Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Indian J Pharmacol. 2019 Sep-Oct;51(5):296-301. doi: 10.4103/ijp.IJP_298_19. Epub 2019 Nov 26.
Nicorandil is a well-known antianginal agent, which has been recommended as one of the second-line treatments for chronic stable angina as justified by the European guidelines. It shows an efficacy equivalent to that of classic antianginal agents. Nicorandil has also been applied clinically in various cardiovascular diseases such as variant or unstable angina and reperfusion-induced damage following coronary angioplasty or thrombolysis. Different mechanisms have been involved in the protective effects of nicorandil in various diseases through either opening of adenosine triphosphate-sensitive potassium (KATP) channel or donation of nitric oxide (NO). The predominance or participation of any of these proposed mechanisms depends on the dose of nicorandil used, the location of diseased conditions, and if this mechanism is still functioning or not. The protection afforded by nicorandil has been shown to be mainly attributed to KATP channel opening in experimental models of myocardial and pulmonary fibrosis as well as renal injury or glomerulonephritis, whereas NO donation predominates as a mechanism of protection in hepatic fibrosis and inflammatory bowel diseases. Therefore, in different diseased conditions, it is important to know which mechanism plays the major role in nicorandil-induced curative or protective effects. This can bring new insights into the proper use of selected medication and its recommended dose for targeting certain disease.
尼可地尔是一种著名的抗心绞痛药物，欧洲指南推荐其作为慢性稳定型心绞痛的二线治疗药物之一。它的疗效与经典的抗心绞痛药物相当。尼可地尔还在各种心血管疾病中得到了临床应用，如变异性或不稳定型心绞痛以及经皮冠状动脉成形术或溶栓治疗后的再灌注损伤。不同的机制通过开放三磷酸腺苷敏感性钾 (KATP) 通道或一氧化氮 (NO) 的供体参与了尼可地尔在各种疾病中的保护作用。这些拟议机制中的任何一种的优势或参与程度取决于尼可地尔的使用剂量、疾病部位以及该机制是否仍在起作用。尼可地尔的保护作用主要归因于心肌和肺纤维化以及肾损伤或肾小球肾炎的实验模型中的 KATP 通道开放，而在肝纤维化和炎症性肠病中，NO 供体则是保护机制的主要因素。因此，在不同的疾病状态下，了解哪种机制在尼可地尔诱导的治疗或保护作用中起主要作用非常重要。这可以为选择药物的正确使用及其针对特定疾病的推荐剂量提供新的见解。
