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Review
. 2004 Jul;90(7):e38.
doi: 10.1136/hrt.2003.031831.

Persistent nicorandil induced oral ulceration

C M Healy  1 , Y Smyth, S R Flint
Affiliations
Review

Persistent nicorandil induced oral ulceration

C M Healy et al. Heart. 2004 Jul.

Abstract

Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required.

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Figures

Figure 1
Figure 1
Case 1: large painful ulcer on left lateral border of tongue, demonstrating the typical punched out appearance of nicorandil induced oral ulcers.
Figure 2
Figure 2
Case 2: ulcer of 10 weeks’ duration involving the lower labial sulcus.
Figure 3
Figure 3
Case 3: large ulcer involving the left buccal mucosa.
See this image and copyright information in PMC

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