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Treating with Medications

In angina patients, medications may be prescribed to reduce symptoms, prevent a possible heart attack in the future, or both.

Antianginal Drugs

Antianginal drugs help relieve and/or prevent angina attacks.  They do so by reducing the heart muscle's oxygen demand, by increasing its oxygen supply, or by doing both.

The three types of antianginal drugs are nitrates, beta blockers and calcium channel blockers.

Nitroglycerin and Nitrates

Nitrates dilate (widen) blood vessels, lower blood pressure, and reduce the heart's workload.  They also improve the flow of blood to the heart muscle.

Nitroglycerin (or "nitro") is a short-acting nitrate.  It works quickly, and is therefore used to relieve an angina attack.  Nitroglycerin is available as sublingual tablets (taken under the tongue) or as a spray.

During an angina attack, the tiny nitroglycerin tablet is placed under the tongue and allowed to dissolve.  The drug is quickly absorbed into your bloodstream and begins to work within a few minutes.  When prescribed as a spray, nitroglycerin is sprayed onto or under the tongue, or on the inside of the cheek.

Nitroglycerin is safe and none habit forming, and can be taken repeatedly without becoming ineffective.

Stopping an Angina Attack

Take short-acting nitroglycerin tablets or spray for fast relief (one spray equals one sublingual tablet).  Follow these steps:

Sit down when taking the nitroglycerin, or the medicine may make you feel dizzy.
Place a tablet under the tongue and let the tablet dissolve completely.  Do not swallow or bite the tablet.  (With the spray, spray once onto the tongue or on the inside of the cheek).

Wait five minutes.  If you still have angina, take a second tablet or spray.
Wait another five minutes.  If the angina still hasn't gone away, take a third tablet or spray.
If your angina lasts longer than 15 minutes, and three doses have not relieved it, you may be having a heart attack.  Call for medical help immediately.

Nitroglycerin can also be used to prevent angina in situations known to bring on angina pain.  For example, if you plan to climb several flights of stairs, taking a sublingual tablet a few minutes before the planned activity can help prevent angina.

Nitroglycerin tablets are sensitive to light, heat, and moisture.  Carry the tablets tightly closed in their original glass bottle.  Store them in a cool, dry place.

Long-acting nitrates release nitroglycerin slowly, over a period of hours.  They are used to prevent angina attacks–they cannot relieve an angina attack once it has begun.

Long-acting nitrates are available in several forms.  Tablets or capsules are taken by mouth, from one to four times a day.  The ointment is applied to the skin several times a day.  The transdermal patch, a small sticky disk, is applied to the skin, delivering the drug for up to 24 hours.

To prevent the loss of their effectiveness, long-acting nitrates should be discontinued for several hours each day.  If you use a patch, for example, take it off at night and apply a fresh one in the morning.

You may experience headaches when first starting on nitrates (headaches often ease off with time).  Other side effects may include dizziness and fainting.

If you use any nitrate drugs (including nitroglycerin), never take sildenafil (Viagra)–your blood pressure could suddenly drop to an unsafe level.

Examples of Nitrates:  sublingual tablets (Nitrostat), spray (Nitrolingual), ointment (Nitrol), patches (Nitro-dur, Transderm-nitro), isosorbide dinitrate (Isordil, Sorbitrate)

Beta Blockers

Beta blockers slow down the heart rate, lower blood pressure, and make the heart beat less forcefully.  By their actions, they reduce the workload on the heart and thus reduce its oxygen demand.

Angina patients who take beta blockers are able to exercise longer without getting symptoms.  In people who have had a heart attack, beta blockers are often prescribed to help prevent a second heart attack.

A number of beta blockers are available, mostly as tablets or capsules.  Depending on how long they work, they are prescribed from one to four times a day.  Beta blockers can be used either along or with other antianginal drugs.

Side effects from beta blockers may include fatigue, shortness of breath, wheezing, dizziness, insomnia, nightmares and impotence.

Never stop taking beta blockers abruptly and without your doctor's knowledge–this could cause worsening of your angina and might even bring on a heart attack.

Example of Beta blockers:  atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal)

Calcium Channel Blockers

Calcium channel blockers dilate blood vessels (veins and arteries), lower blood pressure and make the heart beat less forcefully.  By their actions, they reduce the workload on the heart.

In addition, calcium channel blockers relax the walls of the coronary arteries, and therefore are effective in treating and preventing coronary spasm and variant angina.

Calcium channel blockers are available as tablets or capsules.  Depending on how long they work, they are taken from one to four times a day.  They can be used either alone or with other antianginal drugs.

Common side effects with calcium channel blockers include headache, dizziness, constipation, swelling of the legs, low blood pressure and slow heartbeat.

Calcium channel blockers:  diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan, Isoptin)