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The effects of nicorandil on wound healing (case series) [Abstract]

Riddell, Andrew David, Leaper, David J. and Harding, Keith Gordon 2008. The effects of nicorandil on wound healing (case series) [Abstract]. Wound Repair and Regeneration 16 (6) , A80. 10.1111/j.1524-475X.2008.00424.x

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Introduction: We would like to report a series of nicorandil induced non-healing wounds seen over the past year.Nicorandil is a nicotinamide ester, and derivative of synthetic nicotine. It functions as a potassium channel activator. Uniquely Nicorandil has a nitrate group in its structure, adding venodiliatation to its effects. Thus causing increased blood flow in the coronary arteries and decreasing preload, the effects combining to form a highly effective anti anginal. The association of nicorandil use and oral/anal ulceration is now fairly well recognised. Less well known are nicorandil’s association with para-stomal ulceration, and indeed its association with ulceration of the GI tract from mouth to anus. More recently there have been increasing reports of nicorandil-induced ulceration in parts of the body distant to the GI tract. We report a series of cases seen in our wound healing clinics, consisting of, patients, with lesions ranging from post surgical wounds to leg ulceration. All these ulcers had a common clinical appearance: there was no visual evidence of healing, all lesions were extremely painful, and all healed rapidly following withdrawal of nicorandil. Objectives: The aim of this work was bring to a wider audience our experiences of nicorandil’s association with non healing wounds. Methods: Patients included in the study were those who have presented to the Wound Healing Outpatient Clinics’ of the Wound healing research unit at Cardiff university over the last 18 months. All patients were taking Nicorandil, and had typical non healing painful wounds, which have resolved or moved rapidly towards resolution following exclusion of Nicorandil from their treatment. Results: The mechanism and incidence of the non-healing associated with Nicorandil is currently unknown, and may or may not be associated with the properties of arterial and venous dilatation. It had previously been assumed that the nicorandil itself caused the ulceration being seen in the GI tract. We would hypothesise that the effects of nicorandil (either directly or via metabolites) is not in causing Ulceration/Wounds, but in preventing the normal healing mechanisms of healing in a pre-existing wound. Thus explaining why initially non-healing GI tract ulcers were observed (as this is a common site of injury/ ulceration), but since then non-healing wounds, in other sites, and even post surgically have been observed. Conclusion: As the use of nicorandil increases these painful, debilitating, costly, and yet easily treatable wounds will become more common and a high index of suspicion is needed in any patient taking nicorandil, with any non healing wound.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: Poster abstract for European Tissue Repair Society: Joint Meeting with the Tissue Viability Unit of Malta
Publisher: Wiley-Blackwell
ISSN: 1067-1927
Last Modified: 08 Jan 2020 04:14

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