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 Post subject: NICORANDIL - 2016 update
PostPosted: 03 Jun 2016 02:09 
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Joined: 24 Mar 2013 02:28
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prophylaxis and treatment of stable angina (second-line)

low systolic blood pressure; acute myocardial infarction with acute left ventricular failure and low filling pressures; hyperkalaemia; G6PD deficiency; heart failure (class III–IV); diverticular disease (risk of fistula formation or bowel perforation); interactions: Appendix 1 (nicorandil)

Patients should be warned not to drive or operate machinery until it is established that their performance is unimpaired

Nicorandil-induced ulceration
Nicorandil can cause serious skin, mucosal, and eye ulceration; including gastro-intestinal ulcers, which may progress to perforation, haemorrhage, fistula or abscess. Stop treatment if ulceration occurs and consider an alternative.

Mohan- I would only start with 5mg bd in Indian patients .

cardiogenic shock; left ventricular failure with low filling pressures; severe hypotension; hypovolaemia; acute pulmonary oedema

manufacturer advises use only if potential benefit outweighs risk—no information available

no information available—manufacturer advises avoid

nausea, vomiting, rectal bleeding, cutaneous vasodilation with flushing, increase in heart rate (at high doses), dizziness, headache (especially on initiation, usually transitory), weakness;
less commonly oral ulceration, hypotension, myalgia, angioedema;
rarely gastro-intestinal ulceration, anal ulceration, abdominal pain, hepatitis, cholestasis, jaundice, skin ulceration, rash, pruritus; very rarely; eye ulceration; also reported gastrointestinal haemorrhage

Initially 10 mg twice daily (if susceptible to headache 5 mg twice daily), then increased if tolerated to 40 mg twice daily; usual dose 10–20 mg twice daily.

Mohan- I would only start with 5mg bid in Indian patients , and titrate upwards with close monitoring.

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