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Moghadam ET, Tafazoli A. Azithromycin-induced Aphthous Stomatitis: A Case Series. ACTA ACUST UNITED AC 2019; 14:242-246. [PMID: 30827258 DOI: 10.2174/1574884714666190301153040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Azithromycin is one of the most popular antibiotics in current clinical practice. This medication generally considered to be safe and well-tolerated in different demographic populations. Like any other drug, azithromycin use is not without risk and adverse effects. In recent years, cardiovascular accidents have been announced as its major and most important side effect. But azithromycin use can be accompanied with less recognized complications which are significantly discomforting. In this article, we presented a neglected adverse effect of azithromycin in medical literature which is aphthous stomatitis. METHODS We detected three cases with this complication in our center during a one-year period. All the accessible clinical data were recorded and PubMed database was explored to assess the relevant literature. RESULTS The patients had aphthous stomatitis within 24 hours of the first dose which was healed in about 2 to 3 weeks. Naranjo scoring system showed a probable stage for this adverse drug reaction. There was no such a report in our database search process. CONCLUSION It could be stated that aphthous stomatitis is an important adverse effect of azithromycin that can affect the patient's quality of life during therapy and in the majority of cases, it can be neglected by healthcare practitioners.
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Affiliation(s)
- Ehsan T Moghadam
- Orthodontics Department, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ali Tafazoli
- Clinical Pharmacy Department, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Pisano U, Deosaran J, Leslie SJ, Rushworth GF, Stewart D, Ford I, Watson AJM. Nicorandil, Gastrointestinal Adverse Drug Reactions and Ulcerations: A Systematic Review. Adv Ther 2016; 33:320-44. [PMID: 26861848 DOI: 10.1007/s12325-016-0294-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nicorandil is a popular anti-anginal drug in Europe and Japan. Apart from some common adverse drug reactions (ADR), its safety is satisfactory. Several reports have suggested a link between nicorandil, gastrointestinal (GI) ulceration and fistulas. The review aims to critically appraise, synthesize and present the available evidence of all known GI ADR per anatomical location. METHODS The study complied with the PRISMA statement. Literature and pharmacovigilance databases were used to provide rate and/or calculate parameters (median age, median dose, history of symptoms, length of therapy and healing time after withdrawal of the drug). Differences in distribution of quantitative variables were analyzed via Mann-Whitney test. Correlation between quantitative variables was assessed with a Spearman's correlation coefficient. A p value <0.05 was significant. RESULTS Oral ulcerations occur in 0.2% of the subjects, anal ulcerations are present between 0.07% and 0.37% of patients. Oral and distal GI involvements are the most common ADR (28-29% and 27-31% of all GI ADR, respectively). The hepatobiliary system, the pancreas and salivary glands are not affected by nicorandil exposure. The time to develop oral ulcerations is 74 weeks among people on <30 mg/day compared to only 7.5 weeks in individuals on higher regimens (p = 0.47). There is a significant correlation between dose and ulcer healing time (Spearman's 0.525, p < 0.001). CONCLUSIONS Ulcerative disease is a very commonly reported GI ADR. A delayed ulcerative tendency supports the hypothesis of an ulcerogenic metabolite. Nicorandil seems to act as a cause of the ulcerations, but appears to also work in synergy with other promoting factors. Whether the action of the metabolites relies on a specific mechanism or a simple chemical ulceration is still to be established.
