Nicorandil: Warnings, Administration, Recommendations and Side Effects

It is an antianginal medicine, it is used to prevent the pain of angina pectoris. It works as a potassium channel activator.

Angina is pain that comes from the heart. It is usually caused by the narrowing of one or more of the arteries that supply blood to your heart.

This narrowing reduces the blood supply to parts of the heart muscle .

When the heart needs more blood and oxygen than it can pass through narrow arteries (for example, when a person is walking fast or climbing stairs), angina pain occurs.

Nicorandil works by relaxing or widening blood vessels.

This increases the supply of blood and oxygen to the heart and helps reduce the number of angina attacks that occur. It can also reduce the risk of other heart conditions.

Nicorandil will be prescribed to the patient if other medicines (more frequently used) are not suitable for this, or if they have not been sufficient to control the chest pains.


Some drugs are not suitable for people with certain conditions, and sometimes a drug can only be used if special precautions are taken.

For these reasons, before starting to take nicorandil it is important that the patient tell their doctor:

  • If you are pregnant or breast-feeding.
  • If you have low blood pressure.
  • If you have recently had a heart attack or know that you have heart failure.
  • If you have a problem with fluid build-up in your lungs, i.e. pulmonary edema.
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking or using other medicines.


Before starting treatment, the user should read the manufacturer’s printed information leaflet from inside the package.

This will give you more information about nicorandil and will also provide you with a complete list of the side effects you might experience from taking it.

It is important to take nicorandil according to your doctor’s instructions. It is usual to take one tablet (either 10 mg or 20 mg) twice a day, in the morning and in the evening.

When starting treatment, the doctor may prescribe a smaller dose (such as half a tablet) and then increase it after a short time.

This will help avoid unwanted side effects, particularly headaches.

The doctor will say what dose is right for the patient, and this information will be printed on the label of the tablet pack.

You need to take the tablets at the same time each day, as this will help you remember to take your doses regularly.

Nicorandil tablets can be taken before or after meals and should be taken with a drink of water.

If the patient forgets to take a dose, they should take it as soon as they remember (unless it is almost time for their next dose, in which case that dose should be skipped).

It is not advisable to take two doses together to make up for a forgotten dose.


Nicorandil tablets are not suitable for pain relief if the person has an attack of angina, however it works to prevent it.

Therefore, the doctor will also prescribe a nitrate medication, such as glyceryl trinitrate (TNG), for the patient to take if this happens.

If after using TNG the pain has not been relieved within a few minutes, it is necessary to call an ambulance.

In addition, for greater effectiveness it is advisable to follow the following instructions:

  • Try to keep regular appointments with the doctor so that you can check on the patient’s progress.
  • Treatment with nicorandil is generally long-term unless an adverse effect is experienced. You need to continue taking the tablets unless your doctor tells you otherwise.
  • Nicorandil can make the patient feel dizzy or faint, especially when starting to take it. So you should not drive or use tools or machines.
  • It is advisable not to drink alcohol while the patient is under treatment, as alcohol will increase feelings of dizziness.
  • If the patient buys medicines without a prescription, it is necessary to consult with a pharmacist to obtain information about the interference that it may have with the treatment.
  • It is very important that the patient does not take any erectile dysfunction medication while on this treatment, unless it has been prescribed by a doctor.

Side effects

Along with their helpful effects, most medications can cause unwanted side effects, although not everyone experiences them.

Below are the most common side effects associated with nicorandil.

The unwanted effects often improve as the body adjusts to the new drug, but it is advisable to consult with a doctor if any of the following continue or become bothersome:

Headache – This is very common when treatment is started, but should soon subside. It is necessary to consult a doctor so that he can recommend a suitable pain reliever.

Feeling or being sick: it is also common, eating simple meals until this calms down is recommended. It is recommended to take the tablet after a meal.

Feeling dizzy or weak: it is recommended not to drive or use tools or machines while the patient is affected.

Feeling flushed, increased heart rate: if any of these become problematic the patient should urgently see a doctor.

It is important to know that some people taking nicorandil tablets have developed ulcers, particularly mouth, eye, or skin ulcers.

Although this is a rare side effect, the patient should inform their doctor immediately if they develop ulcers or if they notice blood in their stools when going to the bathroom.

If the patient experiences other symptoms that they think may be due to the tablets, they should consult a doctor for more information.