Nicorandil-induced severe perianal ulceration.
BACKGROUND
Nicorandil is a potassium channel activator used in the prevention and long-term treatment of angina pectoris. It is widely prescribed and its use is supported by data from powerful randomised controlled trials. The colorectal community is becoming increasingly aware of a subgroup of patients with anal ulceration and other gastrointestinal manifestations of nicorandil use.


METHODS
This study is a retrospective review of patients identified as having nicorandil-induced perianal ulceration. We report our experience of 11 patients.


RESULTS
All eleven patients experienced severe debilitating ulceration of the perianal area and perineum. Multiple therapies were tried unsuccessfully before the association with nicorandil was recognised. Upon recognition of the association of nicorandil with these ulcers, the therapy was stopped resulting in resolution of the perianal symptoms.


CONCLUSIONS
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.
Department of Coloproctology, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, UK. richard.p.baker@leedsth.nhs.uk
R P
RP
Baker
W
W
Al-Kubati
M
M
Atuf
R K S
RK
Phillips
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000188:drug therapy; D005260:Female; D005401:Fissure in Ano / Q000139:chemically induced* / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014665:Vasodilator Agents; D020108:Nicorandil