Table 2. Drugs for angina 2,3,5,23.
| Drug | Indications | Mechanism | Adverse effects | Precautions |
|---|---|---|---|---|
| Nitrates (short- and long-acting) | Relief of acute or anticipated pain (short-acting) Prevention of angina (long-acting) |
Systemic and coronary vasodilation | Headache Hypotension Syncope Reflex tachycardia |
Avoid sildenafil and similar drugs Tolerance with long-acting nitrates |
| Beta blockers | First-line therapy for exertional angina and after myocardial infarction | Reduce blood pressure, heart rate and contractility Prolongs diastolic filling time |
Fatigue Altered glucose Bradycardia Heart block Impotence Bronchospasm Peripheral vasoconstriction Hypotension Insomnia or nightmares |
Avoid with verapamil because of risk of bradycardia Avoid in asthma, 2nd and 3rd degree heart block and acute heart failure |
| Dihydropyridine calcium channel antagonists (e.g. amlodipine, felodipine, nifedipine) | Alternative, or in addition, to a beta blocker Coronary spasm |
Systemic and coronary vasodilator | Hypotension Peripheral oedema Headache Palpitations Flushing |
Avoid short-acting nifedipine because of reflex tachycardia and increased mortality in ischaemia |
| Non-dihydropyridine calcium channel antagonists (e.g. verapamil, diltiazem) | Alternative, or in addition, to a beta blocker | Arteriolar vasodilator Centrally acting drugs reduce heart rate, blood pressure, contractility, and prolong diastole |
Negative inotropic effect Bradycardia Heart block Constipation Hypotension Headache |
Avoid verapamil in heart failure and in combination with a beta blocker |
| Nicorandil | Angina | Systemic and coronary vasodilator | Headache Dizziness Nausea Hypotension Gastrointestinal ulceration |
Avoid sildenafil and similar drugs Metformin may reduce efficacy |
| Ivabradine | Angina Chronic heart failure |
Reduces heart rate | Visual disturbances Headache Dizziness Bradycardia Atrial fibrillation Heart block |
Caution with drugs that induce or inhibit cytochrome P450 3A4 Avoid in renal or hepatic failure |
| Perhexiline | Refractory angina | Favours anaerobic metabolism in active myocytes | Headache Dizziness Nausea, vomiting Visual change Peripheral neuropathy |
Narrow therapeutic range Need to monitor adverse effects and drug concentrations |