 

• Other vasodilators unless advised by your doctor 

• Regular non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin, or steroid tablets – these can increase the risk of stomach ulcers 

• Medicines for Parkinson’s disease, like co-careldopa or levodopa  

• Muscle relaxants, such as baclofen 

• Diuretics 

• Nitrates 

• Other heart medications 

• Herbal or over-the-counter remedies 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of nicorandil?

Common side effects of nicorandil include[1]: 

• Headache (especially during the first few days) 

• Dizziness 

• Flushing 

• Nausea 

Serious side effects of nicorandil include[1]: 

• Ulcers in the mouth, stomach, or bowel 

• Eye inflammation 

• Skin ulcers 

• Severe allergic reactions 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2].

Frequently asked questions about nicorandil

How long does nicorandil take to work? 
It usually starts working within one hour, with the full effect in 4 to 5 days[1]. 

Can I take nicorandil long-term? 
Yes. Nicorandil is safe and effective for long-term use when monitored by a doctor[1]. 

Is nicorandil better than other heart medicines? 
It is often used if other treatments are not effective or cause side effects[1]. 

Do I need to stop taking nicorandil before surgery? 
You can usually continue taking it, but always inform your surgical team[1]. 

Will nicorandil affect my sex life? 
It shouldn't directly, but you must not take it with erectile dysfunction medications[1]. 

Can I play sports while taking nicorandil? 
Yes. Physical activity is encouraged but should be increased gradually[1]. 

Does nicorandil affect contraception? 
No, but if you vomit due to side effects, this may reduce the effectiveness of oral contraceptives[1]. 

Can I drink alcohol while taking nicorandil? 
Yes, in moderation. Alcohol may increase dizziness or light-headedness[1]. 

Can I drive while taking nicorandil? 
Avoid driving until you know how nicorandil affects you[1]. 

For the official NHS guide for nicorandil, visit their website.