Nicorandil: serious gastrointestinal ulceration

(1) Nicorandil is a vasodilator with limited efficacy, marketed for symptomatic relief of angina pectoris. Oral ulcerations, sometimes quite large, are an adverse effect of nicorandil that has been known since the 1990s. Cases of painful anal ulceration were reported later. (2) More recently, it has emerged that nicorandil can also cause very painful chronic ulceration of the colon and small intestine. Painful parastomal ulceration has also been reported in patients with ileostomies or colectomies. (3) Gastrointestinal ulceration has been reported from the mouth to the perineum. It is sometimes associated with skin ulcers. (4) In some cases the lesions are sufficiently extensive and refractory to warrant surgery (colostomy) or immunosuppressant treatment. However, simply withdrawing nicorandil generally leads to recovery with a few weeks. (5) Nicorandil should not be considered a standard treatment for angina pectoris. It is better to choose another drug such as a betablocker. Nicorandil must be withdrawn if cutaneous or gastrointestinal ulceration occurs.