Beyond the Usual: Unmasking Nicorandil’s Hidden Side – A Case of Colonic Ulceration

A BSTRACT Nicorandil, a potassium channel opener commonly used in the management of ischemic heart disease, has been associated with gastrointestinal adverse effects, including ulceration. Here, we present a case of severe rectal bleeding in a patient receiving nicorandil therapy. A 62-year-old male with a history of ischemic heart disease and chronic kidney disease on maintenance hemodialysis presented to the emergency department with per rectal bleeding and hemodynamic instability. Multiple ulcers with active bleeding were seen on flexible sigmoidoscopy. Nicorandil therapy was promptly discontinued, and the patient underwent a blood transfusion. The patient made an uncomplicated recovery. This case underscores the importance of considering nicorandil-induced ulceration as a potential cause of gastrointestinal bleeding in patients with cardiovascular comorbidities.