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Angina pectoris in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Wilbert S. Aronow, William H. Frishman
Other drugs under investigation to be considered for FDA approval include nicorandil, ivabradine, and trimetazidine (117). Nicorandil is a coronary vasodilator with a unique dual mechanism of action that involves a nitrate-like effect and a potassium ion channel opening action (109,118–120). The Impact of Nicorandil in Angina (IONA) study showed at 1.6-year follow-up in patients with stable angina pectoris that 2565 patients randomized to nicorandil 20 mg twice daily had a 17% significant reduction in CAD death, nonfatal MI, or unplanned hospital admission for cardiac chest pain compared with 2561 patients randomized to placebo (120). Another study of 402 patients with stable angina pectoris showed that nicorandil added to standard antianginal therapy reduced the number of ischemic attacks by 50% (119).
Stomas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
John R.T. Monson, Iain Andrew Hunter
Multiple case reports and series indicate that a similar picture of parastomal ulceration and fistulation can be associated with the use of nicorandil.1,69,222 Use of nicorandil should be a key part of history taking in this situation. Alternatives are available, and cessation of nicorandil therapy should therefore be considered. Nicorandil ulcers will generally heal within eight to 12 weeks of stopping the drug.
Angina
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Nicorandil 10 mg twice a day is licensed for treatment of angina. It is a potassium-channel activator with a nitrate component, and has both arterial and vasodilating properties. It is a coronary artery vasodilator. It has similar efficacy to other anti-anginal drugs, and is most commonly used as an additional treatment. Nicorandil has not been shown to reduce the number of deaths. It reduces the incidence of acute coronary syndromes and hospitalisation for angina.
Intravenous nicorandil for patients with acute decompensated heart failure: a meta-analysis of randomized controlled trials
Published in Scandinavian Cardiovascular Journal, 2023
Nicorandil is an anti-anginal drug which has been widely used in patients with coronary artery disease [5]. As an adenosine-sensitive potassium channel opener and a nitrate-moiety nicotinamide ester, nicorandil stimulates cyclic guanosine monophosphate production, activates K ion channels, and promotes K ion outflow in vascular smooth muscle cells, thereby exerting the vasodilation efficacy [6]. Besides, accumulating experimental analyses confirmed the benefits of nicorandil on the myocardium, which involve the improvement of microcirculation, anti-apoptosis, and the promoting energy metabolism etc. [7,8]. In view of these benefits, nicorandil has been suggested as an alternative treatment for patients with HF [9]. However, for patients with ADHF, the clinical evidence for the use of intravenous nicorandil remains limited [10]. In this study, we performed a systematic review and meta-analysis to summarize the results of previous randomized controlled trials (RCTs), and to systematically evaluate the efficacy and safety of intravenous nicorandil for the treatment of ADHF.
5-Fluorouracil, capecitabine and vasospasm: a scoping review of pathogenesis, management options and future research considerations
Published in Acta Cardiologica, 2022
Eleftherios Teperikidis, Aristi Boulmpou, Panagiotis Charalampidis, Chalil Tsavousoglou, George Giannakoulas, Christodoulos E. Papadopoulos, Vassilios Vassilikos
Further available options for treating vasospastic angina include nicorandil and fasudil (Class IIa) [63]. Nicorandil is a dual nitrate and ATP-sensitive K channel agonist [66]. We ran a PubMed search using ‘fluorouracil and nicorandil’ which yielded 3 results, 2 of which were case reports where nicorandil was successfully used as part of a multi-drug regimen, including nitrates, in the treatment of 5-FU cardiotoxicities [67,68]. However, nicorandil is not widely available and therefore clinical experience is minor, whilst its use in routine clinical treatment is limited. Fasudil is an intracellular calcium antagonist and a Rho Kinase inhibitor that is approved in Japan and China for the treatment of cerebral vasospasm. Rho kinase is an important mediator of vasoconstriction [69]. Several other potential mechanisms for this molecule have been proposed. While its use in the treatment of vasospasm is classified as Class IIa, we ran a PubMed search using ‘fluorouracil and fasudil’ which yielded no results. Finally, ranolazine and trimetazidine, two broadly used regimens in the treatment of chronic stable angina, may be considered as therapeutic options in 5-FU vasospastic angina. While our search for ‘fluorouracil and ranolazine’ did not produce any results, we were able to locate 1 case report for ‘fluorouracil and trimetazidine’ [70]. In this report, trimetazidine was successfully administered along with CCB and nitrates in a capecitabine re-challenge attempt.
Nicorandil and atorvastatin attenuate carbon tetrachloride – induced liver fibrosis in rats
Published in Immunopharmacology and Immunotoxicology, 2020
Asmaa Ramadan Abdel-Sattar, Ali Ahmed Abo-Saif, Amira M. Aboyoussef
According to the results of the present study, the anti-inflammatory effect of nicorandil was evident from the significant down regulation of TNF-α level, which is one of the most important cytokines released during liver fibrosis. In addition, it is involved in the onset of lipid peroxidation, cell membrane disruption and replacement of the necrotic area with connective tissue [51]. Moreover, it also decreased hepatic MPO activity and reduced the amount of fibrous tissue in the liver as presented by its ability to reduce the relative liver weight which was significantly increased by CCl4. Interestingly, the anti-inflammatory effect of nicorandil may explain its beneficial antifibrotic effect. These comes in harmony with Wei et al. who reported that nicorandil can inhibit TNFα release in mast cells and lymphocytes, inhibit degranulation and the release of inflammatory cytokines and preformed mediators such as IgG from a wide range of cells [52].