Experiences with

Nicorandil

Nicorandil is a medicine used to treat and reduce chest pain caused by angina.

It works by relaxing and widening your blood vessels and increasing the blood and oxygen supply to your heart.

Your doctor will usually prescribe nicorandil when other heart medicines have not worked or are not suitable for you.

This medicine is only available on prescription and comes as tablets.

Who can take nicorandil

Most adults aged 18 and over can take nicorandil.

Who may not be able to take nicorandil

Nicorandil is not suitable for some people. To make sure it's safe for you, tell your doctor if you have:

• ever had an allergic reaction to nicorandil or any other medicine
• low blood pressure (hypotension)
• a problem with fluid build-up in the lungs (pulmonary oedema)
• recently had a heart attack or been told you have heart failure
• low blood potassium levels and are taking potassium supplements
• kidney problems
• a genetic condition called glucose-6-phosphate dehydrogenase deficiency
• a digestive condition that affects the large intestine (diverticular disease)

Dosage

Nicorandil comes as 10mg tablets.

You'll usually take 20mg a day but this may go up to 40mg if your doctor thinks you need it.

If you often get headaches, you may be given a smaller starting dose of 5mg, twice a day. This can be increased after about a week.

Your dose will depend on how nicorandil works for you.

How to take it

You'll usually take 1 tablet in the morning and 1 tablet in the evening.

You can take nicorandil with or without food. Swallow your tablet whole with a drink of water.

The tablets have a score line across the middle. This helps you break them in half if you only need to take 5mg doses, or have difficulties swallowing tablets whole.

How long to take it for

Treatment with nicorandil is usually long term, even for the rest of your life.

Talk to your doctor if you want to stop taking nicorandil. Stopping nicorandil can make your angina pain come back. It usually takes around 2 days for nicorandil to be completely out of your body.

If you're bothered by side effects, your doctor may be able to prescribe a different medicine for your angina.

If you forget to take it

If you miss a dose of nicorandil, take the missed dose as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

The amount of nicorandil that can lead to an overdose varies from person to person.

you take more than your prescribed dose of nicorandil and:

• feel dizzy or weak (these can be signs of low blood pressure)
• your heart is beating faster or you have an irregular heartbeat

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the nicorandil packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of nicorandil happen in more than 1 in 100 people. There are things you can do to help cope with them:

If this advice does not help and any of these side effects continue to bother you, keep taking the medicine, but tell your doctor or pharmacist.

Serious side effects

Call your doctor or call 111 now if you get:

• red, itchy or watery eyes – these can be signs of conjunctivitis or a corneal ulcer
• painful sores (ulcers) on the eyes, skin or the lining of your mouth
• stomach pain, feeling or being sick, loss of appetite, or blood in your poo – these are signs of stomach ulcers

Serious allergic reaction

In rare cases, nicorandil may cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of nicorandil. For a full list, see the leaflet inside your medicine packet.

Cautions with other medicines

Some medicines can lower your blood pressure too much when they're taken with nicorandil. This can make you feel dizzy or faint.

There are also some medicines that may affect the way nicorandil works.

Tell your pharmacist or doctor if you're taking:

• medicines used to treat high blood pressure (hypertension)
• antidepressants such as amitriptyline
• muscle relaxants, such as baclofen
• riociguat, a medicine used for pulmonary hypertension
• medicines that increase potassium levels – these include ACE inhibitors, such as lisinopril or ramipril, and angiotensin receptor blockers (ARBs), such as valsartan, losartan or candesartan
• medicines for Parkinson's disease, like co-careldopa or levodopa
• dapoxetine, vardenafil, sildenafil, tadalafil or other medicines to treat erection problems (erectile dysfunction) or hypertension. Taking these with nicorandil can cause a serious drop in blood pressure
• regular non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, or steroid tablets – these can increase the risk of stomach ulcers

Taking nicorandil with painkillers

It's safe to take nicorandil with paracetamol.

But talk to your doctor before taking painkillers like ibuprofen and high-dose aspirin, known as non-steroidal anti-inflammatory drugs (NSAIDs). This is because they can increase the risk of stomach ulcers.

Your doctor can help you decide on the best pain relief for you.

Mixing nicorandil with herbal remedies and supplements

Tell your doctor or pharmacist if you have low blood potassium levels and are taking potassium supplements. When mixed with nicorandil, they may make the level of potassium in your blood too high.

There's not enough information to say that other herbal remedies or supplements are safe to take with nicorandil. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Nicorandil and pregnancy

Nicorandil is not usually recommended in pregnancy. This is because there is not enough information available to say whether it's safe or not.

If you're trying to get pregnant, or are already pregnant, talk to your doctor about the benefits and possible harms of taking nicorandil.

Your doctor will be able to recommend the best treatment for you and your baby.

Nicorandil and breastfeeding

Nicorandil is not usually recommended while you're breastfeeding. We do not know how much nicorandil passes into breast milk or whether it could have any effects on your baby.

Although other medicines are preferred while you are breastfeeding, it's important you take the medicine that works for you. If you are breastfeeding, or planning to breastfeed, talk to your doctor to help you decide what's best for you and your baby.

Your doctor may say it's OK to take nicorandil while breastfeeding. However, tell your doctor, health visitor, midwife or pharmacist as soon as possible if:

• your baby is not feeding as well as usual
• your baby seems more irritable than usual
• your baby is being sick
• your baby has skin rashes or mouth ulcers
• your baby is flushed
• you have any other concerns about your baby

Nicorandil and fertility

There's no evidence to suggest that taking nicorandil reduces fertility in either men or women.

Related links

HealthUnlocked contains information from NHS Digital, licensed under the current version of the Open Government Licence