Contraindications of Antianginal Drugs

Contraindications of Antianginal Drugs

Understanding the contraindications of antianginal drugs is crucial for safe and effective patient care. Each class of antianginal drugs has specific contraindications based on their mechanisms of action and potential adverse effects. Here's a comprehensive overview of contraindications for various antianginal drugs:

Nitrates:

Hypersensitivity to nitrates

Severe hypotension or hypovolemia

Increased intracranial pressure

Hypertrophic obstructive cardiomyopathy

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

Severe anemia

Beta-blockers:

Severe bradycardia or heart block

Cardiogenic shock

Decompensated heart failure

Severe peripheral arterial disease

Prinzmetal's angina

Uncontrolled asthma or severe COPD

Untreated pheochromocytoma

Calcium Channel Blockers:

a. Dihydropyridines:

Cardiogenic shock

Severe aortic stenosis

b. Non-dihydropyridines:

Severe left ventricular dysfunction

Sick sinus syndrome without a pacemaker

Second or third-degree AV block

Atrial fibrillation/flutter in patients with accessory bypass tract (WPW syndrome)

Potassium Channel Openers (Nicorandil):

Cardiogenic shock

Left ventricular failure with low filling pressures

Hypotension

Fatty Acid Oxidation Inhibitors (Trimetazidine):

Severe renal impairment (creatinine clearance < 15 ml/min)

Parkinson's disease and related movement disorders

Severe hepatic impairment

If Channel Inhibitors (Ivabradine):

Heart rate < 70 bpm before treatment

Cardiogenic shock

Acute myocardial infarction

Severe hepatic insufficiency

Pacemaker dependence

Unstable angina

Pregnancy and lactation

Late Sodium Current Inhibitors (Ranolazine):

Severe hepatic impairment

Concurrent use of strong CYP3A4 inhibitors

Concurrent use of drugs that prolong the QT interval

Pre-existing long QT syndrome

Antiplatelet Agents:

Active pathological bleeding

History of intracranial hemorrhage

Severe hepatic impairment (for clopidogrel)

Known hypersensitivity to the drug

Statins:

Active liver disease or unexplained persistent elevations in serum transaminases

Pregnancy and lactation

Concomitant use of certain medications (e.g., cyclosporine, gemfibrozil)

General considerations for antianginal drug contraindications:

Hypersensitivity: Any known hypersensitivity or allergic reaction to a specific drug or its components is a contraindication for its use.

Pregnancy and lactation: Many antianginal drugs are contraindicated or should be used with caution during pregnancy and breastfeeding due to potential risks to the fetus or infant.

Severe hepatic or renal impairment: Depending on the drug's metabolism and excretion, severe liver or kidney dysfunction may contraindicate its use or require dose adjustments.

Drug interactions: Certain combinations of medications may be contraindicated due to pharmacokinetic or pharmacodynamic interactions that could lead to adverse effects or reduced efficacy.

Age-related considerations: Some antianginal drugs may be contraindicated or require special caution in elderly patients due to altered drug metabolism, increased susceptibility to side effects, or comorbidities.

Comorbidities: Certain underlying conditions may contraindicate the use of specific antianginal drugs.