Nicorandil

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Nicorandil is a drug used to treat angina. It is marketed as Ikorel ®.

It acts by relaxing the smooth muscle of the blood vessels, especially those of the venous system. It does this through two methods. Firstly it is a potassium channel activator, and secondly it donates NO to activate guanylate cyclase. Guanylate cyclase then causes activation of GMP leading to both arterial and venous vasodilatation. As it is selective for vascular potassium channels, it has no significant action on cardiac contractility and conduction.

Although it can dilate the coronary vessels of a healthy individual, its effects on the coronary vessels of someone with ischaemic heart disease will be little as they will already completely dilated. Instead it dilates the venous system which reduces preload and the work of the heart.

Common effects include flushing, palpitation, weakness, headache, mouth ulcers, nausea and vomiting.