Medications for Coronary Artery Disease (CAD) and Angina

Vasodilators

• Nitroglycerin (Nitrogard, Nitrostat, Nitro-Bid, Nitro-Dur)

Vasodilators help dilate or enlarge blood vessels. People with CAD have blood vessels that are narrowed, which reduces the amount of blood that can be delivered to the heart muscle. Nitrates or nitroglycerin may be used to immediately relieve an attack of angina that is occurring, or prevent or reduce future attacks. Nitrates come in many preparations, including tablets, sprays (for use under the tongue), ointments, or patches for placement on the skin. The tablets or sprays are used at times of anginal episodes, while the ointment or patch is used on a daily basis for prevention of attacks.

Possible side effects include:

• Dizziness or lightheadedness, especially when getting up from a lying or sitting position
• Fast pulse (tachycardia)
• Flushing of face and neck
• Headache
• Nausea or vomiting
• Restlessness

Beta Blockers

• Metoprolol (Lopressor, Toprol-XL)
• Atenolol (Tenormin)
• Nadolol (Corgard)
• Propranolol (Inderal)
• Carvedilol (Coreg)
• Bisoprolol (Ziac)
• Pindolol Timolol (Isatalol)
• Acebutelol (Sectral)
• Labetalol (Normodyne, Trandate)
• Betaxolol (Kerlone)
• Cartelol (Cartrol)
• Penbutolol (Levatol)
• Esmolol (Brevibloc)

These medications help slow the heart rate and reduce blood pressure, especially during exercise. They are intended to prevent anginal attacks or heart attacks . Beta blockers are also prescribed when recovering from a heart attack in order to lessen the likelihood of recurrence.

Possible side effects include:

• Decreased sexual ability
• Dizziness or lightheadedness
• Trouble sleeping/nightmares
• Unusual tiredness or weakness
• Low blood pressure
• Breathing difficulty or asthma

Calcium Channel Blockers

• Nifedipine (Adalat, Procardia)
• Verapamil (Calan, Isoptin, Verelan)
• Diltiazem (Cardizem, Dilacor, Tiazac)
• Amlodipine (Norvasc)
• Felodipine (Plendil)
• Isradipine (DynaCirc)
• Nisoldipine (Sular)

These medications affect the movement of calcium into the cells of the heart and blood vessels. As a result, blood vessels open wider (dilate); the supply of blood and oxygen to the heart is increased, while the heart's workload is decreased. This helps to prevent anginal attacks, as well as lessen the possibility of heart attacks.

Possible side effects include:

• Constipation
• Swollen legs
• Unusual tiredness or weakness
• Headache
• Palpitations

Antiplatelet Agents

• Aspirin
• Clopidogrel (Plavix)
• Ticlodipine (Ticlid)
• Dipyridamole (Persantine)

Antiplatelet agents prevent the formation of blood clots by keeping platelets from clumping and sticking together.

Possible side effects include:

• Nausea and vomiting
• Diarrhea
• Skin rash
• Ringing in the ears (tinnitus)
• Skin bruising
• Irritation of the stomach lining
• Bleeding from the digestive system and other internal organs
• Allergic reaction

Anticoagulants

• Warfarin

Anticoagulants are given to “thin” the blood, in an effort to prevent the formation of blood clots. The most serious side effect is bleeding.

Possible side effects include:

• Bloody or tarry black stools
• Nosebleeds
• Heavy menstrual periods
• Easy bruising
• Allergic reaction

Nicorandil

This medication, which contains a nitrate, dilates blood vessels due to its effect on potassium flow in the heart cells and blood vessels.

Ranolazine (Ranexa)

Ranolazine is a new anti-anginal medication that does not depend on reductions in heart rate or blood pressure. It reduces the frequency of anginal chest pain, but has not been shown to reduce heart attacks.

Possible side effects include:

• Dizziness
• Headache
• Nausea
• Constipation
• Prolongation of the QT-interval on the electrocardiogram
• Ranolazine has the potential to interact with other medications and should be avoided in patients with liver or severe kidney disease.

Angiotensin-converting Enzyme (ACE Inhibitors)

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)

ACE inhibitors work to dilate blood vessels by interfering with the action of angiotensin, a chemical that contracts and narrows blood vessels.

Possible side effects include:

• Cough
• Headache
• Dizziness
• Increased levels of potassium in the blood

Aspirin

A small, daily dose of aspirin has been shown to decrease the risk of heart attack by preventing blood clots from forming. Ask your doctor before taking aspirin daily. A possible side effect of taking aspirin regularly is bleeding in the stomach and gastrointestinal tract.