BMJ 2007;335:936-937 (3 November), doi:10.1136/bmj.39246.714896.BE
Practice
Lesson of the week
Anal ulceration induced by nicorandil
Fayyaz Akbar, senior house officer, Andrew Maw, consultant colorectal surgeon, Arnab Bhowmick, consultant colorectal surgeon
Department of General Surgery, Glan Clwyd Hospital, Rhyl LL18 5UJ
Correspondence to: A Maw Andrew.Maw@cd-tr.wales.nhs.uk
In patients with anal fissures or anal ulceration, treatment with the drug nicorandil should be considered as a possible cause
| The first 150 words of the full text of this article appear below. |
Nicorandil is widely used to treat angina, particularly in patients with severe coronary vessel disease. Anal ulceration is a recognised side effect of its use,1 2 but the association between the two is not widely appreciated. We want to alert primary care practitioners, general physicians, dermatologists, cardiologists, and surgeons who may encounter such cases of the importance of this association.
Case report
A 73 year old man was referred to our department with a one year history of rectal bleeding, mucus discharge, and anal pain. Associated conditions included diabetes mellitus, hypertension, hypercholesterolaemia, and severe ischaemic heart disease. Despite two previous coronary artery bypass operations, he continued to have angina. His medication included aspirin, atenolol, amlodipine, simvastatin, allopurinol, gliclazide, and 30 mg nicorandil twice a day.
Initial assessment found a small posterior anal fissure and anal skin tags. For investigation of the bleeding, he underwent a rigid sigmoidoscopy and a barium enema, results of
Discussion
Conclusion
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Rapid Responses:
Read all Rapid Responses
- Nicorandil induced ulceration - Terminal ileum ulcers with perforation
- Ali Al-Ameri, et al.
bmj.com, 29 Nov 2007 [Full text] - Anal Ulcers and Nicorandil
- Nabeela Nisar
bmj.com, 11 Nov 2007 [Full text]
This article
- Full text
- Respond to this article
- Read responses to this article
- Alert me when this article is cited
- Alert me when responses are posted
- Alert me when a correction is posted
Services
- Email this article to a friend
- Find similar articles in BMJ
- Find similar articles in ISI Web of Science
- Find similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Related content
Bookmark with
What's new
Latest blogs
Services
Tools
Online poll
Resources
Rapid responses for this article
Most read last week
Print issues
Student BMJ
Intimate examinations
Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.
