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by Badash M

Medications for Coronary Artery Disease (CAD)

The information provided here is meant to give you a general idea about each of the medications 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 medications 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 Medications

  • Nitroglycerin
  • Metoprolol
  • Atenolol
  • Nadolol
  • Propranolol
  • Carvedilol
  • Bisoprolol
  • Pindolol Timolol
  • Acebutolol
  • Labetalol
  • Betaxolol
  • Carteolol
  • Penbutolol
  • Esmolol
  • Atorvastatin
  • Pravastatin
  • Lovastatin
  • Simvastatin
  • Fluvastatin
  • Rosuvastatin
  • Nifedipine
  • Verapamil
  • Diltiazem
  • Amlodipine
  • Felodipine
  • Isradipine
  • Nisoldipine
  • Aspirin
  • Clopidogrel
  • Ticlopidine
  • Dipyridamole
  • Warfarin
  • Benazepril
  • Captopril
  • Enalapril
  • Fosinopril
  • Lisinopril
  • Moexipril
  • Perindopril
  • Quinapril
  • Ramipril

Over-the-Counter Medications

Prescription Medications

Vasodilators
  • Nitroglycerin
Vasodilators help dilate or widen 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:
  • Headache
  • Lightheadedness or faintness from low blood pressure
  • Rapid heart rate— tachycardia
  • Flushing of face and neck
  • Nausea or vomiting
  • Restlessness
Beta-Blockers
  • Metoprolol
  • Atenolol
  • Nadolol
  • Propranolol
  • Carvedilol
  • Bisoprolol
  • Pindolol Timolol
  • Acebutolol
  • Labetalol
  • Betaxolol
  • Carteolol
  • Penbutolol
  • Esmolol
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
  • Lightheadedness or faintness from low blood pressure
  • Trouble sleeping/nightmares
  • Unusual tiredness or weakness
  • Breathing difficulty or asthma
Statins
  • Atorvastatin
  • Pravastatin
  • Lovastatin
  • Simvastatin
  • Fluvastatin
  • Rosuvastatin
Statins are drugs that help to lower cholesterol levels and decrease inflammation. They are often prescribed to people diagnosed with CAD. These medications may reduce the risk of stroke and heart attack.
Possible side effects include:
  • Headache
  • Stomach ache
  • Diarrhea
  • Muscle weakness
  • Rarely, liver damage
Calcium Channel Blockers
  • Nifedipine
  • Verapamil
  • Diltiazem
  • Amlodipine
  • Felodipine
  • Isradipine
  • Nisoldipine
These medications affect the movement of calcium into the cells of the heart and blood vessels. As a result, blood vessels 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
  • Ticlopidine
  • Dipyridamole
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 by affecting the potassium flow in the heart cells and blood vessels.
Ranolazine
Ranolazine is an 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:
  • Lightheadedness
  • Headache
  • Nausea
  • Constipation
  • Potential to interact with other medication—This medication should be avoided in people with liver or severe kidney disease.
Angiotensin-converting Enzyme (ACE Inhibitors)
  • Benazepril
  • Captopril
  • Enalapril
  • Fosinopril
  • Lisinopril
  • Moexipril
  • Perindopril
  • Quinapril
  • Ramipril
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
  • Lightheadedness
  • Increased levels of potassium in the blood

Over-the-Counter Medication

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 medications, follow these general guidelines:
  • Take your medication 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

Antihypertensive medication selection. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 6, 2014. Accessed January 28, 2014.

Antiplatelet and anticoagulant drugs for coronary artery disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 6, 2014. Accessed January 28, 2014.

How is coronary heart disease treated? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/cad/treatment.html. Updated August 23, 2012. Accessed January 28, 2014.

Lipid-lowering pharmacotherapy overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 24, 2013. Accessed January 28, 2014.

Management of angina. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2013. Accessed January 28, 2014.

4/16/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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: 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. Updated March 2, 2012. Accessed January 28, 2014.

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