Drug | Features |
Nitrates: nitroglycerine (acts within minutes sublingually), isosorbide mono and dinitrate is longer acting | Anti-anginal effect is due to decreased preload thereby reducing myocardial oxygen demand; decrease coronary vasospasm in Prinzmetal’s angina; dilate epicardial coronary arteries |
Calcium channel blockers | Non-dihydropyridines preferred such as diltiazem and verapamil |
Beta blockers | Antianginal effect due to beta 1 blockade, decreases heart rate and contractility, decreases myocardial oxygen requirements; atenolol, metoprolol, carvedilol preferred |
Ranolazine | It reduces sodium influx during ventricular depolarization by blocking Na channels; may prolong QTc; adverse effects include dizziness, edema, tinnitus, vertigo, constipation, dry mouth, asthenia, palpitations, hypotension |
Dipyridamole (persantine) | Acts as vasodilator and platelet inhibitor, inhibits enzyme phosphodiesterase, increases cAMP; adverse effects include dizziness, diarrhea, headache, flushing,arthralgia, bleeding tendencies |
Ivabradine | Inhibits funny currents in SA node, decreases heart rate; levels affected by drugs acting on Cyt P450 enzymes; adverse effects include blurred vision, gastrointestinal upset, AF, prolongation of QTc, bradycardia |
Trimetazidine | Increases myocardial resistance to ischemia by decreasing beta oxidation of fatty acids thereby decreasing oxygen demand; cytoprotective effect; adverse effects include nausea, vomiting, thrombocytopenia, agranulocytosis, hepatic dysfunction, may worsen Parkinson syndrome |
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