Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris

Meany, Thomas B.; Richardson, Peter J.; Camm, A. John; Coltart, J; Griffith, Michael; Maltz, M. B.; Signy, Mark

doi:10.1016/0002-9149(89)90208-7

Cited by 33 publications

(13 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since nicorandil appears to be as effective as nitroglycerin in clinical cases [18][19][20][21][22][23][24][25], it was assumed that it would be very useful to document the similarities and differences between the two drugs, with particular emphasis on the effects on large coronary arteries as well as coronary resistance vessels. Therefore, this study was designed to compare the effects of nitroglycerin and nicorandil on large and small coronary arteries and systemic hemodynamics.…”

mentioning

confidence: 99%

Coronary effects of nicorandil in comparison with nitroglycerin in chronic conscious dogs

Hashimoto

Kinoshita

Ohbayashi

1991

Cardiovasc Drug Ther

View full text Add to dashboard Cite

The effects of nicorandil (0.2 mg/kg, IV) and nitroglycerin (15 micrograms/kg, IV) on large and small coronary arteries were compared in conscious dogs instrumented with ultrasonic crystals and electromagnetic flow meters in the circumflex coronary artery. Nicorandil dilated the large coronary arteries to the same extent, but with a longer duration of action than nitroglycerin. The small coronary arteries dilated for a very short period of time with nitroglycerin, but dilated markedly with nicorandil. The dilatory action of nicorandil on large coronary arteries persisted after the action on the small coronary artery fell to the control value, indicating that the dilatory action on the large coronary arteries is due to the direct relaxing effect on smooth muscle and is not the result of the flow-dependent effect. The measurement of the plasma concentration of nicorandil after incremental infusions of the agent showed that the dilation of the small coronary artery took place at only a very high level (above 200 ng/ml). On the other hand, the large coronary arteries responded to nicorandil at a much lower concentration (about 100 ng/ml, the clinically effective plasma concentration of nicorandil) than the small coronary resistance arteries. In conclusion, whereas nicorandil possesses a dilatory action on both large and small coronary arteries, in a clinical setting, with a daily dosage of 15-30 mg, part of the beneficial effects of nicorandil may be the result of a dilation of the large coronary arteries and may be due to the fact that a coronary steal phenomenon does not occur after nicorandil administration.

show abstract

mentioning

confidence: 99%

Coronary effects of nicorandil in comparison with nitroglycerin in chronic conscious dogs

Hashimoto

Kinoshita

Ohbayashi

1991

Cardiovasc Drug Ther

View full text Add to dashboard Cite

show abstract

“…Meany et al 30 reported that nicorandil improved exercise capacity within 12 h of its administration, but further study is necessary to demonstrate that a similar durability of the effect could be obtained with the dosage used in this trial. In addition, the treatment period was short at 2 weeks so long-term efficacy and safety need to be established in Chinese patients with AP.…”

Section: Study Limitationsmentioning

confidence: 73%

Double-Blind, Multicenter, Active-Controlled, Randomized Clinical Trial to Assess the Safety and Efficacy of Orally Administered Nicorandil in Patients With Stable Angina Pectoris in China

Zhu

Yuan-dong

Guo

et al. 2007

Circ J

View full text Add to dashboard Cite

Background The efficacy and safety of nicorandil were evaluated in Chinese patients with stable angina pectoris (AP) in a double-blind, multicenter, active-controlled, randomized clinical trial. Methods and ResultsAfter a 2-week washout period, 232 patients with stable AP were randomized to receive either nicorandil (5 mg tid; 115 patients) or isosorbide mononitrate (ISMN: 20 mg bid; 117 patients) for 2 weeks. Exercise capacity, number of weekly anginal attacks, nitroglycerin (NTG) consumption, and safety were evaluated. Nicorandil and ISMN significantly prolonged the time to 1 mm ST-segment depression in an exercise tolerance test. Both drugs improved the total exercise time and the time to onset of chest pain. There was no significant difference between the 2 groups. Nicorandil significantly decreased the number of anginal attacks and NTG consumption. ISMN decreased the number of anginal attacks significantly; however, there was no significance in NTG consumption, and the ratio of anginal attack reduction was at least 50% was significantly higher with nicorandil. Nicorandil was well tolerated and there was no safety profile difference compared with ISMN. Thus, nicorandil may have equivalent or better antianginal effect than ISMN. Conclusions Nicorandil is beneficial as treatment for AP. (Circ J 2007; 71: 826 -833)

show abstract

“…Recently Camm and Maltz [121] reported that significant improvement in exercise capacity with the effect of placebo was maintained at 6 hours after single oral doses of 20, 40, and 60 mg of nicorandil and of placebo. Meany et al [122] administered twice-daily doses of nicorandil for 2 weeks, increasing from 5 mg to 20 mg, in chronic stable angina pectoris and showed a statistically significant improvement in exercise duration.…”

