Nicorandil is a vasodilator used in Europe and Asia to treat patients with angina and ischemic heart disease. Some patients may develop anal ulcerations during therapy.
Mechanism of primary action: potassium channel activator with relaxation of vascular smooth muscle. Venous dilation reduces cardiac work by reducing preload.
Clinical features:
(1) The patient develops anal ulcers after starting therapy. These may occur spontaneously or after minor trauma.
(2) Patients with ulcers are often taking higher doses of nicorandil.
(3) The ulcers are nonhealing unless the drug is stopped. Healing may take anywhere from 2 weeks to 6 months. The ulcers are often refractory to surgery.
(4) Patients rarely may have ulcers in the mouth or elsewhere in the GI tract.
(5) Diagnosis requires exclusion of other causes (Crohn's disease, syphilis, amebiasis, anal carcinoma, etc.)
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