Objectives: A prospective observational study to compare the safety and efficacy of Nitrates and Nicorandil in anginal pain and to track the occurrence of headache, giddiness and SGPT variations. Patients and Methods: Patients were randomly arranged into 2 groups, each group receiving either nitrates or nicorandil directed on 110 patients during a study period of 6 months. Comparison was done among both the groups using Visual Analog Scale (VAS) and Numerical Pain Relief Score. Appraisal was done in patients with anginal discomfort being treated with either nicorandil or nitrates within one hour of admission into hospital Emergency Department. Results: Severity of pain was significantly reduced in patients treated with Nitrates, compared to that of Nicorandil. Blood pressure and pulse maintenance were comparatively efficient with Nitrate administration. However, during the 6- month study period, 24% of patients treated with Nitrates developed Side effects, compared to 26% of patients using Nicorandil. Significant SGPT variations were observed with both the medications. Conclusion: Nitrates has greater efficacy compared to that of Nicorandil. Incidence of side effects were also observed to be slightly greater in Nicorandil treatment group than in Nitrates treatment group. Consequently, this study supports the use of Nitrates over Nicorandil as the initial treatment for anginal pain in patients admitted to the Emergency Department.