Nicorandil: angina tablet and the ulcer warnings

Nicorandil is used to treat chest pain caused by angina and to prevent angina symptoms. The NHS explains that it works by relaxing and widening blood vessels, increasing the blood and oxygen supply to the heart.

It is a preventer rather than a rescue medicine. For an attack in progress, GTN is the quick option.

You usually take nicorandil twice a day, often long term and sometimes for the rest of your life. The tablets can be broken in half if your doctor tells you to. If you miss a dose, take it when you remember unless the next dose is nearly due, and then skip the missed one.

If you take too much, speak to a pharmacist or call NHS 111, and go to A&E if told to. Do not stop taking nicorandil unless your doctor tells you to.

Most adults can take it. The NHS lists the following as reasons it may not be suitable: a previous allergic reaction or serious side effect from nicorandil or a similar medicine, low blood pressure, fluid in the lungs, recent heart problems, low blood potassium in people on potassium supplements, kidney problems, glucose-6-phosphate dehydrogenase deficiency and diverticular disease.

Because diverticular disease and kidney problems are on the list, tell your prescriber if you have either.

Among the serious side effects are corneal ulcers, with eye pain and sensitivity to light; stomach ulcers, with pain, nausea, loss of appetite and blood in the stool; and painful ulcers on the skin or inside the genitals, bottom or nose.

Report any new painful sore or eye symptoms promptly. The NHS says to call NHS 111 for serious side effects. Anaphylaxis, with a swollen throat or tongue, a raised itchy rash and difficulty breathing, needs a 999 call.

Headaches are common, as are nausea and vomiting, flushing of the face, neck and chest, dizziness and weakness. Tell a pharmacist or doctor if they persist.

Interacting medicines include blood pressure tablets, erectile dysfunction medicines such as sildenafil, antidepressants such as amitriptyline, muscle relaxants such as baclofen, Parkinson's disease medicines, anti-inflammatory painkillers like ibuprofen and aspirin, steroid tablets and potassium supplements. Avoid salt substitutes such as LoSalt, which raise blood potassium.

It is best not to drink alcohol while taking nicorandil because it may increase the risk of side effects, particularly dizziness and light-headedness.

Nicorandil is not recommended in pregnancy because there is not enough information about its safety, and it is not usually recommended while breastfeeding, although a doctor may advise it if the benefits outweigh the risks.

Because the ulcer warnings involve places people do not usually inspect, it helps to be aware of your own mouth, skin and eyes. A mouth sore that does not heal, a painful patch of skin or an irritated, light-sensitive eye is worth reporting without delay, and the NHS advises calling NHS 111 about suspected serious side effects.

At each review, tell your clinician how often angina still occurs, whether headaches or flushing are troublesome, and whether you have had any stomach pain or blood in the stool. Check the labels of any new tablets with a pharmacist, especially painkillers, steroids or anything containing potassium.