Section: Studies In Angina Pectarismentioning

confidence: 99%

“…Generally, nicorandil is administered at a dose of 5 to 10 mg given three times after meals or four times daily after meals and at bedtime. Administration four times daily may be more effective than less frequent dosing, particularly in cases of nocturnal or early morning angina, but more than one study in patients with stable exertional angina has shown a prolonged improvement in exercise tolerance for up to 6 hours after a single oral administration of 20 mg of nicorandil [120][121][122], although the plasma level declined so rapidly that there was no correlation between the plasma level and the duration of the antianginal effect. Sublingual nitroglycerin may be coadministered with nicorandil as needed to stop acute anginal attacks.…”

Section: Dosage and Administrationmentioning

confidence: 99%

“…In addition, nicorandil may even be effective in patients with rest and effort angina who do not respond to the combination therapy with calcium antagonist and an oral nitrate [125]. A frequent administration of three or four times daily might prove to be disadvantageous when compared with a smaller dosage of two times daily, however, twice daily dosing is also effective in patients with chronic stable angina pectoris [122]. Thus, nicorandil appears to be a promising addition to the cmTently available arsenal of antianginal drugs, particularly due to its low incidence of serious side effects.…”

Section: The Role Of Nicorandil In Therapymentioning

confidence: 99%

See 1 more Smart Citation

Pharmacology and therapeutic effects of nicorandil

Kinoshita

Sakai²

1990

Cardiovasc Drug Ther

View full text Add to dashboard Cite

Nicorandil, a nicotinamide derivative, is an orally efficacious antianginal drug possessing a nitrate moiety in its chemical structure. This drug is an effective and well-tolerated treatment for various types of angina pectoris. Its general efficacy is similar to that of nitrates, with several unique effects on the cardiovascular system. Nicorandil causes sustained dilation of both the arterial resistance and conductive vessels, thus markedly dilating the coronary artery and increasing coronary blood flow. In addition, nicorandil, unlike nitroglycerin or isosorbide dinitrate, possesses little hemodynamic effect on heart rate, blood pressure, or cardiac contractility with clinical doses yielding antianginal effects. The mechanism causing coronary vasodilation has not been completely clarified but appears to be associated partly with increases in c-GMP, as well as the hyperpolarization of the smooth muscle membrane. Nicorandil, in single oral doses of 10-30 mg, has been shown to be effective in chronic stable angina, as assessed objectively by increases in exercise duration and/or the time to onset of ST-segment depression during treadmill exercise. In open studies and controlled efficacy evaluations, nicorandil in daily oral doses of 15-40 mg demonstrated significant effectiveness in the treatment of various types of angina pectoris. Headaches due to vasodilation may occur, and some side effects occurred in 5.1-34% of patients receiving nicorandil, but were generally minor in nature. There was no depressant effect on atrioventricular conduction, which occurs frequently in patients treated with calcium antagonists of the verapamil and diltiazem type. Nicorandil may be effective even in patients with rest and effort angina who do not respond to combination therapy with calcium antagonists and oral nitrates. Thus, nicorandil appears to be a valuable addition to the arsenal of antianginal drugs due to its low incidence of serious side effects.

show abstract

Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris

Cited by 33 publications

References 23 publications

Coronary effects of nicorandil in comparison with nitroglycerin in chronic conscious dogs

Coronary effects of nicorandil in comparison with nitroglycerin in chronic conscious dogs

Double-Blind, Multicenter, Active-Controlled, Randomized Clinical Trial to Assess the Safety and Efficacy of Orally Administered Nicorandil in Patients With Stable Angina Pectoris in China

Pharmacology and therapeutic effects of nicorandil

Contact Info

Product

Resources

About