Nicorandil is a drug which has been developed as an anti-anginal medication. Its structure is characterized by a dual mechanism of action. The nicotinamide moiety acts as an opener of ATP-sensitive potassium channels, whereas the NO2 group explains its nitrate-like properties. The nitric oxide-like action leads to a dilatation of the large coronary arteries, whereas its potassium channel opening action is responsible for the dilatation of coronary resistance vessels. Nicorandil has also been found to dilate veins, enabling it to decrease both preload and afterload and to increase coronary blood flow. The ATP-sensitive potassium channel opening mimics preconditioning in the absence of ischemia and may therefore exert cytoprotective effects. These have been thought to be the reason for a reduction in major coronary events and all cardiovascular events of nicorandil in addition to a specific anti-anginal medication in the Impact Of Nicorandil in Angina study. This review summarizes the pharmacologic properties of nicorandil and assesses its actual place in different cardiovascular disease states.

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