Nicorandil-induced severe perianal ulceration

Abstract

Nicorandil is a rare cause of severe perianal ulceration. This association should be recognised as these ulcers are resistant to other forms of treatment but heal well on ceasing nicorandil use.

Nicorandil Associated Colonic Ulceration: Case Series of an Increasingly Recognized Complication

“…Although it is a generally well-tolerated drug, it does have some systemic side effects such as headache and nausea. More site-specific side effects have been increasingly recognized, such as oral ulceration and stomatitis [2,3], followed by case reports of anal [4,5] and perianal ulcerations [6,7]. More recently, there have been emerging case reports highlighting the possibility of nicorandil-induced ulcerations in the rectum, colon and small intestine [8][9][10][11][12][13].…”

Nicorandil associated anal ulcers: an estimate of incidence

“…1,5,10 The fact that they are uncommon may delay prompt diagnosis. 5 The appearance of unexplained non-healing ulceration in any anatomical site, even if it is not mucosal tissue, should prompt one to consider nicorandil as a potential cause.…”

“…The risk of this unpleasant complication of nicorandil should be known by prescribing physicians as well as their patients. However, many patients often suffer for considerable periods of time before the complication is recognised, 5 suggesting that some doctors may not be aware of this complication. Other aspects of this condition are as yet unknown, including its pathogenesis, as well as the other risk factors that may contribute to the development of anal ulceration in nicorandil users.…”

“…The pain caused by the condition is often debilitating and failure to make the correct diagnosis has sometimes led to prolonged suffering, with an average duration of symptoms before correct diagnosis of two years. 5 Patients have even been subjected to unnecessary treatments, including abdominoperineal resection, when the link between nicorandil and anal ulcer was not realised in time.…”

“…5 Anal ulceration is an uncommon complication of nicorandil and there are many aspects of the condition that are not understood, including its pathogenesis and incidence. We have therefore used the best data available to us to make an estimate of the incidence of this condition in a health district with a remarkably stable population of approximately 200,000 people.…”