Medicines to Treat Angina Pectoris

Definition

Literally, the term "angina pectoris" refers to "chest pain": we are talking about a complex syndrome characterized by intense pain in the back sternum, which often also spreads to the shoulders, neck, jaw and left arm .

Angina pectoris occurs when the heart's demand for blood exceeds that available (in the coronary circulation).

Causes

Coronary atherosclerosis and secondary myocardial ischemia are the two main predisposing factors for angina pectoris: in fact, myocardial blood supply can be reduced due to the presence of an atheroma in a coronary artery. chest, in the context of angina pectoris, is generally the result of a more or less intense effort, while it tends to relieve itself during rest.

Symptoms

Characteristic of angina pectoris is chest pain, of an oppressive and constricting type, similar to a vice: the pain tends to gradually reduce with rest. Sometimes, the pain also radiates to nearby areas (jaw, throat, stomach) and it is not affected by breathing. Other symptoms associated with angina pectoris include: anxiety, heartburn, heartbeat, weakness, dyspnoea, nausea, sweating, vomiting.

The information on Angina - Medicines for the Treatment of Angina Pectoris is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Angina - Medicines for the Treatment of Angina Pectoris .

Medicines

The correction of risk factors and the implementation of simple rules of behavior can reduce the risk of the appearance of angina:

Avoid a sedentary lifestyle: practice constant exercise every day
Avoid a diet rich in lipids and simple sugars: follow a low-calorie diet
Not smoking
Avoid alcohol
Possibly follow a drug treatment for the metabolic syndrome, one of the most dangerous predisposing factors for cardiovascular diseases in general and angina pectoris in particular.

The goal of treatment for angina (especially in its stable form) is prevention of myocardial infarction and death: for this reason, it is essential to minimize the onset of ventricular changes and thrombosis.
Angina pectoris can be treated with sublingual NITROGLYCERIN, possibly associated with a BETBLOCKING drug (if the patient has mild stable angina without left ventricular dysfunction). Beta-blockers improve exercise tolerance, reduce typical angina symptoms and decrease the work of the heart; it is recommended not to abruptly stop taking these drugs, as such behavior could exacerbate angina.In some cases, it is necessary to associate a CALCIUM ANTAGONIST drug with a beta-blocker, and then eventually replace it with a long-acting nitrate.
For some patients, beta-blockers may be unsuitable, especially in the case of loss of left ventricular function: in this case, it is recommended to take calcium channel blockers, such as diltiazem or verapamil, possibly associated with a nitrate.
PLATE ANTI-AGGREGANTS (eg acetylsalicylic acid) are also widely used in therapy for the prevention of angina pectoris.
Statins are indicated to minimize the possibility of cardiovascular disease in patients at risk; for the long-term prevention of angina, a treatment with nicorandil, a calcium channel activator with a nitrate component, is recommended.
If even the drugs are not sufficient to relieve chest pain and to avoid the complications of angina pectoris, it is possible to proceed with a surgical intervention, such as the insertion of an aortocoronary bypass or angioplasty.

The following are the classes of drugs most used in the therapy against angina pectoris, and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and the dosage most suitable for the patient, based on the severity of the disease, the state health of the patient and his response to treatment:

Beta-blockers for the treatment of angina pectoris: the function of these drugs is exercised at the level of the beta receptors of the complex adrenergic system (target: bronchi, liver, pancreas, peripheral vessels, heart). Many beta-blocking drugs are available in slow-release products, therefore it is often (although not always) only a daily administration is required; those with a shorter duration of action, on the other hand, require 2-3 administrations over a 24-hour period. Beta-blockers can promote asthma, myocardial depression and slow heart rate: not recommended in patients with marked unstable heart failure, asthma and bronchospasm.

Atenolol (eg. Atenol, Tenoretic, Tenormin): it is recommended to start therapy with a dose of 50 mg of active ingredient per day; in case of non-response after 7 days of therapy, it is possible to take 100 mg of the drug, once a day. Consult your doctor before taking the drug.
Nadolol (eg Corgard): initiate therapy for angina pectoris with a dose of 40 mg of the drug, once a day. The maintenance dose may increase up to 80 mg, always to be taken once a day. Do not exceed 160-240 mg per day.
Labetalol (eg Trandate, Ipolab): the drug, more suitable for the treatment of hypertension, can also be taken in the treatment of angina pectoris: start therapy with a dose of 15 mg / hour, to be gradually increased. Do not exceed 120 mg per hour.
Acebutolol Hydrochloride (eg Prent, Sectral): for the treatment of angina pectoris, it is recommended to start therapy with an active dose of 400 mg, once a day (or 200 mg, twice a day). "severe angina, take 300 mg of the drug three times a day. Do not exceed 1200 mg per day. Consult your doctor.
Metoprolol Tartrate (eg. Seloken, Lopresor, Metoprolol AGE): for prophylaxis of angina pectoris, take 100 mg of the drug in a single dose or in two divided doses; for the maintenance dose, take 100-450 mg of active ingredient per day. Maintain the same dosage for the treatment of angina pectoris.
Carvedilol (eg Colver): administer in doses of 6.25 mg, to be taken orally, twice a day, on a full stomach. The maintenance dose can be increased up to 25 mg, always to be taken in a double daily dose. Consult your doctor.
Timolol Maleate (eg Blocadren, Cusimolol, Ialutim): start therapy with a drug dose of 10 mg, to be taken orally twice a day; the maintenance dose for the treatment of angina is to take 10-20 mg of the drug twice a day.