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Affiliation(s)
- Umberto Pisano
- Department of General Surgery, Raigmore Hospital, Inverness, UK.
| | | | | | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Abstract
INTRODUCTION Non-healing ulcers can be caused by a number of conditions, including vascular disease, diabetes, malignancy and some infections. Drug-related ulcers are rare, and a high index of clinical suspicion is required for diagnosis, in parallel with exclusion of more sinister underlying causes. CASE REPORT We present a patient with a complex medical background, who had a 10-week history of a non-healing ulcer on his nasal bridge. Inflammatory, autoimmune and malignant causes for the ulcer were excluded by histopathology. CONCLUSION Nicorandil was deemed to be the most likely cause for the patient's ulcer. Nicorandil is an anti-anginal medication known to cause oral ulceration and skin lesions in the perianal and peristomal regions and around surgical wounds. However, there are no previously reported cases of facial ulcers. The ulcer required surgical debridement and healed completely within six months, following discontinuation of nicorandil. This case highlights the importance of having a high index of clinical suspicion regarding non-healing ulcers, and of considering drugs as an aetiological factor, especially in patients with a complex medical background who are taking numerous medications.
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Nicorandil-induced oral ulceration: report of 3 cases and review of the Japanese literature. ACTA ACUST UNITED AC 2011; 112:754-9. [DOI: 10.1016/j.tripleo.2011.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/16/2011] [Accepted: 05/24/2011] [Indexed: 11/23/2022]
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Nicorandil-induced tongue ulceration with or without fungal infection. Odontology 2011; 100:100-3. [DOI: 10.1007/s10266-011-0015-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022]
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Finucane KA, Archer CB. Recent advances in cardiorespiratory medicine: management of pulmonary embolism and prevention of venous thromboembolism, recent treatment strategies in childhood asthma, and dermatological adverse reactions to cardiovascular drugs. Clin Exp Dermatol 2008; 33:356-60. [PMID: 18312463 DOI: 10.1111/j.1365-2230.2007.02637.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article is the fifth in a series of CPD articles aimed at reviewing the recent general medical literature relating to topics that may be of interest to dermatologists. This issue looks at advances in cardiorespiratory medicine, including the management of pulmonary embolism and prevention of venous thromboembolism (VT), recent treatment strategies in childhood asthma, and an update on dermatological adverse reactions to cardiovascular drugs.
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Affiliation(s)
- K A Finucane
- Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, UK
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Abstract
This leading article refers to the paper by Abdelrazeq AS, Owen C, Smith L, McAdam JG, Pearson HJ, Leveson SH. Nicorandil-associated para-stomal ulceration: case series Eur J Gastroenterol Hepatol 2006; 18:1293-1295. We apologise to all concerned for the dissociation between the two papers, which was due to an administrative error. Nicorandil is used widely in patients with coronary artery disease. Nicorandil is well tolerated with only minor side effects. Nicorandil's association with oral, anal, gastrointestinal ulceration, and more recently para-stomal ulceration has been reported. Medical awareness of nicorandil association with ulcerations should be high to help avoid unnecessary and harmful treatment as only cessation of the drug would heal the ulceration. Nicorandil is an antianginal drug used for the treatment of symptomatic coronary artery disease. It is characterized by an arterial and venous vasodilator effect with dual mechanism of action. Nicorandil is not a first-line agent in the management of angina but it is used in combination with other antianginal medications in stable and unstable angina. It is generally well tolerated with minor side effects such as headache, nausea, flushing and dizziness. The association of nicorandil with mouth and anal ulcers as well as the association with ulceration throughout the gastrointestinal tract has been reported, and recently, an association with para-stomal ulceration has also been described. Medical awareness of the association of nicorandil with ulceration in any part of the gastrointestinal tract should be highlighted among all medical professionals to help avoid delays in withdrawing the treatment and to avoid unnecessary and sometimes invasive and costly interventions.
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Rival AL, Allombert-Blaise C, Ly A, Grandjean JP, Faure M, Claudy A. [Nicorandil-associated anal ulceration]. Ann Dermatol Venereol 2007; 133:781-3. [PMID: 17072194 DOI: 10.1016/s0151-9638(06)71043-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nicorandil is a potassium-channel activator used in the treatment of angina pectoris. The first cases of anal ulcerations induced by nicorandil were published in 2002. CASE REPORT A 71-year-old man presented with a 2-year history of anal ulcerations occurring within a few months of initiation of treatment with Nicorandil. Histological tests on a biopsy sample showed granulation tissue with non-specific chronic inflammation. Nicorandil was stopped and this resulted in complete healing of the ulcers after three months. DISCUSSION Nicorandil can induce chronic and extensive anal ulcerations. The pathogenesis is unknown. Patients are usually treated with high doses of nicorandil. Dermatologists should be aware of this rare side-effect which heals after withdrawal of the drug.
