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Mental nerve paraesthesia secondary to nicorandil-induced oral ulceration: a case report Emma Morgan Lee Feinberg Bijaya Rajlawat Anne Field Dental Update 2024 50:1, 707-709.
Authors
EmmaMorgan
Academic Clinical Fellow and Dental Core Trainee, University of Liverpool
Nicorandil, used as a treatment for angina pectoris, continues to be prescribed in the UK. The association between nicorandil and oral ulceration is well documented. Nicorandil-induced oral ulceration characteristically presents as a persistent, large, deep ulcer that can have a great impact on quality of life. A 63-year-old female was referred to the oral medicine department with a non-healing ulcer and associated paraesthesia of the left lower lip. Her drug history included nicorandil 30 mg once daily. A provisional diagnosis was made of nicorandil-induced oral ulceration with associated paraesthesia, secondary to mental nerve involvement. Following liaison with cardiology, and cessation of nicorandil medication, the ulceration healed, and the patient reported improved sensation to the lower lip.
CPD/Clinical Relevance: Nicorandil-induced oral ulceration should be considered in the differential diagnosis of oral ulceration.
Article
Nicorandil was first introduced into the UK in 1994 and continues to be used as a treatment for angina pectoris.1 The yellow card scheme run by the Medicines and Healthcare products Regulatory Agency (MHRA) records information regarding suspected safety concerns or incidents involving medicines or medical devices. Between 1994 and 2020, 230 cases of nicorandil-induced oral stomatitis and ulceration were recorded.2 These data may under-represent the true number of cases as data collection relies on voluntary reporting by health professionals and patients. Despite this, the pathogenesis of nicorandil-induced oral ulceration is still unclear. Ulceration can present at any point while taking nicorandil, with oral ulceration reported less frequently than elsewhere in the gastrointestinal tract.3 Nicorandil-induced oral ulceration has distinctive features: persistent deep, large ulcers with an irregular border.4,5 Such deep ulcers, with associated inflammation and soft tissue swelling, may have the potential to affect underlying structures, including nerves. We present a case of nicorandil-induced oral ulceration, which presented as paraesthesia of the lower lip secondary to mental nerve involvement.
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