Letter: Nicorandil‐Induced Peristomal Ulceration

Kidd, Lawrence R; Dixon, Catherine

doi:10.1111/j.1742-481x.2010.00720.x

Cited by 8 publications

(5 citation statements)

References 5 publications

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“…This 10‐year survey of 148 French cases of NIU is the first available survey based on spontaneous pharmacovigilance reports of both cutaneous and mucosal lesions induced by nicorandil. During this same period, 199 other cases were reported worldwide in 61 published articles: 173 cases of mucosal lesions, 21 cases of cutaneous lesions and 5 cases of mucosal and cutaneous lesions (Table ) .…”

Section: Discussionmentioning

confidence: 98%

Nicorandil‐induced ulcerations: a 10‐year observational study of all cases spontaneously reported to the French pharmacovigilance network

Babic

Petitpain²,

Guy

et al. 2018

International Wound Journal

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Nicorandil-induced ulcers remain often poorly recognised, with a late diagnosis and an inadequate management. We aimed to provide a clinical overview of the 148 spontaneously reported cases of nicorandil-induced ulcers to the French pharmacovigilance network between 2005 and 2014 and to complete this picture with worldwide published cases over the same period. Spontaneously reported nicorandil-induced ulcers were mainly mucosal (oral and anal) with a previous trauma in 23·0% of patients, revealed by a severe complication in 12·8% of cases. The mean cumulative dose of nicorandil was higher in serious cases. The median delay between the start of nicorandil use and the onset of the ulcer was 23·4 months, and after the ulcer was diagnosed, the median time to incriminate nicorandil was still 3·3 months, being shorter for mucosal ulcerations than for cutaneous ulcerations (5·2 versus 14·0 months, P = 0·001). The anatomic distribution in the 199 published cases differed slightly, but delays were similar. The hypothesis of mechanism becomes more precise, leaving no doubt about the necessity to discontinue the treatment. Practitioners need to be aware that nicorandil-induced ulcers can occur in many locations, possibly multiple and complicated, and should be simply managed by discontinuing treatment with no further reintroduction of nicorandil.

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Section: Discussionmentioning

confidence: 98%

Nicorandil‐induced ulcerations: a 10‐year observational study of all cases spontaneously reported to the French pharmacovigilance network

Babic

Petitpain²,

Guy

et al. 2018

International Wound Journal

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“…There has also been a case of a rectovaginal fistula10 that healed completely within 6 months of nicorandil cessation. However, the association with nicorandil had only been made after the patient had undergone a colostomy that was then complicated by peristomal ulceration 10 11. Moreover, a study of patients with diverticulitis who received nicorandil demonstrated significant complications including: nicorandil - associated perforation, fistulation and abscess formation 12…”

Section: Discussionmentioning

confidence: 99%

When treatment can be worse than the disease: nicorandil-induced colitis

2015

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A 75-year-old woman presented with severe abdominal pain and diarrhoea. Symptoms started 10 years earlier but multiple investigations failed to offer a clear diagnosis. On recent admission, blood tests, endoscopies and CT scans indicated chronic colonic inflammation. Treatment strategies for bowel inflammation were unsuccessful and the patient was subsequently discussed at a multidisciplinary team meeting with surgeons for consideration of colectomy. A drug review highlighted that the patient was taking an antiangina drug, nicorandil, thought to cause bowel ulceration. This was discontinued, which dramatically improved symptoms and avoided surgery and the patient was discharged within days. Follow-up colonoscopy showed much improved colitis, and the diarrhoea had resolved. It is important that clinicians are aware of the link between pharmacotherapy, specifically nicorandil and gastrointestinal ulceration and inflammation causing severe diarrhoea. Drug cessation is the only necessary and immediately effective treatment. Awareness of this will become more clinically relevant as nicorandil use increases.

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“…This case strongly suggests drug‐induced corneal ulceration, based on the sequence of events, the exclusion of other pathologies and the spontaneous regression of the side effect when the drug was discontinued. Nicorandil ulcerations seem to occur at vulnerable sites, being peristomal after the Hartmann's procedure, penile after circumcision and perianal after haemorrhoidectomy ; they are also associated with implantation scarring after implanting a pace maker, diverticulosis, and so forth. In our case, the patient was not treated with nicorandil at first cataract surgery, which remained uneventful.…”

Section: Casementioning

confidence: 99%

A case of nicorandil‐induced unilateral corneal ulceration

Tréchot

Batta

Petitpain³

et al. 2013

International Wound Journal

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Nicorandil, a second-generation nitro derivative, has been reported to induce single or multiple ulcerations in many locations, including oral, anal, perianal, vulvovaginal, perivulval, penile, gastrointestinal, colic, peristomal and skin locations. Ocular locations are now highly suspected. Herein, we report the case of a 78-year-old woman who experienced corneal ulceration at second cataract surgery (right eye) while being treated with nicorandil for 3 years. Four years before, she had had an uneventful first cataract surgery (left eye). The ulcers healed within 6 weeks after simple withdrawal of nicorandil, an expected delay for this type of chemical ulcer. The substitution of nicorandil with classic nitric oxide donors has already been done without complication. Surgical intervention is unnecessary and inappropriate. Case reports of ocular side effects induced by nicorandil are rare and probably underestimated.

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Letter: Nicorandil‐Induced Peristomal Ulceration

Cited by 8 publications

References 5 publications

Nicorandil‐induced ulcerations: a 10‐year observational study of all cases spontaneously reported to the French pharmacovigilance network

Nicorandil‐induced ulcerations: a 10‐year observational study of all cases spontaneously reported to the French pharmacovigilance network

When treatment can be worse than the disease: nicorandil-induced colitis

A case of nicorandil‐induced unilateral corneal ulceration

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