ATC Group: C01DX Other vasodilators used in cardiac diseases

Molsidomine is a long acting vasodilating drug. Molsidomine, a sydnonimine acting as a heterocyclic direct nitric oxide donor, has been used for the treatment of patients with stable angina pectoris. It’s also established drug for the treatment of coronary heart disease. Molsidomine is metabolized in the liver to the active metabolite linsidomine. Linsidomine is an unstable compound that releases nitric oxide (NO) upon decay as the actual vasodilating compound.

Nicorandil is a derivative of the niacinamide that is structurally combined with an organic nitrate. It provides a dual mode of action leading to relaxation of vascular smooth muscle. Nicorandil is a potassium-channel opener that causes vasodilatation of arterioles and large coronary arteries. Its nitrate-like properties produce venous vasodilation through stimulation of guanylate cyclase. Nicorandil has a direct effect on coronary arteries without leading to a steal phenomenon. The overall action improves blood flow to post-stenotic regions and the oxygen balance in the myocardium.

Vericiguat is a stimulator of soluble guanylate cyclase (sGC). Heart failure is associated with impaired synthesis of nitric oxide (NO) and decreased activity of its receptor, sGC. The pharmacodynamic effects of vericiguat are consistent with the mode of action of a sGC stimulator resulting in smooth muscle relaxation and vasodilation.