From the Guidelines
Medications for angina include several classes that work to improve oxygen supply or reduce demand in the heart, with the most recent and highest quality study recommending a personalized approach to treatment 1.
First-line Treatments
- Nitrates like nitroglycerin (0.3-0.6mg sublingual for acute attacks, or long-acting forms like isosorbide mononitrate 30-60mg daily) dilate blood vessels to improve blood flow.
- Beta-blockers such as metoprolol (25-100mg twice daily) or atenolol (25-100mg daily) reduce heart rate and contractility, decreasing oxygen demand.
- Calcium channel blockers like amlodipine (5-10mg daily) or diltiazem (120-360mg daily) relax arterial smooth muscle, improving coronary blood flow.
Ongoing Prevention
- Antiplatelet agents like aspirin (81-325mg daily) help prevent clot formation.
Additional Options
- Ranolazine (500-1000mg twice daily) improves cellular metabolism without affecting heart rate or blood pressure.
- Nicorandil (10-20mg twice daily, available in some countries) combines nitrate and potassium channel activator properties.
Personalized Approach
- Treatment should be individualized based on symptom severity, comorbidities, and tolerance, considering the patient's unique needs and underlying pathophysiology 1.
- A combination of two or more anti-ischaemic drugs with additive or synergistic effects may be needed to control symptoms effectively, taking into account the type of chronic stable angina and the individual patient 1.
From the FDA Drug Label
Metoprolol has been shown to be an effective antianginal agent, reducing the number of angina attacks and increasing exercise tolerance. Amlodipine has been evaluated in 8 placebo-controlled, double-blind clinical trials of up to 6 weeks duration involving 1038 patients with chronic stable angina. In 5 of the 8 studies, significant increases in exercise time were seen with the 10 mg dose.
Medications for Angina:
- Metoprolol: effective antianginal agent, reducing angina attacks and increasing exercise tolerance 2
- Amlodipine: increases exercise time and reduces angina attacks in patients with chronic stable angina 3
From the Research
Medications for Angina
The following medications are used to treat angina:
- Beta blockers: used to reduce heart rate and decrease oxygen demand 4, 5, 6
- Nitrates: used to improve blood flow to the heart muscle and reduce symptoms of angina 4, 7
- Calcium channel blockers: used to reduce heart rate and improve blood flow to the heart muscle 4, 7, 5
- Ranolazine: used to reduce symptoms of angina and improve quality of life 4, 7
- Aspirin: used to reduce the risk of heart attack and stroke 4, 8
- Statins: used to lower cholesterol levels and reduce the risk of heart disease 8
- Ivabradine: used to reduce heart rate and improve symptoms of angina 5
- Trimetazidine: used to improve blood flow to the heart muscle and reduce symptoms of angina 7, 6
- Nicorandil: used to improve blood flow to the heart muscle and reduce symptoms of angina 7
- Fasudil: used to improve blood flow to the heart muscle and reduce symptoms of angina 7
Special Considerations
- Patients with diabetes mellitus and/or left ventricular systolic dysfunction should be started on angiotensin converting enzyme inhibitors 4
- Patients with refractory angina may require additional treatments such as enhanced external counterpulsation, transmyocardial revascularization, and stem cell therapy 7