Common questions about nicorandil

Nicorandil is a type of medicine called a potassium channel activator. It works by relaxing and widening your blood vessels, which increases the supply of blood and oxygen to your heart. This helps reduce the chest pain angina causes.

Nicorandil starts to work after about 1 hour, but it usually takes about 4 to 5 days for it to fully take effect.

Nicorandil is generally safe to take for a long time. In fact, it works best when you take it for a long time.

Nicorandil is not usually the first-choice treatment for angina. The usual medicines used to prevent angina attacks are:

• beta blockers (like bisoprolol) – these make the heart beat slower and with less force
• calcium channel blockers (like amlodipine) – these relax the arteries, increasing blood supply to the heart muscle

If these medicines do not work for you or give you side effects, you may be given another medicine, such as nicorandil, ivabradine or ranolazine. These medicines are also known as second-line treatments for angina.

Nicorandil, ivabradine and ranolazine work in different ways, so it's difficult to say whether one is better than the others.

Some people may need to take a combination of medicines to control their angina symptoms.

You can take nicorandil as normal before and after surgery.

Nicorandil should not affect your sex life. But medicines used to treat erectile dysfunction, such as sildenafil or tadalafil, or vardenafil or dapoxetine (used to treat premature ejaculation), are not recommended while taking nicorandil.

Taking them together can lead to a serious drop in your blood pressure.

You do not need to stop playing sports if you take nicorandil. But try to build up your activity gradually and take regular breaks.

Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.

Nicorandil does not affect any type of contraception, including the combined pill, progestogen-only pill or emergency contraception.

However, if nicorandil makes you sick (vomit), your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.

Find out more:

• What to do if you're sick or have diarrhoea when taking the combined pill
• What to do if you're sick or have diarrhoea when taking the progestogen-only pill

Nicorandil can make you feel dizzy, especially when you first start taking it or after taking a bigger dose.

If this happens, do not drive a car, ride a bike, or use tools or machinery until you feel better.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking nicorandil. GOV.UK has more information on the law on drugs and driving.

Drinking alcohol can increase the blood pressure-lowering effect of nicorandil. This can make you feel dizzy or light-headed.

During the first few days of taking nicorandil or after an increase in your dose, avoid drinking alcohol until you see how the medicine affects you. If you find nicorandil makes you feel dizzy, it's best to stop drinking alcohol.

You can eat and drink normally while taking nicorandil, but do not use salt substitutes such as Lo-Salt. This is because they're high in potassium. When mixed with nicorandil, they can make the level of potassium in your blood too high.

You can boost the health of your heart by making some key lifestyle changes:

• Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke.
• Cut down on alcohol – drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week.
• Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic, walking every day will help.
• Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to follow these tips for a lower salt diet too. Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
• Manage stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
• Vaccinations – if you have heart failure, it's recommended that you have the flu vaccine every year and the pneumococcal vaccine as recommended by your GP. Ask your doctor about these vaccinations. You can have them free on the NHS. The coronavirus (COVID-19) vaccine is recommended for most people. Make sure you've had all the doses that you are eligible for. Talk to your doctor if you think you might be in one of the at risk groups.