Case of perianal ulcers as adverse effect of nicorandil: BMJ
Dr Patricia McGettigan, at clinical pharmacology and medical education , William Harvey Research Institute, Queen Mary University of London, UK and colleagues have reported a case of Painful perianal ulcers following use of nicorandil.
Nicorandil is a nicotinamide ester that dilates arteries and veins, reducing after-load and pre-load on the heart. Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence recommend nicorandil as second line treatment in the management of stable angina that is inadequately controlled by first line agents such as β blockers and calcium antagonists or where these agents are not tolerated.
It has been documented to cause a rare but serious adverse reaction of painful, non-healing ulcers that affect the skin and mucosa, eye, including the gastrointestinal tract and genitalia. These warnings have been reiterated by the World Health Organization.
A 73 year old man presented with painful ulcers around his anus that have worsened, despite his use of a barrier cream. His bowel habit was unchanged, his weight is stable, he is not anaemic, and he has experienced no rectal bleeding. He had ischaemic heart disease for which he took aspirin, atorvastatin, bisoprolol, diltiazem, nicorandil, and ramipril.
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