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Nicorandil

  • Chapter
Pharmacological Treatment of Chronic Stable Angina Pectoris

Part of the book series: Current Cardiovascular Therapy ((CCT))

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Abstract

For many patients with chronic stable angina, achieving adequate symptom control requires a combination of medical therapies, together with myocardial revascularization where indicated. When recurrent symptoms fail to respond to beta-blockers or calcium channel antagonists, and when these are poorly tolerated or contra-indicated, selection of the most appropriate second-line agent requires careful consideration of individual factors. Most importantly, treatment should be specifically targeted with minimal side-effects. Nicorandil is a balanced vasodilator, which is effective in all types of angina. Its nitrate-like action reduces venous return (preload) and, to a lesser extent, dilates epicardial coronary arteries. Through activation of K+ ATP channels, nicorandil also decreases total peripheral resistance (afterload) and coronary arteriolar resistance thus improving coronary flow reserve. Overall its clinical efficacy is similar to conventional anti-angina agents, including long-acting nitrates, however it is not associated with tolerance and appears to offer additional prognostic benefit for patients with atherosclerosis.

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK

    Jason M. Tarkin MBBS, MRCP

  2. London Deanery, London, UK

    Jason M. Tarkin MBBS, MRCP

  3. Cardiovascular and Cell Sciences Research Institute, St George’s, University of London, London, UK

    Juan Carlos Kaski MD, DSc, FRCP, FESC, FACC, FAHA

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  1. Jason M. Tarkin MBBS, MRCP
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  2. Juan Carlos Kaski MD, DSc, FRCP, FESC, FACC, FAHA
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Correspondence to Juan Carlos Kaski MD, DSc, FRCP, FESC, FACC, FAHA .

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Editors and Affiliations

  1. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Avanzas

  2. Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, United Kingdom

    Juan Carlos Kaski

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Tarkin, J.M., Kaski, J.C. (2015). Nicorandil. In: Avanzas, P., Kaski, J. (eds) Pharmacological Treatment of Chronic Stable Angina Pectoris. Current Cardiovascular Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-17332-0_6

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  • DOI: https://doi.org/10.1007/978-3-319-17332-0_6

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