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Package leaflet: Information for the user Nicorandil 10mg Tablets Nicorandil 20mg Tablets Nicorandil Read all of this leaflet carefully before you may also develop on the skin, genital tract and start taking this medicine because it contains nasal passages or around a stoma (where there important information for you. is an artificial opening for waste removal such as • Keep this leaflet. You may need to read it again. a colostomy or ileostomy). These are more likely • If you have any further questions, ask your doctor to happen if you have a problem with your large or pharmacist. intestine (‘diverticular disease’). • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if Talk to your doctor before taking medicines for 9 their signs of illness are the same as yours. inflammation (corticosteroids) or non-steroidal • If you get any side effects, talk to your doctor or anti-inflammatory medicines including aspirin, pharmacist. This includes any possible side effects with Nicorandil Tablets. If taken together, you may Font: Font: Pil dimension :155x300 not listed in this leaflet. See section 4. be more likely to get ulcers or the other problems mentioned above. What is in this leaflet: These side effects can happen at the beginning of 1. What Nicorandil Tablets are and what they are treatment or later in treatment. Talk to your doctor used for straight away if you notice any of the signs above. 2. What you need to know before you take Nicorandil See section 4 for a full list of side effects. Tablets Talk to your doctor or pharmacist before taking 3. How to take Nicorandil Tablets Nicorandil Tablets if: 4. Possible side effects • you have low blood pressure. 5. How to store Nicorandil Tablets • you have low blood potassium levels and are 6. Contents of the pack and other information taking potassium supplements. • you have kidney problems or are taking other 1. WHAT NICORANDIL TABLETS ARE AND WHAT medicines that may increase potassium levels THEY ARE USED FOR • you have heart problems such as heart failure. The name of your medicine is Nicorandil 10mg • you have a genetic condition called “glucose-6- Tablets or Nicorandil 20mg Tablets (referred to as phosphate dehydrogenase deficiency”. Nicorandil Tablets throughout this leaflet). Nicorandil If any of the above apply (or you are not sure), talk Tablets contain the active substance “nicorandil”. to your doctor or pharmacist before taking Nicorandil This belongs to a group of medicines called Tablets. 'potassium-channel activators'. Children Nicorandil Tablets are not recommended for use in Nicorandil Tablets are used to prevent or reduce children. painful signs (“angina pectoris”) of your heart disease. It is used in adults who cannot take Other medicines and Nicorandil Tablets heart medicines called “beta-blockers” or “calcium Tell your doctor or pharmacist if you are taking, have antagonists”. recently taken or might take any other medicines. This includes medicines obtained without a Nicorandil Tablets work by increasing the blood flow prescription, including herbal medicines.This is through the blood vessels of the heart. They improve because Nicorandil Tablets can affect the way some the blood and oxygen supply of your heart muscle other medicines work. Also some medicines may and reduces its workload. affect the way Nicorandil Tablets work. 2. WHAT YOU NEED TO KNOW BEFORE YOU Do not take this medicine, and talk to your doctor if TAKE NICORANDIL TABLETS you are taking any of the following: Do not take Nicorandil Tablets if: • Medicines for erectile dysfunction (impotence) • You are allergic (hypersensitive) to nicorandil or such as sildenafil, tadalafil or vardenafil any of the other ingredients of this medicine (listed • Medicines to treat ‘pulmonary hypertension’ such in section 6). Signs of an allergic reaction include: as riociguat. a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue. Do not take this medicine and talk to your doctor or • You have severe low blood pressure pharmacist if any of the above apply to you. (“hypotension”). Signs include feeling dizzy, light- headed or faint. Tell your doctor before taking Nicorandil Tablets, if • You have heart problems such as cardiogenic you are taking any of the following: shock, or left ventricular failure with low filling • Medicines to treat high blood pressure pressure or cardiac decompensation. • Medicines that widen the blood vessels • You are taking medicines to treat erectile (vasodilators) dysfunction (impotence) such as sildenafil, • Medicines that increase blood potassium levels tadalafil, vardenafil (phosphodiesterase inhibitors) • Dapoxetine – a medicine used to treat premature or medicines to treat “pulmonary hypertension” ejaculation [such as riociguat (guanylate cyclase stimulators)]. • Medicines for inflammation - corticosteroids and Your blood pressure may be affected if these non-steriodal anti-inflammatory drugs such as medicines are taken with Nicorandil Tablets. ibuprofen. If taken with Nicorandil Tablets you may • You have low blood volume. be more likely to get ulcers • You have a build-up of fluid in the lungs (“pulmonary • Medicines for depression oedema”). • Aspirin (acetylsalicylic acid) Do not take Nicorandil Tablets if any of the above Nicorandil Tablets with alcohol apply to you. If you are not sure, talk to your doctor or Nicorandil may lower your blood pressure. If you pharmacist before taking Nicorandil Tablets. drink alcohol while you are being treated with Nicorandil Tablets your blood pressure may become Warnings and precautions even lower. Talk to your doctor straight away if you notice any of the following serious side effects during treatment: Pregnancy and breast-feeding • red, itchy, swollen or watery eyes. If you are