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Affiliation(s)
- A-L Rival
- Service de Dermatologie, Hôpital Edouard Herriot, place d'Arsonval, 69437 Lyon Cedex 03
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Schmid JP, Schroeder V. Nicorandil – Review of Pharmacological Properties and Clinical Applications. ACTA ACUST UNITED AC 2005. [DOI: 10.1159/000089603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Katory M, Davies B, Kelty C, Arasaradnam R, Skinner P, Brown S, Bagley J, Shorthouse AJ, Hunt LM, Slater R. Nicorandil and idiopathic anal ulceration. Dis Colon Rectum 2005; 48:1442-6. [PMID: 15906129 DOI: 10.1007/s10350-005-0027-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Several reports have implicated nicorandil as a reversible cause of anal ulceration. We have recently commenced a specialist clinic for patients presenting with severe anal ulceration to assess treatment in this difficult group. Recognition of this association may avoid unnecessary surgery. METHODS Twenty-six patients treated with nicorandil had severe painful anal ulceration. Examination under anesthesia was required to biopsy the lesions to exclude neoplasia or inflammatory bowel disease. In total, three patients had proximal diverting stomas without subsequent ulcer resolution, two had perineal debridement with one requiring subsequent skin grafting, and one had an abdominoperineal excision for unremitting pain. RESULTS The association of perianal ulceration with nicorandil became apparent only in the latter part of this series. Ten ulcers successfully re-epithelialized when nicorandil was stopped. Nine patients reported anal pain relief and partial healing on clinical examination at two months but failed to show subsequent complete resolution. One patient agreed to nicorandil cessation and reported symptomatic anal pain relief at two weeks but subsequently developed unstable angina requiring hospital admission. Nicorandil was recommenced with anal pain relapse. CONCLUSIONS Failure to recognize nicorandil as an etiologic factor in the development of anal ulceration, when other potential underlying well-recognized inflammatory or neoplastic processes have been excluded, may lead to unnecessary surgical intervention in a group of high-risk patients. One of our patients had a potentially avoidable abdominoperineal resection. Pharmaceutical manipulation with alternative antiangina medication may induce healing. Pharmacologic manipulation should be coordinated with a physician to minimize precipitation of unstable angina.
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Affiliation(s)
- Mark Katory
- Sheffield Teaching Hospitals NHS Trust, Sheffield, South Yorkshire, United Kingdom
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Webster K, Godbold P. Nicorandil induced oral ulceration. Br Dent J 2005; 198:619-21. [PMID: 15920586 DOI: 10.1038/sj.bdj.4812350] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 11/15/2004] [Indexed: 11/08/2022]
Abstract
Oral ulceration has many different causes. The association between Nicorandil and oral ulceration is not a new phenomenon. There have been several previous case reports regarding a possible association although none in publications for general dental practice. In this report we have a case series of seven patients and we compared our findings with those in the current literature.
