Interactions between nicorandil and sulphonylureas highlighted
Sulphonylureas can cause potentially harmful interactions
with the potassium channel activator nicorandil (Ikorel), say researchers.
Dr Frank Reimann, department of clinical biochemistry,
Addenbrooke's Hospital, Cambridge, and colleagues have demonstrated in
an in vitro system that the activity of nicorandil is severely
impaired by glimepiride and glibenclamide. However, its activity is unaffected
by gliclazide, which is a more selective sulphonylurea, they say.
The researchers point out that nicorandil is increasingly
used for the treatment of angina and, because the incidence of angina
and type 2 diabetes comorbidity is high, polypharmacy with nicorandil
and sulphonylureas is likely. Sulphonylureas stimulate insulin secretion
by binding to sulphonylurea receptors in the ATP-sensitive potassium (KATP)
channels in beta cells. Certain sulphonylureas block KATP channels in
both pancreatic and cardiac beta cells. In contrast, gliclazide is highly
specific to pancreatic beta cells and has little effect on cardiac KATP
channels.
Dr Fiona Gribble, a co-author of the research, commented:
"If you have patients who are being treated with the anti-anginal drug
nicorandil then it is essential you use a drug that [is specific to pancreatic
cells], such as gliclazide."
The study is published in Diabetes (2001;50:2253).
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