About the shortage of nicorandil tablets

The previous shortage of nicorandil tablets that started in November 2025 has now resolved. 

Nicorandil is indicated for the treatment of chronic stable angina pectoris.

To help patients have continuous access to the medicine, we made a Serious Scarcity Substitution Instrument (SSSI) that started on 28 November 2025 and ended on 31 March 2026. The SSSI allowed a pharmacist to dispense an equivalent quantity of the substitute medicine for the prescribed medicine, if appropriate, without a new prescription. 

With the available substitutions, if a 10 mg dose of nicorandil was prescribed: 

• either brand of nicorandil (APO-Nicorandil or Ikotab) in a 10 mg tablet could be dispensed and taken
• either brand of nicorandil in a 20 mg tablet could be dispensed and half a tablet taken.

If a 20 mg dose of nicorandil was prescribed:

• either brand of nicorandil in a 20 mg tablet could be dispensed and taken
• either brand of nicorandil in a 10 mg tablet could be dispensed and 2 tablets taken.

The information about the SSSI for patients, pharmacists and prescribers is no longer relevant.

Up-to-date information about the shortage is published on the Medicine Shortage Reports Database. Search for ‘nicorandil’.

Information for patients

If the nicorandil tablets your doctor has prescribed are not available, we have approved substitutions your pharmacist can make without needing a new prescription. This may mean you will need to switch between different brands or strengths. For example: 

• You may need to switch between the 10 mg and 20 mg tablets during the shortage when only one of these products is available – the substitute medicines contain a different strength of the same active ingredient that your doctor prescribed, and your pharmacist will supply the correct total dose.
• All of the products contain the same medicine (nicorandil) and are taken by mouth, but the strength may be different, which may result in you taking more tablets, or halving them to make a dose.
• If your pharmacist offers you a substitute medicine, they should explain the differences and how to take the product you have been switched to.
• Talk to your doctor or pharmacist if you have any questions about this substitution.
• As excipients (inactive ingredients) vary between brands, tell your pharmacist if you are allergic or intolerant to certain ingredients. You can also find information about excipients in the Consumer Medicine Information (CMI) leaflet for the medicine, which is available from your pharmacist or on the homepage of the TGA website (‘Search for health products on our register’).

How to obtain a 10 mg dose 

If your pharmacist gives you nicorandil 20 mg tablets as a substitute, the tablets are a different strength to your usual dose and might look different. They will explain how to take them: 

• Break a 20 mg nicorandil tablet in half and take only one of the halves to get a 10 mg dose.

How to obtain a 20 mg dose 

If your pharmacist gives you nicorandil 10 mg tablets as a substitute, they are a different strength to your usual dose and might look different. They will explain how to take them: 

• Take 2 of the nicorandil 10 mg tablets to get a 20 mg dose.

If you are unable to fill your prescription or do not consent to the substitution, speak to your doctor about other options for your situation.

Information for pharmacists

The SSSI allows you to substitute nicorandil 10 mg or 20 mg tablets for someone with a prescription for either strength of nicorandil tablets. You can do this without prior approval from the prescriber if you follow the Specific permitted circumstances (in Schedule 1) and General permitted circumstances (in Schedule 2) of the SSSI.

You are encouraged to use your professional and clinical judgement to determine whether substitution is suitable for a patient and to gain their consent. Always refer patients to their prescriber if: 

• an appropriate substitutable medicine is not available
• you feel a medicine is not clinically appropriate for a patient, or if you consider alternative treatments other than substitution may be more appropriate.

Situations where substitution is inappropriate could include when a patient: 

• does not have the dexterity needed to comfortably break the 20 mg tablets, if needed, either because of their age or medical conditions
• has cognitive, visual or hearing impairments that could make substituting their medicine difficult.

When you use the SSSI to substitute the scarce and substitutable medicine: 

• you must instruct the patient on how to take the substitute tablet, or refer them to their prescriber or GP for guidance
• you can use Consumer Medicines Information (CMI) leaflets to help explain the substitution to patients and to get their consent; you may need to use translation services, a carer or organisations such as a local Aboriginal Community Controlled Health Organisation (ACCHO) if needed to ensure the patient fully understands the situation. 

Inform the prescriber by email, fax or phone as soon as is practical after you make the substitution. 

If a patient is also using glyceryl trinitrate spray or tablets to treat acute angina pectoris, consider taking this opportunity to check these medicines have not expired and that the patient is using them correctly. 

You can find information on Pharmaceutical Benefits Scheme (PBS) subsidy arrangements for medicines substituted using an SSSI on the PBS website.

Information for prescribers

Consider the current shortage of nicorandil tablets when prescribing for your patients, particularly when initiating new patients. 

Your patients may need to switch between different brands or strengths of nicorandil tablets when the prescribed medicine is unavailable.

With the SSSI in place, a pharmacist may substitute the prescribed nicorandil tablets with the alternative strength and give information and guidance on how to administer the substitute product, or they may recommend the patient contact you for this information.

Consider checking how your patient is using the substitute strength at their next appointment.

The pharmacist will refer the patient to you if: 

• an appropriate substitutable medicine is not available
• they feel a medicine is not clinically appropriate for a patient, or if alternative treatments other than substitution may be more appropriate.

Situations where substitution is inappropriate could include when a patient: 

• does not have the dexterity needed to comfortably break the 20 mg tablets, if needed, either because of their age or medical conditions
• has cognitive, visual or hearing impairments that could make substituting their medicine difficult.

General information

Please note that the dates given for these shortages may change and we encourage you to check the Medicine shortage reports database for updates about the supply of nicorandil tablets.

Please also keep in mind that we can work with pharmaceutical companies to communicate information about medicine shortages to health professionals and patients, but we cannot compel companies to increase supply.

While we can suggest approaches to manage the supply of medicines during shortages, we do not have the power to regulate the clinical decisions of health professionals.

We will continue to monitor the supply of nicorandil tablets and work with the supplier to update this advice if needed.

Reporting problems

Consumers and health professionals are encouraged to report problems with medicines or vaccines. Your report will contribute to the TGA's monitoring of these products.

The TGA cannot give advice about an individual's medical condition. You are strongly encouraged to talk with a health professional if you are concerned about a possible adverse event associated with a medicine or vaccine.