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Affiliation(s)
- K Webster
- Department of Maxillofacial Surgery, University Hospital Birmingham Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
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Jang HS, Jo JH, Kim BS, Jun GJ, Lee JB, Kim MB, Oh CK, Kwon KS. A case of severe tongue ulceration and laryngeal inflammation induced by low-dose nicorandil therapy. Br J Dermatol 2005; 151:939-41. [PMID: 15491452 DOI: 10.1111/j.1365-2133.2004.06199.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Simpson D, Wellington K. Nicorandil: a review of its use in the management of stable angina pectoris, including high-risk patients. Drugs 2004; 64:1941-55. [PMID: 15329045 DOI: 10.2165/00003495-200464170-00012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Nicorandil (Adancor, Angicor, Dancor, Nikoril [Europe], Ikorel [Europe and Oceania], Sigmart [Japan, Korea and Taiwan]) is an adenosine triphosphate (ATP)-sensitive potassium (KATP) channel agonist with nitrate-like properties used in the management of stable angina pectoris. With well established monotherapeutic antianginal activity and a beneficial effect (when added to optimal antianginal therapy) on clinical outcomes in high-risk patients with stable angina, twice-daily oral nicorandil is a useful alternative or addition to other antianginal therapy.
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Affiliation(s)
- Dene Simpson
- Adis International Limited, Auckland, New Zealand.
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Abstract
Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required.
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Affiliation(s)
- C M Healy
- Department of Oral Medicine, Dublin Dental Hospital, Lincoln Place, Dublin 2, Republic of Ireland.
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Passeron T, Lacour JP, Mantoux F, Fabiani P, Dubois D, Ortonne JP. Chronic anal ulceration due to nicorandil. Br J Dermatol 2004; 150:394-6. [PMID: 14996132 DOI: 10.1111/j.1365-2133.2003.05799.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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FUTATSUYAMA M, ISHIHARA H, HIGO J, KIDOU M, ONO T. A Case of Oral Ulcerations Induced by Nicorandil. ACTA ACUST UNITED AC 2004. [DOI: 10.2336/nishinihonhifu.66.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Field EA, Allan RB. Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Aliment Pharmacol Ther 2003; 18:949-62. [PMID: 14616160 DOI: 10.1046/j.1365-2036.2003.01782.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Oral ulceration is a common complaint of patients attending out-patient clinics. The aim of this review is to provide the gastroenterologist with a differential diagnosis of oral ulceration, and a practical guide for the management of recurrent aphthous stomatitis, including topical and systemic therapy. The association of recurrent aphthous stomatitis with Behçet's disease and other systemic disorders, including coeliac disease, is discussed. Recent evidence concerning the immunopathogenesis of Behçet's disease is reviewed, including renewed interest in the role of Streptococcus sanguis and possible infectious triggering of an inappropriate immunoinflammatory response, resulting in tissue damage. The efficacy and limitations of conventional treatment for this mutisystem disorder are outlined together with the potential role of novel biological agents, such as anti-tumour necrosis factor-alpha therapy. Oral ulceration, as a manifestation of inflammatory bowel disease and a complication of drug therapy, is described. Guidance is given concerning indications for referral of patients with oral ulceration to an oral physician/surgeon for further investigations, including biopsy if appropriate.
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Affiliation(s)
- E A Field
- Oral Medicine Unit, Liverpool University Dental Hospital and School, Liverpool, UK.
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Boulinguez S, Sommet A, Bédane C, Viraben R, Bonnetblanc JM. Oral nicorandil-induced lesions are not aphthous ulcers. J Oral Pathol Med 2003; 32:482-5. [PMID: 12901730 DOI: 10.1034/j.1600-0714.2003.00166.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES (i) To accurately define these lesions determining whether oral nicorandil-induced lesions are aphthous ulcers; (ii) To determine clinical characteristics of oral nicorandil-induced lesions. MATERIALS AND METHODS Two slide conferences were held. A total of 60 dermatologists assigned diagnosis and clinical criteria to 11 photographs of oral nicorandil-induced lesions. Two slides were randomly selected and duplicated to be used as control. The panel of slides included independent lesions and photographs of different lesions of the same patient. Statistical analysis used chi2-test, estimation of the percentage interobserver agreement, and kappa-values. RESULTS The diagnosis of non-aphthous ulcer (71.8%) was significantly held in comparison with the diagnosis of oral aphthous ulcer (28.2%; P<0.001). To differentiate aphthous ulcer from non-aphthous ulcer, physicians significantly used three clinical criteria. The diagnosis of non-aphthous ulcer were significantly associated with the absence of yellow-based ulceration (P<0.001), with the linear shape (P=0.006) and the absence of inflammatory halo (P=0.003). CONCLUSION Oral nicorandil-induced lesions are not aphthous ulcers. We propose that at this stage of our knowledge, oral nicorandil-induced ulcer is the most suitable terminology.