Nitrates for the treatment of angina pectoris: by reducing the venous return, these drugs lighten the workload at the level of the left ventricle.
Most common side effects: postural hypotension, hot flashes, headache

Nitroglycerin (eg Venitrin T for infusion, Trinitrin for infusion, Natispray Spray, Triniplas patches, Trinitrina coated tablets): drug of excellence for the treatment of symptoms related to angina pectoris; however, its therapeutic effect is rather short (it lasts about 20-30 minutes after taking). In the form of sublingual tablets, it is recommended to take a drug dose ranging from 0.3 to 0.6 mg, to be placed under the language: proceed with an additional application, if necessary, every 5 minutes. In the form of a lingual spray, it is recommended to apply 1-2 sprays on the tongue or under the tongue every 3-5 minutes, as needed, for no more than 3 sprays in 15 minutes. The duration of action can be prolonged by taking nitroglycerin preparations transdermally, although in this case, the chances of developing tolerance are greatly increased. Furthermore, nitroglycerin can also be taken by continuous intravenous infusion: start with 5 mcg per minute, increasing the dose by another 5 mcg / min every 3-5 minutes, up to 20 mcg per minute. Subsequently, it is possible to increase the dosage from 10 to 20 mcg per minute, up to a maximum of 200-400 mcg per minute. Consult your doctor.
Isosorbide dinitrate (eg Carvasin, Dinike, Nitrosorbide): the drug is active if formulated as sublingual tablets and is indicated for patients with mild angina pectoris (requiring occasional administration of nitrates). In ischemic manifestations, the drug is also indicated in the form of tablets to be taken orally. Unlike nitroglycerin, the therapeutic effect is not immediate, but the duration of action is much longer (a few hours). When the drug is ineffective in its sublingual form, it is indicated if taken intravenously. Indicatively, for the prevention of angina pectoris episodes, it is recommended to take a dose ranging from 30 to 120 mg of the drug divided into several doses over 24 hours. By IV injection, take the drug at a dose of 2-10 mg so. Do not exceed 20 mg per hour. It can also be administered by aerosol spray, in this case it is advisable to spray 1-3 doses of 1.25 mg under the tongue.
Isosorbide mononitrate (eg. Duronitrin, Elan, Ismo, Diffutab, Ismo-20, Leicester, Monocinque, Monoket, Vasdilat): particularly suitable for prophylaxis of angina: administer isosorbide mononitrate at a dose of 1-3 mg, three times a day for mild or moderate forms, to be increased up to 5 mg for severe angina. treatment of angina: orally, take 2 mg (max. 3) per day; sublingually, take 0.3-1 mg of the drug, to be repeated when necessary. The drug is also available for intravenous infusion: in this case , administer 10-200 mcg of active per minute.

Nicorandil (eg. Ikorel, precond): the drug is an activator of potassium channels, characterized by a nitrate component: it is indicated both for the prevention and for the treatment of angina pectoris, thanks to its vasodilating properties (action on veins and arteries) The drug is not on the market in Italy The active ingredient is administered intravenously or orally Do not take in combination with drugs to treat erectile dysfunction (eg Viagra).

Calcium antagonists for the treatment of angina pectoris: they act positively in the treatment and prevention of angina pectoris by dilating the blood vessels, also affecting the muscle cells of the arterial walls: by increasing and promoting the flow of blood to the heart, the possibility of episodes of angina pectoris.

Verapamil (eg Isoptin, Kata): the drug is available in immediate-release tablets: start therapy with an active dose of 80-120 mg, to be taken three times a day; alternatively, take 40 mg of the drug, 3 times a day. The exact maintenance dose depends on the response to treatment, and may possibly be increased daily or weekly. Consult your doctor. The drug is also available in the form of slow-release tablets: for the treatment of angina pectoris, start therapy with a dose of 180 mg, to be taken orally, before going to bed. Again, the maintenance dose should be established on the basis of the response to treatment.

PLEASE NOTE: in the case of presumed or ascertained ischemic heart disease, Verpamil associated with a beta-blocker drug greatly increases the risk of heart failure!

Amlodipine (eg. Abis, Natam, Makadip, Pressac): for the treatment of chronic stable or vasospastic angina, it is recommended to take 5-10 mg of active orally, once a day.
Diltiazem (eg. Altiazem, Tildiem, Diladel): at a dose of 30-60 mg, to be taken 3-4 times a day, the drug is indicated for the initial prophylaxis of angina pectoris. It is possible to increase the dosage up to 180- 360 mg per day (divided into several doses, for maintenance therapy).

Antiplatelet agents for the treatment of angina pectoris: acetylsalicylic acid and heparin are the two active ingredients with anticoagulant action most used for the prevention of angina pectoris.

Acetylsalicylic acid (eg. Aspirin, Cardioaspirin, Aspirinetta): the drug is used both for the treatment of episodes of angina pectoris, and for its prevention: in the first case, it is recommended to start therapy with a dose ranging from 75 to 325 mg , to be taken within the shortest possible time from the ascertained diagnosis of the disease. Therapy should be continued for life. The same dose is considered for the prevention of angina pectoris. The exact dose must always be determined by the doctor based on the severity of the patient's condition.
Heparin (eg. Heparin Cal Acv, Heparin Sod.Ath, Ateroclar, Trombolisin): the drug is successfully used in the therapy for unstable angina, often associated with acetylsalicylic acid. Indicatively, for the treatment of angina pectoris, take 5000 IU of drug once daily (bolus infusion), followed by 1000 units per hour (by continuous infusion). Dalteparin (eg Fragmin) is taken subcutaneously, and requires a reduced frequency of administration compared to heparin (common): the drug is available in doses ranging from 2500IU / 0.2ml, up to 18000IU / 0.72ml. The dosage for the treatment and prophylaxis of angina is exclusively a medical competence.