From the Guidelines
Trimetazidine is not recommended in patients with severe renal impairment (creatinine clearance <30 ml/min) due to the risk of adverse effects, and its use in patients with moderate renal impairment requires careful dose adjustment and monitoring. The medication's primary elimination through renal excretion, with approximately 60% of the drug excreted unchanged in urine, necessitates caution in patients with impaired renal function 1. In patients with moderate renal impairment (creatinine clearance 30-60 mL/min), the recommended dose should be reduced to minimize the risk of adverse effects, although the exact dose reduction is not specified in the provided evidence.
Key Considerations
- Trimetazidine's metabolic mechanism of action, which shifts cardiac metabolism from fatty acid to glucose oxidation, remains beneficial for cardiac protection even in renally impaired patients 1.
- The medication itself does not typically cause direct nephrotoxicity but can lead to increased exposure and side effects when kidney function is compromised 1.
- Patients with renal impairment should be monitored for signs of drug accumulation, such as increased dizziness, movement disorders, or gastrointestinal symptoms 1.
- Regular monitoring of renal function is essential when administering trimetazidine to patients with impaired renal function, with consideration of both medication and individual risk factors 1.
Monitoring and Dose Adjustment
- The trend in creatinine (or eGFR over months) is more important than the absolute value when monitoring renal function in the context of trimetazidine use 1.
- A patient-based monitoring regimen should be developed, considering both medication and individual risk factors, to minimize the risk of worsening renal function and acute kidney injury 1.
From the Research
Effects of Trimetazidine on Kidney Function
- Trimetazidine has been shown to have a protective effect on kidney function in patients with impaired renal function, particularly in the context of contrast-induced nephropathy (CIN) 2, 3, 4.
- Studies have demonstrated that trimetazidine can reduce the incidence of CIN in patients undergoing coronary angiography, with a significant difference in the rate of CIN between trimetazidine and control groups 2, 3.
- The mechanism of trimetazidine's protective effect on kidney function is thought to be related to its anti-ischemic and anti-oxidant properties, which can help to reduce the deleterious effects of ischemia-reperfusion injury on the kidney 5.
- Trimetazidine has also been shown to be safe and well-tolerated in patients with renal impairment, although the systemic exposure of trimetazidine was found to be increased in subjects with renal impairment compared to healthy subjects 6.
Clinical Evidence
- A systematic review and meta-analysis of randomized controlled trials found that trimetazidine can significantly reduce the incidence of CIN and decrease the level of serum creatinine after operation in patients with renal insufficiency 4.
- Another study found that trimetazidine can reduce the early and long-term effects of experimental renal warm ischemia, with a dose-dependent effect on renal function and inflammation 5.
- The clinical evidence suggests that trimetazidine may be a useful adjunctive treatment for patients with impaired renal function undergoing coronary angiography or other procedures that involve the use of contrast media 2, 3, 4.
Pharmacokinetics and Safety
- The pharmacokinetics of trimetazidine have been found to be affected by age and renal impairment, with increased systemic exposure in subjects with renal impairment compared to healthy subjects 6.
- Trimetazidine has been shown to be safe and well-tolerated in patients with renal impairment, although the increased systemic exposure may require dose adjustment in some patients 6.