Purpose
Nicorandil is a widely used third-line treatment for ischemic heart disease. It can be associated with the development of stomatitis and oro-anal ulceration. The current report suggests an association between nicorandil and the development of colonic ulceration, both in isolation and in combination with anal ulceration.
Methods
This is a case report of four patients with new onset lower gastrointestinal symptoms. All had a history of ischemic heart disease and angina. All were taking several cardiac medications, including nicorandil.
Results
Four patients (3 men) were investigated. Colonoscopy revealed both solitary and multiple colonic ulcers. Pathology showed acute nonspecific inflammation. Two patients also displayed concomitant anal ulceration. Nicorandil therapy was stopped in all patients. No other active treatment was offered. All patients became asymptomatic within six weeks of cessation of nicorandil therapy with resolution of the anal and colonic ulceration.
Conclusion
Nicorandil may induce colonic ulceration and should be considered in the differential diagnosis of idiopathic colonic ulceration in appropriate patients.
References
Patel DJ, Purcell HJ, Fox KM. Cardioprotection by opening of the K (ATP) channel in unstable angina. Eur Heart J 1999;20:51–7.
IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial [published correction appears in Lancet 2002;360:806]. Lancet 2002;359:1269–75.
Gomma AH, Purcell HJ, Fox KM. Potassium channel openers in myocardial ischaemia: therapeutic potential of nicorandil. Drugs 2001;61:1705–10.
Boulinguez S, Bedane C, Bouyssou-Gauthier ML, Cornee-Leplat I, Truong E, Bonnetblanc JM. Giant buccal aphthosis caused by nicorandil. Presse Med 1997;26:558.
Agbo-Godeau S, Joly P, Lauret P, Szpirglas R, Szpirglas H. Association of major aphthous ulcers and nicorandil. Lancet 1998;352:1598–9.
Watson A, Al-Ozairi O, Fraser A, Loudon M, O’Kelly T. Nicorandil associated anal ulceration. Lancet 2002;360:546–7.
Vella M, Molloy RG. Nicorandil-associated anal ulceration. Lancet 2002;360:1979.
Healy CM, Smyth Y, Flint SR. Persistent nicorandil induced oral ulceration. Heart 2004;90:38.
King PM, Suttie SA, Jansen JO, Watson AJ. Perforation of the terminal ileum: a possible complication of nicorandil therapy. Surgery 2004;2:56–7.
Egred M, Andron M, Morrison WL. Nicorandil may be associated with gastrointestinal ulceration. BMJ 2006;332:889.
Webster K, Godbold P. Nicorandil induced oral ulceration. Br Dent J 2005;198:619–21.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Titi, M.A., Seow, C. & Molloy, R.G. Nicorandil-Induced Colonic Ulceration: A New Cause of Colonic Ulceration. Report of Four Cases. Dis Colon Rectum 51, 1570–1573 (2008). https://doi.org/10.1007/s10350-008-9218-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-008-9218-3