Can trimetazidine be administered three times a day?

Trimetazidine Dosing Frequency

Yes, trimetazidine can be given three times a day—the standard dose is 20 mg three times daily (60 mg total daily dose), which has been the established regimen for stable angina pectoris for decades. 1, 2

Standard Dosing Regimen

• The conventional dose of trimetazidine is 20 mg administered three times daily (t.i.d.), which has been validated in multiple clinical trials for stable angina pectoris 1, 2
• This three-times-daily regimen has demonstrated efficacy in reducing anginal attacks, decreasing nitroglycerin use, and improving exercise capacity 2
• The 20 mg t.i.d. dosing has been shown to improve left ventricular function and heart rate variability in heart failure patients when added to optimal medical therapy 3

Alternative Once-Daily Formulation

• A modified-release formulation of trimetazidine 80 mg once daily is now available as an alternative to the traditional 35 mg twice-daily modified-release formulation 4
• The once-daily 80 mg formulation was developed specifically to simplify the medication regimen and potentially improve patient compliance 4
• Both the 80 mg once-daily and 35 mg twice-daily modified-release formulations have demonstrated similar safety profiles in clinical trials 4

Clinical Context for Three-Times-Daily Dosing

• The immediate-release 20 mg formulation requires three-times-daily administration due to its pharmacokinetic profile 1, 2
• This dosing frequency has been effective both as monotherapy and as adjunctive therapy to conventional antianginal agents (beta-blockers, calcium antagonists, nitrates) 2
• The three-times-daily regimen has shown efficacy comparable to propranolol 120-160 mg/day and nifedipine 40 mg/day, but without affecting hemodynamic parameters 2

Practical Considerations

• The choice between three-times-daily immediate-release and once or twice-daily modified-release formulations depends on available formulations and patient adherence concerns 4, 2
• Trimetazidine has a favorable tolerability profile with low incidence of adverse events (primarily mild gastrointestinal disorders), making the three-times-daily regimen generally well-tolerated 2
• The drug does not affect heart rate, blood pressure, or rate-pressure product, distinguishing it from hemodynamically active antianginals 2