Nicorandil for angina

The usual dose is one tablet (either 10 mg or 20 mg) twice daily.

The most common side-effects are headache and feeling dizzy. These should settle as you get used to the tablets.

Do not transfer the tablets from the blister packs into other containers (such as dosette boxes).

Type of medicine Anti-anginal medicine (a potassium-channel activator)
Used for To prevent angina chest pain
Also called Ikorel®
Available as Tablets

Angina is a 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 your heart muscle. When your heart needs more blood and oxygen than can get through the narrowed arteries (for example, when you walk fast or climb stairs), you feel angina pain.

Nicorandil works by relaxing (widening) your blood vessels. This increases the supply of blood and oxygen to your heart, and reduces the pain you feel. It can also reduce the risk of further heart conditions.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking nicorandil it is important that your doctor or pharmacist knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have low blood pressure.
  • If you have recently had a heart attack, or been told you have heart failure.
  • If you have a problem with fluid build-up in your lungs (known as pulmonary oedema).
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about nicorandil tablets and a full list of side-effects which you may experience from taking them.
  • Take nicorandil exactly as your doctor has told you. It is usual to take one tablet (either 10 mg or 20 mg) twice daily, in the morning and evening. When starting your treatment your doctor may give you a smaller dose (such as half a tablet) and then increase it after a short while. This will help avoid any unwanted side-effects, particularly headache. Your doctor will tell you what dose is right for you, and this will also be printed on the label of the pack to remind you.
  • Try to take your tablets at the same times each day, as this will help you to remember to take them. You can take them before or after meals. Swallow the tablets whole (without chewing or crushing them) with a drink of water.
  • If you forget to take a dose, take it as soon as you remember. If it is almost time to take your next dose, skip the missed dose and take your next dose when it is due. Do not take two doses together to make up for a forgotten dose.
  • Nicorandil tablets are not suitable to take to treat an angina attack. Your doctor will also prescribe glyceryl trinitrate (GTN) for you to take if this happens. If after using GTN your pain has not eased within a few minutes, call for an ambulance.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • Treatment with nicorandil is usually long-term unless you experience an adverse effect. Continue to take the tablets unless you are advised otherwise.
  • Nicorandil may cause you to feel faint or dizzy, particularly when you first start taking it. Do not drive or use tools or machines until you know how you react. Also it is best not to drink alcohol while you are on nicorandil, as alcohol will increase the feelings of dizziness.
  • If you buy any medicines, check with a pharmacist that they are suitable for you to take with your other medicines. It is very important that you do not take any medicines for erectile dysfunction while you are on nicorandil, unless they have been prescribed by your doctor.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Common nicorandil side-effects - these effect less than 1 in 10 people who take this medicine
What can I do if I experience this?
Headache This is very common when you first start nicorandil, but it should soon settle down. In the meantime, ask your doctor or pharmacist to recommend a suitable painkiller
Feeling or being sick Eat simple meals until this settles down - avoid rich or spicy meals
Feeling dizzy or weak If this happens, do not drive or use tools or machines. Do not drink alcohol
Flushing, increased heart rate If either of these becomes troublesome, speak with your doctor

Some people taking nicorandil tablets have developed mouth or skin ulcers. Although this is a rare side-effect, you should let your doctor know if it happens to you.

If you experience any other symptoms which you think may be due to this medicine, discuss them with your pharmacist or doctor.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light. Do not transfer nicorandil tablets from the blister packs into other containers. This is because the blister packs contain a desiccant to keep them fresh and without it they will degrade quickly. Once you have opened a blister pack, the tablets will keep for 30 days. Do not use tablets from packets that have been opened for longer than this.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

  • Manufacturer's PIL, Ikorel® tablets; Sanofi, The electronic Medicines Compendium. Dated January 2011.
  • British National Formulary; 64th Edition (Sep 2012) British Medical Association and Royal Pharmaceutical Society of Great Britain, London

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Adrian Bonsall
Last Checked:
31/10/2012
Document ID:
1184 (v24)
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