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You are in: Home > Heart Information > Treatments For Heart Conditions > Drug Treatment > Drug Treatment Of Angina

Drug Treatment Of Angina

If you have frequent angina attacks it is likely that you will need to take a combination of drugs to help:

• Relieve chest pain
• Prevent chest pain from worsening
• Protect you from serious events such as heart attacks

There are several groups of drugs which are useful in preventing angina. Your doctor will try and find the most effective combination for you. These may include:

• ACE inhibitors (Angiotensin Converting Enzyme inhibitors)
• Antiplatelets: usually this will be aspirin. In the event of true aspirin intolerance or allergy, clopidogrel or dipyridamole may be considered as an alternative.
• ARBs (Angiotensin II receptor blockers): these are mainly used in angina when ACE inhibitors are not suitable.
• Beta blockers
• Calcium channel blockers: can be effective in reducing the number of angina attacks as well as helping you to be more active. Sometimes calcium channel blockers, for example diltiazem, are used in combination with beta blockers, or for people who are not able to take beta blockers, to control angina.
• Nitrates: see below.
• Potassium channel activators: tend to be used in combination with other drugs. They may be helpful when angina is not well controlled by other drugs.
• Statins: even if your cholesterol is not high your doctor may prescribe statin tablets to lower your cholesterol.

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Nitrates for angina

Nitrates open up the arteries by relaxing the muscle in the artery wall causing the blood vessels to dilate. This reduces the work the heart muscle has to do.

Nearly everyone will need GTN (glyceryl trinitrate) to relieve angina pain as it happens. It is absorbed in the mouth, under the tongue (sublingual) making it effective in 1 –2 mins with the effect lasting 20 - 30 mins. It can be used in tablet or spray form, whichever you prefer. See the angina section for more information on using GTN.

Nitrates are also available as:

• Long acting preparations: these take longer to start working, so they are not much use for immediate pain relief. But, they work for much longer, after each dose, than a short acting preparations (which loses its effect after 20 minutes or so).
• 'Slow release' or 'modified release' tablets: when you swallow these they gradually release a steady amount of nitrate which is absorbed into the body. These tend to be used to prevent angina attacks and improve your ability to take exercise.
• Skin patches or ointments: release a steady amount of nitrate into the bloodstream through the skin. Patches should be applied to the chest or back and not directly over the heart. Only one patch should be used a day, which should be removed at night unless specifically being used to combat night time angina. Apply the patch to a different area of skin every time. Do not apply the patch to inflamed or cracked skin (the drug can be absorbed too rapidly).

If a nitrate stays in your bloodstream all the time, your body becomes used to it and the nitrate then has much less of an effect. To overcome this 'tolerance' your drug will be prescribed so that your blood stream will be free of nitrate for a few hours each day.

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