Antianginal Drugs Comparison Chart

Antianginal Drugs Comparison Chart

Antianginal drugs are medications used to treat angina pectoris, a type of chest pain caused by reduced blood flow to the heart. This chart provides an overview of the main classes of antianginal drugs, their mechanisms of action, common examples, and key considerations.

Nitrates

Mechanism: Vasodilation, reducing preload and afterload

Examples: Nitroglycerin, Isosorbide mononitrate, Isosorbide dinitrate

Considerations:

Rapid onset of action

Risk of tolerance with continuous use

Headache and hypotension as common side effects

Available in various formulations (sublingual, oral, transdermal)

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Beta-Blockers

Mechanism: Decrease heart rate and myocardial contractility

Examples: Metoprolol, Atenolol, Propranolol

Considerations:

Effective for both acute and chronic angina

May worsen asthma or COPD symptoms

Can cause fatigue and sexual dysfunction

Gradual discontinuation required to avoid rebound effects

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Calcium Channel Blockers

Mechanism: Vasodilation and reduction in myocardial oxygen demand

Examples: Amlodipine, Diltiazem, Verapamil

Considerations:

Divided into dihydropyridines (e.g., amlodipine) and non-dihydropyridines (e.g., diltiazem, verapamil)

Dihydropyridines primarily affect blood vessels, while non-dihydropyridines also affect heart rate and contractility

Can cause peripheral edema and constipation

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Ranolazine

Mechanism: Inhibits late sodium current, reducing intracellular calcium overload

Examples: Ranolazine (Ranexa)

Considerations:

Used as add-on therapy for chronic stable angina

Does not significantly affect heart rate or blood pressure

May prolong QT interval

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Ivabradine

Mechanism: Selective inhibition of the If current in the sinoatrial node, reducing heart rate

Examples: Ivabradine (Corlanor)

Considerations:

Used in patients with stable angina who cannot tolerate beta-blockers

Does not affect blood pressure or myocardial contractility

Can cause visual disturbances (phosphenes)

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Trimetazidine

Mechanism: Metabolic modulator, optimizing cardiac energy metabolism

Examples: Trimetazidine (not available in all countries)

Considerations:

Used as add-on therapy for chronic stable angina

Generally well-tolerated with minimal hemodynamic effects

May cause parkinsonian symptoms in some patients

When using antianginal drugs, it's essential to consider:

Individual patient characteristics and comorbidities

Potential drug interactions with other medications

Monitoring for side effects and adjusting doses as needed

Combining different classes of antianginal drugs for optimal management

Educating patients on proper use, especially for as-needed medications like sublingual nitroglycerin

Addressing underlying causes of angina, such as coronary artery disease, through lifestyle modifications and additional treatments

In conclusion, this chart provides a concise overview of the main antianginal drug classes, their mechanisms, and key considerations. Healthcare providers should use this information in conjunction with clinical guidelines and patient-specific factors to develop appropriate treatment plans for individuals with angina pectoris.