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Antianginal Drugs: Calcium Channel Blockers and Ranolazine01:25

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Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
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In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
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Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
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Angina IV: Management01:26

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IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
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Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
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Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is...
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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Ranolazine for stable angina pectoris.

Carlos A Salazar1, Juan E Basilio Flores2, Liz E Veramendi Espinoza2

  • 1Department of Medicine, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, San Martin de Porres, Lima, Peru.

The Cochrane Database of Systematic Reviews
|February 9, 2017
PubMed
Summary

Ranolazine, an anti-anginal drug, showed uncertain effects on mortality and quality of life in stable angina patients. While it reduced angina episodes as add-on therapy, it increased non-serious adverse events.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Stable angina pectoris significantly impacts mortality and quality of life.
  • Ranolazine is a second-line anti-anginal drug with modest effects and uncertain clinical relevance.

Purpose of the Study:

  • To assess ranolazine's effects on mortality, quality of life, myocardial infarction, angina episodes, and adverse events in stable angina patients.
  • Evaluated ranolazine as monotherapy and add-on therapy against placebo or other anti-anginals.

Main Methods:

  • Systematic review and meta-analysis of 17 randomized controlled trials (RCTs) involving 9975 participants.
  • Searched major databases (CENTRAL, MEDLINE, Embase) up to February 2016.
  • Assessed risk of bias and evidence quality using GRADE criteria.

Main Results:

  • Limited data available for most comparisons; focused on ranolazine vs. placebo.
  • Add-on ranolazine reduced angina episodes but increased non-serious adverse events (moderate quality evidence).
  • Ranolazine monotherapy showed uncertain effects on mortality, quality of life, and myocardial infarction incidence, with increased non-serious adverse events (low to very low quality evidence).

Conclusions:

  • Ranolazine monotherapy is associated with an increased risk of non-serious adverse events.
  • Ranolazine as add-on therapy reduced angina episodes but also increased non-serious adverse events.
  • Overall evidence quality is low to moderate, indicating uncertainty regarding ranolazine's benefits and risks in stable angina.