Nicorandil for angina.

Nicorandil (Ikorel-Rhône-Poulenc Rorer; Merck & Lipha) is marketed for the prevention and long-term treatment of angina pectoris. The drug, which has been used in Japan for about ten years, was introduced in the UK last year as the first of a new class of anti-anginal drug. Nicorandil combines the properties of an organic nitrate with those of a potassium-channel activator, causing dilatation of coronary arteries and arterioles, systemic resistance vessels and veins. The manufacturer claims that nicorandil is 'effective monotherapy for up to 80% of patients', that 'efficacy is sustained because haemodynamic tolerance does not occur' and that the drug 'frees patients from many of the limitations of earlier therapies'. We examine these claims.