Nicorandil for angina (Ikorel)

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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.

Store the tablets in their original container - do not transfer from the blister pack into another container.

Type of medicineAn anti-anginal medicine (a potassium-channel activator)
Used forTo prevent angina chest pain
Also calledIkorel®
Available asTablets

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 it 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 helps to reduce the number of angina attacks you have. It can also reduce the risk of further heart conditions. You will be prescribed nicorandil if other (more frequently used) medicines are not suitable for you, or if they have not been sufficient to control your chest pains.

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

  • If you are pregnant 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, called 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 the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about nicorandil and will also provide you with a full list of side-effects which you could experience from taking it.
  • Take nicorandil exactly as your doctor tells you to. 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 information will be printed on the label of the pack of tablets to remind you about what the doctor said to you.
  • Try to take your tablets at the same times each day, as this will help you to remember to take your doses regularly. You can take nicorandil tablets either before or after meals. Swallow the tablet with a drink of water.
  • If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.
  • Nicorandil tablets are not suitable to take to relieve pain if you are having an angina attack. Your doctor will also prescribe a nitrate medicine, such as 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 by your doctor.
  • 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. It is best not to drink alcohol while you are on nicorandil, as alcohol will increase these feelings of dizziness.
  • If you buy any medicines 'over the counter', please check with a pharmacist that they are suitable for you to take with your prescribed medicines, as some anti-inflammatory painkillers may not be. 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. The table below contains some of the most common ones associated with nicorandil. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Very common nicorandil side-effects (these affect more than 1 in 10 people)
What can I do if I experience this?
HeadacheThis 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
Common nicorandil side-effects (these affect less than 1 in 10 people)What can I do if I experience this?
Feeling or being sickEat simple meals until this settles down - avoid rich or spicy food. Try taking the tablet after a meal if you are not already doing so
Feeling dizzy or weakDo not drive or use tools or machines while affected
Feeling flushed, increased heart rateIf either of these becomes troublesome, speak with your doctor

Important: some people taking nicorandil tablets have developed ulcers - particularly mouth, eye or skin ulcers. Although this is a rare side-effect, you should let your doctor know straightaway if you develop any ulcers, or if you notice any blood in your stools when you go to the toilet.

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light. Keep the blister strip in the outer carton. Do not transfer nicorandil tablets from the blister strips into other containers (including dosette boxes). This is because the original packaging contains a desiccant to keep the tablets fresh and without it they will degrade quickly.

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 due to have an operation or any dental treatment, please 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

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
Document ID:
1184 (v25)
Last Checked:
08/01/2016
Next Review:
07/01/2019
The Information Standard - certified member

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