Symptoms: pronounced decrease in blood pressure, tachycardia.
Treatment: gastric lavage, administration of activated charcoal (especially in the first 2 hours after overdose), maintenance of CCC function, elevated position of the limbs, symptomatic and supportive therapy, intravenous administration of calcium gluconate and dopamine. It is possible to use hemodialysis.
hypersensitivity to the drug,
acute myocardial infarction (and within 3 months after),
cardiogenic shock, collapse,
unstable angina,
chronic heart failure of the III or IV functional class according to the classification NYHA,
severe bradycardia (heart rate <50 beats / min),
atrioventricular block of II and III degree,
left ventricular failure with low filling pressure,
arterial hypotension (sBP <100 mmHg)),
concomitant administration of PDE-5 inhibitors (sildenafil, vardenafil, tadalafil),
pregnancy (see " Use during pregnancy and lactation»),
lactation period (see " Use during pregnancy and lactation»),
age under 18 (efficacy and safety not established).
With caution: cardiac arrhythmias, Prinzmetal angina, arterial hypotension, grade I atrioventricular block, renal and/or liver dysfunction, hypovolemia, pulmonary edema, angle-closure glaucoma, hyperkalemia, anemia.
When taken concomitantly with antidepressants, PDE-5 inhibitors (sildenafil, vardenafil, tadalafil), vasodilators, hypotensive agents, tricyclic antidepressants, diuretics, beta-blockers, MAO inhibitors and ethanol — increased antianginal action.
With simultaneous administration of the drug with sapropterin, it is possible to reduce blood pressure below normal.
From the CCC side: palpitations, tachycardia, decreased blood pressure, flushes of blood to the face, peripheral edema.
From the central nervous system: weakness, headache (does not require withdrawal of the drug, can be mitigated by reducing the initial dose of the drug), dizziness, tinnitus, insomnia.
From the digestive tract: nausea, vomiting, unpleasant sensations, a feeling of overflow in the stomach, stomatitis (extremely rare), in some cases, an increase in the activity of hepatic transaminases (ALT, AST), and ALP is possible.
Hypersensitivity reactions: allergic reactions may develop.
relief of angina attacks,
prevention of stable angina attacks (in combination with other antianginal agents and in monotherapy for intolerance to beta-blockers and BCC).
Nicorandil has an antianginal effect, which is based on a combination of nitrate-like properties and the ability to open potassium channels. Due to the opening of potassium channels, nicorandil causes hyperpolarization of the cell membrane, and the nitrate-like effect is to increase the intracellular content of cyclic guanyl monophosphate. These pharmacological effects lead to relaxation of smooth muscle cells and cellular protection of the myocardium in ischemia. Hemodynamic effects are expressed in a balanced reduction in pre-and post-loading (in contrast to BCC, which act mainly on post-loading). Taking into account the selective vasodilation of the coronary arteries, as a result, the load on the ischemic myocardium is minimal. Nicorandil does not affect the contractility of the myocardium, practically does not change the heart rate. Reduces systemic blood pressure by less than 10%, has a beneficial positive effect on cerebral circulation in patients with ischemic stroke. Nicorandil does not affect the parameters of lipid metabolism and glucose metabolism. Nicorandil relieves an attack of angina with a decrease in pain within 4-7 minutes after taking it under the tongue and completely relieves it within 12-17 minutes
Nicorandil is rapidly and completely absorbed from the gastrointestinal tract, reaching Cmax in the blood plasma after 0.5–1 h. It is not subject to intensive metabolism in the liver, T1/2 — 50 min. It is mainly excreted by the kidneys.
Nicorandil is slightly bound to plasma proteins. The free fraction in the blood plasma is about 75%.
Pharmacokinetic parameters do not depend much on the patient's age, the presence of concomitant liver or kidney pathology, and the appointment of concomitant therapy.
Dancor
Nicorandil
Inside, with water, regardless of the meal.
Prevention of stable angina attacks (long-term therapy of stable angina). The drug is usually prescribed in a dose of 10 to 20 mg 2-3 times a day. The recommended initial dose of the drug is 10 mg 2 times a day. The effective therapeutic dose of the drug is selected individually, depending on the severity and duration of the disease. The maximum daily dose is 80 mg. If a headache occurs, the initial dose may be reduced.
Relief of an attack of angina. The drug should be taken immediately at the first signs of an attack of angina — the drug in a dose of 20 mg is placed under the tongue and held until completely dissolved, without swallowing.
