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Medicines for Coronary Artery Disease (CAD) and Angina

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Prescription medicines

Vasodilators
  • Nitroglycerin (Nitrogard, Nitrostat, Nitro-Bid, Nitro-Dur)
Beta-blockers
  • Metoprolol (Lopressor, Toprol-XL)
  • Atenolol (Tenormin)
  • Nadolol (Corgard)
  • Propranolol (Inderal)
  • Carvedilol (Coreg)
  • Bisoprolol (Ziac)
  • Pindolol Timolol (Istalol)
  • Acebutolol (Sectral)
  • Labetalol (Normodyne, Trandate)
  • Betaxolol (Kerlone)
  • Carteolol (Cartrol)
  • Penbutolol (Levatol)
  • Esmolol (Brevibloc)
Statins
  • Atorvastatin (Lipitor)
  • Pravastatin (Pravachol)
  • Lovastatin (Mevacor)
  • Simvastatin (Zocor)
  • Fluvastatin (Lescol)
  • Rosuvastatin (Crestor)
Calcium channel blockers
  • Nifedipine (Adalat, Procardia)
  • Verapamil (Calan, Isoptin, Verelan)
  • Diltiazem (Cardizem, Dilacor, Tiazac)
  • Amlodipine (Norvasc)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nisoldipine (Sular)
Antiplatelet agents
  • Aspirin
  • Clopidogrel (Plavix)
  • Ticlodipine (Ticlid)
  • Dipyridamole (Persantine)
Anticoagulants
  • Warfarin
Nicorandil
Ranolazine (Ranexa)
Angiotensin-converting enzyme (ACE inhibtors)
  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)

Over-the-Counter Medicines

Prescription Medicines

Vasodilators
  • Nitroglycerin (e.g., Minitran, Nitro-Bid)
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 (Zebeta)
  • Pindolol (Apo-Pindol)
  • Acebutolol (Sectral)
  • Labetalol (Trandate)
  • Betaxolol (Kerlone)
  • Cartelol (Cartrol)
  • Penbutolol (Levatol)
  • Esmolol (Brevibloc)
These medicines 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
Statins
  • Atorvastatin (Lipitor)
  • Pravastatin (Pravachol)
  • Lovastatin (Mevacor)
  • Simvastatin (Zocor)
  • Fluvastatin (Lescol)
  • Rosuvastatin (Crestor)
Statins are drugs that help to lower cholesterol levels and decrease inflammation. They are often prescribed to people diagnosed with coronary artery disease (CAD). These medicines may reduce the risk of stroke and heart attack .
Possible side effects include:
  • Headache
  • Stomach ache
  • Diarrhea
  • Muscle weakness
  • Liver damage (rare)
Calcium Channel Blockers
  • Nifedipine (Adalat, Procardia)
  • Verapamil (Calan, Isoptin, Verelan)
  • Diltiazem (Cardizem, Dilacor, Tiazac)
  • Amlodipine (Norvasc)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nisoldipine (Sular)
These medicines 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:
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 (Coumadin)
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 medicine, 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 an anti-anginal medicine 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
  • Changes in electrocardiogram readings
  • Potential to interact with other medicine—This medicine 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

Over-the-Counter Medicine

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.

Special Considerations

If you are taking medicines, follow these general guidelines:
  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

References

American Stroke Association website. Available at: http://www.strokeassociation.org/ . Accessed June 18, 2009.

Atorvastatin. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed April 16, 2010.

Coronary artery disease. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD%5FWhatIs.html . Updated February 2009. Accessed June 18, 2009.

Libby P, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: WB Saunders; 2007.

Medications for coronary artery disease and angina. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2009. Accessed April 16, 2010.

Mount Auburn Hospital website. Available at: http://www.mountauburn.caregroup.org .

Physicians Desk Reference website. Available at: http://www.pdr.net/ .

United States Pharmacopeial Convention. USP DI. 21st ed. Englewood, CO: Micromedex; 2001.

4/16/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : LaRosa JC, Deedwania PC, Shepherd J, et al. Comparison of 80 versus 10 mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial). Am J Cardiol. 2010;105(3):283-287.

3/5/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDA announces safety changes in labeling for some cholesterol-lowering drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm293623.htm . Published February 28, 2012. Accessed March 5, 2012.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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