From the Guidelines
The most effective prescription for angina is a combination of β-blockers, calcium-channel blockers, and nitrates, tailored to the individual patient's needs and comorbidities, as recommended by the most recent guidelines 1. The treatment of angina should prioritize the reduction of symptoms and improvement of quality of life, while also considering the prevention of cardiovascular events.
- The use of β-blockers, such as metoprolol or atenolol, is recommended as a first-line treatment for angina, as they have been shown to reduce symptoms and improve exercise tolerance 1.
- Calcium-channel blockers, such as amlodipine or verapamil, can be used as an alternative or in combination with β-blockers, especially in patients with certain comorbidities, such as hypertension or diabetes 1.
- Nitrates, such as nitroglycerin or isosorbide mononitrate, can be used to provide immediate relief from angina symptoms, and can be used in combination with β-blockers and calcium-channel blockers 1. It is essential to consider the individual patient's needs and comorbidities when selecting a treatment regimen, and to tailor the treatment to their specific needs.
- For example, patients with diabetes or hypertension may require a different treatment approach than those without these comorbidities.
- Additionally, patients with certain genetic conditions or allergies may require alternative treatments. The use of antianginal drugs should be guided by the principles of personalized medicine, taking into account the patient's unique characteristics, comorbidities, and response to treatment.
- A combination of two or more anti-ischaemic drugs with additive or synergistic effects is often needed to control symptoms effectively.
- The treatment regimen should be regularly reviewed and adjusted as needed to ensure optimal symptom control and prevention of cardiovascular events.
From the FDA Drug Label
One tablet should be dissolved under the tongue or in the buccal pouch at the first sign of an acute anginal attack. The dose may be repeated approximately every 5 minutes until relief is obtained. If chest pain persists after a total of 3 tablets in a 15-minute period, or if the pain is different than is typically experienced, prompt medical attention is recommended Nitroglycerin may be used prophylactically 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack.
The prescription for angina is to take one tablet of nitroglycerin sublingually at the first sign of an acute anginal attack, and the dose may be repeated every 5 minutes until relief is obtained, with a maximum of 3 tablets in a 15-minute period. Nitroglycerin may also be used prophylactically 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack 2.
From the Research
Prescription for Angina
The prescription for angina typically involves a combination of medications and lifestyle changes. Some of the key medications used to treat angina include:
- Nitrates, such as nitroglycerin, which help to relax and widen blood vessels, reducing the amount of blood returning to the heart and increasing oxygen delivery to the heart muscle 3, 4, 5
- Beta-blockers, which slow the heart rate and reduce the force of contraction, decreasing the heart's oxygen demand 6, 7
- Calcium channel blockers, which help to relax and widen blood vessels, reducing the heart's oxygen demand 7
- Ranolazine, which helps to improve blood flow to the heart muscle 7
Administration of Nitroglycerin
Nitroglycerin can be administered in various forms, including:
- Sublingual tablets or sprays, which are placed under the tongue and absorbed quickly into the bloodstream 3, 4, 6
- Intravenous administration, which is often used in emergency situations to rapidly relieve chest pain 5
Treatment Goals
The goals of treatment for angina include: