Antianginal Drugs_ Contraindications and Precautions

Antianginal Drugs: Contraindications and Precautions

Understanding the contraindications of antianginal drugs is crucial for safe and effective patient management. Here's a comprehensive overview of the contraindications for various classes of antianginal medications:

Nitrates:

Absolute Contraindications:

Concurrent use of phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil)

Hypersensitivity to nitrates

Hypertrophic obstructive cardiomyopathy

Relative Contraindications:

Severe hypotension

Severe anemia

Closed-angle glaucoma

Increased intracranial pressure

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Beta-blockers:

Absolute Contraindications:

Severe bradycardia

High-grade atrioventricular (AV) block

Cardiogenic shock

Severe hypotension

Decompensated heart failure

Prinzmetal's angina

Relative Contraindications:

Asthma or severe COPD

Peripheral vascular disease

Diabetes mellitus (may mask hypoglycemia symptoms)

Depression

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Calcium Channel Blockers:

a) Dihydropyridines (e.g., amlodipine, nifedipine):

Absolute Contraindications:

Cardiogenic shock

Severe aortic stenosis

Relative Contraindications:

Severe hypotension

Heart failure with reduced ejection fraction

b) Non-dihydropyridines (e.g., verapamil, diltiazem):

Absolute Contraindications:

Severe bradycardia

High-grade AV block

Sick sinus syndrome (without pacemaker)

Cardiogenic shock

Severe hypotension

Concurrent use of ivabradine

Relative Contraindications:

Heart failure with reduced ejection fraction

Combination with beta-blockers (risk of severe bradycardia)

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Ranolazine:

Absolute Contraindications:

Severe liver cirrhosis

Concurrent use of strong CYP3A inhibitors

QT interval prolongation

Relative Contraindications:

Moderate to severe renal impairment

Concurrent use of drugs that prolong QT interval

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Ivabradine:

Absolute Contraindications:

Heart rate &lt; 60 bpm before treatment

Cardiogenic shock

Acute myocardial infarction

Severe hypotension

Severe hepatic impairment

Sick sinus syndrome

Sinoatrial block

3rd degree AV block

Pacemaker dependence

Unstable angina

Pregnancy and lactation

Relative Contraindications:

Concurrent use of QT-prolonging medications

Severe renal impairment

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Trimetazidine:

Absolute Contraindications:

Hypersensitivity to the drug

Parkinson's disease and parkinsonian symptoms

Severe renal impairment (GFR &lt; 30 ml/min)

Relative Contraindications:

Moderate renal impairment

Elderly patients (due to risk of parkinsonian symptoms)

General Precautions:

Liver Disease: Many antianginal drugs are metabolized in the liver. Dose adjustments or alternative medications may be necessary for patients with hepatic impairment.

Renal Impairment: Some antianginal medications require dose adjustments in patients with reduced renal function.

Elderly Patients: Increased sensitivity to medication effects and higher risk of drug interactions necessitate careful dosing and monitoring.

Pregnancy and Lactation: The safety of many antianginal drugs during pregnancy and breastfeeding is not well-established. Risk-benefit analysis is crucial.