Nicor
Generic Name
Nicorandil
Manufacturer
Eskayef Pharmaceuticals Ltd. (common in BD), various others globally
Country
Bangladesh (for local brands), Japan (originator)
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nicor 10 mg tablet | ৳ 3.00 | ৳ 30.00 |
Description
Overview of the medicine
Nicorandil is a potassium channel activator that also has nitrate-like properties. It is used to treat and prevent stable angina pectoris by dilating both coronary and peripheral blood vessels, reducing cardiac workload and improving blood flow to the heart muscle.
Uses & Indications
Dosage
Adults
Initially 10 mg twice daily. Dose may be increased to 20 mg twice daily depending on response.
Elderly
No specific dose adjustment is usually required, but caution is advised. Start with a lower dose.
Renal_impairment
No specific dose adjustment required in mild to moderate renal impairment. Caution in severe impairment.
How to Take
Tablets should be swallowed whole with a glass of water, with or without food. Do not chew or crush the tablet.
Mechanism of Action
Nicorandil acts as a dual mechanism anti-anginal agent. It activates ATP-sensitive potassium channels in vascular smooth muscle cells, leading to hyperpolarization and vasodilation (arterial and venous). Additionally, its nitrate-like moiety provides nitric oxide, resulting in guanylate cyclase activation, increased cGMP, and further vasodilation.
Pharmacokinetics
Onset
Within minutes to 1 hour.
Excretion
Excreted mainly by the kidneys as metabolites and unchanged drug.
Half life
Approximately 1-2 hours.
Absorption
Well absorbed from the gastrointestinal tract; bioavailability is approximately 75%. Peak plasma concentrations reached within 0.5-1.5 hours.
Metabolism
Primarily metabolized in the liver by denitration.
Side Effects
Contraindications
- Cardiogenic shock
- Left ventricular failure with low filling pressure
- Hypotension
- Concomitant use with phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) due to risk of severe hypotension
- Hypovolaemia
- Pulmonary oedema
Drug Interactions
Tricyclic antidepressants
May potentiate the hypotensive effect.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Increased risk of gastrointestinal ulcers when used concomitantly with Nicorandil.
Other vasodilators (e.g., nitrates, alpha-blockers)
Increased risk of hypotension.
Phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil)
Profound and potentially fatal hypotension due to synergistic vasodilatory effects.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, tachycardia, and collapse. Management should involve supportive care, elevation of the legs, and if necessary, administration of fluids and vasopressors. Monitoring of cardiovascular function is essential.
Pregnancy & Lactation
Use in pregnancy is not recommended unless clearly necessary, as animal studies have shown some adverse effects. It is unknown if Nicorandil is excreted in breast milk; therefore, caution is advised during breastfeeding.
Side Effects
Contraindications
- Cardiogenic shock
- Left ventricular failure with low filling pressure
- Hypotension
- Concomitant use with phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) due to risk of severe hypotension
- Hypovolaemia
- Pulmonary oedema
Drug Interactions
Tricyclic antidepressants
May potentiate the hypotensive effect.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Increased risk of gastrointestinal ulcers when used concomitantly with Nicorandil.
Other vasodilators (e.g., nitrates, alpha-blockers)
Increased risk of hypotension.
Phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil)
Profound and potentially fatal hypotension due to synergistic vasodilatory effects.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, tachycardia, and collapse. Management should involve supportive care, elevation of the legs, and if necessary, administration of fluids and vasopressors. Monitoring of cardiovascular function is essential.
Pregnancy & Lactation
Use in pregnancy is not recommended unless clearly necessary, as animal studies have shown some adverse effects. It is unknown if Nicorandil is excreted in breast milk; therefore, caution is advised during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 2-3 years from the date of manufacture, specific to manufacturer.
Availability
Available in pharmacies worldwide
Approval Status
Approved by regulatory bodies (e.g., DGDA in Bangladesh)
Patent Status
Generic available
Clinical Trials
Nicorandil has been extensively studied in clinical trials for its efficacy and safety in stable angina, demonstrating significant reduction in angina episodes and improved exercise tolerance. Ongoing research explores its role in other cardiovascular conditions.
Lab Monitoring
- No routine laboratory monitoring is typically required for Nicorandil. Blood pressure should be monitored regularly, especially at the start of treatment.
Doctor Notes
- Consider Nicorandil in patients with stable angina refractory to or intolerant of first-line agents.
- Counsel patients on the importance of adherence and not discontinuing the drug abruptly.
- Be vigilant for ulcerations (oral, anal, ocular) which can be severe and require discontinuation.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking Nicorandil suddenly, as this may worsen your angina.
- Report any unusual or severe side effects, especially new ulcers, to your doctor immediately.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Nicorandil may cause dizziness, especially at the start of treatment or when the dose is increased. Patients should be cautious when driving or operating machinery until they know how the medicine affects them.
Lifestyle Advice
- Maintain a healthy lifestyle, including a balanced diet and regular exercise.
- Avoid smoking and excessive alcohol consumption.
- Manage stress effectively to help control angina symptoms.
Alternative Medicines in Bangladesh
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.