Acute effects of intravenous nicorandil on hemodynamics in patients hospitalized with acute decompensated heart failure

J Cardiol. 2010 Nov;56(3):291-9. doi: 10.1016/j.jjcc.2010.06.009. Epub 2010 Aug 14.


Background: Nicorandil injection, a potent vasodilator with K(ATP) channel opening action and nitrate-like action, has been used for treatment of unstable angina. In the present investigation, we examined the effect of intravenous nicorandil on hemodynamics in patients with acute decompensated heart failure (ADHF).

Methods: ADHF patients admitted to hospital with pulmonary artery wedge pressure (PAWP)≥18 mm Hg were enrolled. Patients received nicorandil by an intravenous bolus injection of 0.2mg/kg/5 min followed by continuous infusion at a rate of 0.05, 0.10, or 0.20mg/kg/h for 6h.

Results: Nicorandil administration caused a significant decrease in PAWP and increase in the cardiac index (CI) that began immediately after the injection and were maintained during the continuous infusion. After 6h, nicorandil administration at 0.2mg/kg/5 min followed by 0.20mg/kg/h resulted in a decrease in PAWP (26.5%, p<0.01), an increase in CI (15.8%, p<0.05), and a decrease in total peripheral resistance (13.8%, p<0.01) in a dose-dependent manner. Nicorandil decreased blood pressure significantly, without an excessive decrease or negative impact even in patients with lower systolic blood pressure.

Conclusion: Intravenous administration of nicorandil, by bolus injection followed by continuous infusion, improves PAWP and CI in ADHF patients immediately and continuously as a potent vasodilator with combined preload and afterload reduction. These results demonstrate that nicorandil is a safe and effective new medication for the treatment of ADHF.

Publication types

  • Clinical Trial, Phase II

MeSH terms

  • Acute Disease
  • Aged
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology*
  • Hemodynamics*
  • Hospitalization
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Nicorandil / administration & dosage*
  • Pulmonary Wedge Pressure
  • Vasodilator Agents / administration & dosage*


  • Vasodilator Agents
  • Nicorandil