Nicorandil for angina--an update

Abstract

Around 2 million people in the UK have angina pectoris and are therefore at high risk of severe coronary events such as myocardial infarction (MI) or sudden death. Conventional management of patients with stable angina includes glyceryl trinitrate, a beta-blocker, aspirin and a statin, with the aim of controlling symptoms and reducing the risk of a coronary event. For patients unable to tolerate a beta-blocker, the choice is less clear but calcium channel blockers and long-acting nitrates provide effective symptom control. Another option is nicorandil (Ikorel--Rhône-Poulenc Rorer), a potassium channel activator licensed for the "prevention and long term treatment of chronic stable angina pectoris". In our review of nicorandil 8 years ago, we concluded that it provided symptom control that was as good as, but no better than, other less expensive anti-anginal drugs. Since then, new data have suggested that nicorandil might reduce the frequency of coronary events in patients with stable angina. Here, we consider these findings and reassess the place of nicorandil for patients with angina.