Table 1: Major side-effects, contra-indications, drug–drug interactions (DDI) and precautions of anti-ischaemic drugs [adapted from ESC guidelines]1
(List is not exhaustive: refer to summary of products characteristics for details.)
Download PDF: MIMS Ireland – SUPP – ESC guidelines- algorithm and tables
| Drug class |
Side effects a |
Contraindications |
DDI |
Precautions |
| Short-acting andlong-acting nitrates |
- Headache
- Flushing
- Hypotension
- Syncope and postural hypotension
- Reflex tachycardia
- Methaemoglobinaemia
|
- Hypertrophic obstructive cardiomyopathy
|
- PDE5 inhibitors (sildenafil or similar agents)
- α-adrenergic blockers
- CCBs
|
- |
| ß-blockersb |
- Fatigue, depression
- Bradycardia
- Heart block
- Bronchospasm
- Peripheral vasoconstriction
- Postural hypotension
- Impotence
- Hypoglycaemia/mask hypoglycaemia signs
|
- Low heart rate or heart conduction disorder
- Cardiogenic shock
- Asthma
- COPD caution; may use cardioselective ß-blockers if fully treated by inhaled steroids and long-acting ß-agonists
- Severe peripheral vascular disease
- Decompensated heart failure
- Vasospastic angina
|
- Heart-rate lowering CCB
- Sinus-node or AV conduction depressors
|
|
| CCBs: heart-rate lowering |
- Bradycardia
- Heart conduction defect
- Low ejection fraction
- Constipation
- Gingival hyperplasia
|
- Low heart rate or heart rhythm disorder
- Sick sinus syndrome
- CHF
- Low BP
|
- Cardiodepressant (ß-blockers , flecainide)
- CYP3A4 substrates
|
- |
| CCBs: Dihydropyridines |
- Headache
- Ankle swelling
- Fatigue
- Flushing
- Reflex tachycardia
|
- Cardiogenic shock
- Severe aortic stenosis
- Obstructive cardiomyopathy
|
|
- |
| Ivabradine |
- Visual disturbances
- Headache, dizziness
- Bradycardia
- Atrial fibrillation
- Heart block
|
- Low heart rate or heart rhythm disorder
- Allergy
- Severe hepatic disease
|
- QTc prolonging drugs• Macrolide antibiotics• Anti-HIV• Anti-fungal
|
- Age >75 years
- Severe renal failure
|
| Nicorandil |
- Headache
- Flushing
- Dizziness, weakness
- Nausea
- Hypotension
- Oral, anal, gastrointestinal ulceration
|
- Cardiogenic shock
- Heart failure
- Low blood pressure
|
- PDE5 inhibitors (sildenafil or similar agents)
|
- |
| Trimetazidine |
- Gastric discomfort
- Nausea
- Headache
- Movement disorders
|
- Allergy
- Parkinson disease
- Tremors and movement disorders
- Severe renal impairment
|
|
- Moderate renal impairment
- Elderly
|
| Ranolazine |
- Dizziness
- Constipation
- Nausea
- QT prolongation
|
|
- CYP450 substrates (digoxin, simvastatin, cyclosporine)
- QTc prolonging drugs
|
- |
| Allopurinol323 |
|
|
- Mercaptopurine / Azathioprine
|
|
AV = atrioventricular; CCBs = calcium channel blockers; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; DDI= Drug-Drug Interactions; HIV = Human Immunodeficiency Virus; PDE5 = phosphodiesterase type 5.
a: Very frequent or frequent; may vary according to specific drugs within the therapeutic class. b: Atenolol, metoprolol CR, bisoprolol, carvedilol.
Also see Algorithm on the medical management of patients with stable coronary artery disease.
Table 2 offers recommendations on the optimal Use on nitrates in stable coronary artery disease.
Reference: 1- [Adapted from] 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013 Oct ;34(38):2949-3003. MIMS Ireland Copyright®