pregnant or breast-feeding, think you may • ulcers in your mouth, stomach, guts (small and be pregnant or are planning to have a baby, ask your large) or back passage. These may cause blood doctor or pharmacist for advice before taking this in your stools or vomit, a fistula (abnormal tube- medicine. like passage from one body cavity to another or You should avoid taking this medicine if you are to the skin), a hole, abscess or weight loss. Ulcers pregnant. It is not known whether nicorandil passes into your treatment. Your doctor may start you on a low dose breast-milk. You should not breast-feed while you are and increase it slowly to reduce the frequency of taking this medicine. headaches. Driving and using machines Common (may affect up to 1 in 10 people) Nicorandil Tablets may make you feel dizzy or weak. • Feeling dizzy If this happens, do not drive or use any tools or • Flushing of the skin machines. • Feeling sick (nausea) Nicorandil Tablets contain less than 1 mmol sodium • Being sick (vomiting) (23 mg) per tablet, that is to say essentially 'sodium- • Feeling weak free'. • Very fast, uneven or forceful heart-beat (palpitations) • Skin abscess (swollen, pus-filled lump that appears 3. HOW TO TAKE NICORANDIL TABLETS within or below the skin's surface) Always take this medicine exactly as your doctor has • Ulcers (mouth, small and large intestines, anal) told you. Check with your doctor or pharmacist if you Uncommon (may affect up to 1 in 100 people) are not sure. • Low blood pressure • Abscess (genital, anal or other gastrointestinal 9 How much to take The recommended dose is: locations) - 10mg, twice a day • Corneal ulcer, conjunctival ulcer, conjunctivitis Font: Font: Pil dimension :155x300 - In case you get headaches, your doctor may give you Rare (may affect up to 1 in 1,000 people) a lower dose of 5mg, twice a day for the first 2 to 7 • Rash days. • Itching - Your doctor may increase your dose up to 20mg, twice • Aching muscles not caused by exercise a day. This will depend on your needs, response and Very rare (may affect up to 1 in 10,000 people) tolerance to treatment. • Abdominal pain (including stomach ache) Taking this medicine • High potassium levels in the blood (hyperkalaemia) • Take one dose in the morning and one in the evening. • Yellowing of the skin and eyes, light coloured bowel • Take this medicine by mouth. motions, dark coloured urine – these may be signs of • Swallow the tablets with a glass of water. Do not liver problems crush or chew the tablets. Nicorandil Tablets can be • Swelling of the face, lips, mouth, tongue or throat divided into equal doses. which may cause problems swallowing or breathing • Do not take the tablet out of the blister strip until you Not known (frequency cannot be estimated from are about to take it. the available data) • If you feel the effect of your medicine is too weak or • Double vision too strong, do not change the dose yourself, but ask • Weakness or paralysis of eye muscles affecting your doctor. the movement of the eye, often associated with If you take more Nicorandil Tablets than you should headache If you take more Nicorandil Tablets than you should Reporting of side effects or a child swallows any of the tablets, talk to a doctor If you get any side effects, talk to your doctor or or go to hospital straight away. Take the medicine pharmacist. This includes any possible side effects not pack with you. This is so the doctor knows what you listed in this leaflet. You can also report side effects have taken. You may feel dizzy or weak – signs of low directly via the Yellow Card Scheme at: blood pressure. You may also feel your heart beating www.mhra.gov.uk/yellowcard or search for MHRA irregularly and faster. Yellow Card in the Google Play or Apple App Store. If you forget to take Nicorandil Tablets By reporting side effects you can help provide more If you forget a dose, take it as soon as you remember.
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  • Pharmacological Management of Cardiac Syndrome Y: a Focused Review Ahmad Sharif-Yakan* and Christoph A

    Pharmacological Management of Cardiac Syndrome Y: a Focused Review Ahmad Sharif-Yakan* and Christoph A

    : Ope gy n A lo c o c i e g s n s A Angiology: Open Access Yakan, Angiol Open Access 2015, 3:2 DOI: 10.4172/2329-9495.1000143 ISSN: 2329-9495 Review Open Access Pharmacological Management of Cardiac Syndrome Y: A Focused Review Ahmad Sharif-Yakan* and Christoph A. Nienaber Division of Cardiology, University Hospital Rostock, University of Rostock Faculty of Medicine, Rostock, Germany *Corresponding author: Ahmad Sharif-Yakan, Division of Cardiology, University Hospital Rostock, University of Rostock Faculty of Medicine, Ernst-Heydemann Str.6, 18059, Rostock, Germany, Tel: +493814947701; Fax: +493814947702; E-mail: [email protected] Recieved date: March 28, 2015; Accepted date: April 17, 2015; Published date: April 24, 2015 Copyright: © 2015 Yakan SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The Coronary slow flow phenomenon or cardiac syndrome Y is a relatively newly described microvascular coronary artery disorder that is still not fully understood. It is thought to be caused by increased flow resistance in the microvascular coronary artery beds. Patients affected by the CSY are typically young patients who suffer from myocardial ischemia at rest. Ischemia is often recurrent and as a result, patients suffer from a poor quality of life. The management of patients diagnosed with CSY is especially challenging, owing to its poorly understood pathophysiology, relatively recent recognition as a separate microvascular coronary artery disorder and most importantly the lack of large, homogenous, randomized controlled trials that compares the efficacy of various pharmacological agents.