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Affiliation(s)
- S Boulinguez
- Department of Dermatology, University Hospital Dupuytren, Limoges, France.
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Scully C, Azul AM, Crighton A, Felix D, Field A, Porter SR. Nicorandil can induce severe oral ulceration. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:189-93. [PMID: 11174596 DOI: 10.1067/moe.2001.110306] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To increase physicians' and dentists' awareness that nicorandil is a potential inducer of severe mouth ulceration. STUDY DESIGN Nine new cases of ulceration from 3 European countries were included in this study. RESULTS Oral ulceration developed within 9 months of beginning nicorandil therapy, and ulcers resolved within 1 month of withdrawal of the drug. No lesions developed on other epithelia. CONCLUSIONS A number of drugs used in the care of patients with cardiovascular disease can cause oral adverse effects. Nicorandil, a new potassium-channel activator used in some countries to treat angina pectoris, precipitates persistent ulcerative stomatitis in some patients.
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Affiliation(s)
- C Scully
- Department of Oral Medicine, Eastman Dental Institute of Oral Health Care Sciences, University College London, England.
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Boulinguez S, Reix S, Bedane C, Debrock C, Bouyssou-Gauthier ML, Sparsa A, Le Brun V, De Vencay P, Bernard P, Bonnetblanc JM. Role of drug exposure in aphthous ulcers: a case-control study. Br J Dermatol 2000; 143:1261-5. [PMID: 11122030 DOI: 10.1046/j.1365-2133.2000.03898.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Drug-induced aphthous ulcers have been the subject of several isolated and heterogeneous case reports for the last three decades. OBJECTIVES To perform a case-control study to evaluate the risks linked to drug exposure in aphthous ulcers. METHODS Eighty patients with typical clinical patterns of aphthous ulcers and 152 control patients who had had consultations for skin tumours were studied. A standardized questionnaire, concerning clinical features, life-style and medications taken during the last month, was completed for each patient. RESULTS Case patients had a much higher intake of medications than control patients, respectively, 5.1 and 2. 8 medications per patient (P < 0.0001). Multivariate paired analysis showed an association between aphthous ulcers and two classes of drugs: non-steroidal anti-inflammatory drugs (P < 0.001) and beta-blockers (P = 0.002). Smoking could have a protective effect against aphthous ulcers (P < 0.001). CONCLUSIONS Previous case reports and the results of this study suggest a real link between beta-blockers and aphthous ulcers. Our study did not confirm a role of other drugs but a few interesting case reports with positive reintroduction have to be considered. These results could be beneficial for patients, as healing may occur when the incriminated drug is discontinued.
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Affiliation(s)
- S Boulinguez
- Department of Dermatology and Institute of Epidemiology and Tropical Neurology, University Hospital Dupuytren, 2 Avenue Martin-Luther-King, 87042 Limoges cedex, France
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Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, England, UK
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Shotts RH, Scully C, Avery CM, Porter SR. Nicorandil-induced severe oral ulceration: a newly recognized drug reaction. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:706-7. [PMID: 10397662 DOI: 10.1016/s1079-2104(99)70165-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Nicorandil, a potassium-channel activator used for the long-term treatment of ischemic heart disease, has been recently implicated as having a drug side effect of recurrent aphthous stomatitis. Three patients are reported with drug-induced aphthouslike ulceration secondary to nicorandil.
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Affiliation(s)
- R H Shotts
- Department of Oral Medicine, Eastman Dental Institute of Oral Health Care Sciences, University of London, United Kingdom
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