Why Nicorandil is not Considered to be the First-line Antianginal Drug

• Published in: Medicina pp. 25 - 47
• Main Authors: Bel'diev, S. N., Andreeva, E. V., Berezina, E. I., Egorova, I. V., Medvedeva, I. V., Platonov, D. Yu
• Format: Journal Article
• Language: English
• Published: 2020
• ISSN: 2308-9113; 2308-9113
• DOI: 10.29234/2308-9113-2020-8-3-25-47

According to the results of several short-term randomized controlled trials (RCTs), nicorandil is not inferior in its antianginal efficacy to beta-blockers (BB), calcium channel blockers (CCB) and long-acting nitrates (LAN). At the same time, in some short-term RCTs, as well as in the long-term RCT IONA (2002), it was shown that antianginal efficacy of nicorandil as monotherapy or in combination with other antianginal drugs did not differ from placebo. Ability of nicorandil to reduce the risk of adverse cardiovascular events, demonstrated in the RCT IONA, requires confirmation in a long-term trial with a stronger primary endpoint and concomitant treatment that would meet the current guidelines for the management of patients with chronic coronary syndromes. In this regard, and also taking into account the proven ability of nicorandil to cause gastrointestinal ulcerations, European experts currently consider nicorandil as a drug that is inferior in priority of choice to the first-line antianginal drugs (BB, CCB) and, in some cases, to the second-line drugs (LAN, ivabradine, ranolazine, trimetazidine).