Chronic Coronary Syndromes Drug Summary

Last updated: 27 October 2025
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ACE Inhibitors*^

Content on this page:

ACE Inhibitors*^

ACE Inhibitors*^


Drug Dosage Remarks
Benazepril Initial dose (patient not on diuretic): 
10-20 mg PO 24 hourly
Initial dose (patient taking diuretic): 
5 mg PO 24 hourly
Maintenance dose: 20-40 mg PO 12-24 hourly
Max dose: 80 mg/day		 Adverse Reactions
  • CV effects (hypotension, palpitations, chest pain, arrhythmia); CNS effects (fatigue, headache, dizziness); GI effects (nausea/vomiting, taste disturbances, flatulence); Respiratory effects (persistent dry cough, upper respiratory tract symptoms); Dermatologic effects (skin rashes, angioedema, erythema multiforme, toxic epidermal necrolysis); Hypersensitivity reactions; Renal effect (renal impairment); Electrolyte disturbances (hyperkalemia, hyponatremia); Blood disorders
Special Instructions
  • Patients with heart failure and those who may be salt or water depleted (taking diuretic or on dialysis) may experience hypotension during initial stages of ACE inhibitor therapy
    • Start treatment only under close medical supervision; in these patients use a low dose and have the patient in a supine position
  • Avoid in patients with aortic stenosis or outflow tract obstruction and should generally be avoided in suspected or actual renovascular disease
  • Use with caution in patients with history of hereditary or idiopathic angioedema, porphyria, collagen vascular disease, severe chronic heart failure
  • Renal function should be assessed prior to administration of ACE inhibitors and should be monitored during therapy
    • Patient with renal disease or taking high doses should be monitored regularly for proteinuria
  • Monitor BP with the first dose and WBC and urinary protein before and during therapy
    • Take the first dose at bedtime for there may be precipitous fall in BP 
Captopril  Initial dose: 12.5 mg PO 12 hourly 
May increase dose gradually every 2-4 weeks
Maintenance dose: 25-50 mg PO 12 hourly
Max dose: 150 mg/day 
Cilazapril
 Initial dose: 1 mg PO 24 hourly x 2 days
Maintenance dose: 2.5-5 mg PO 24 hourly 
Delapril
 15-30 mg PO 12 hourly
Enalapril Initial dose (patient not on diuretic):
5 mg PO 24 hourly
Initial dose (patient taking diuretic): 2.5 mg PO 24 hourly 
Maintenance dose: 10-20 mg PO 24 hourly
Max dose: 40 mg/day
Fosinopril Initial dose: 10 mg PO 24 hourly
Maintenance dose: 10-40 mg PO 24 hourly
Imidapril
 Initial dose: 5 mg PO 24 hourly
Maintenance dose: 10 mg PO 24 hourly
Max dose: 20 mg/day 
Lisinopril  Initial dose (patient not on diuretic): 5-10 mg PO 24 hourly
Initial dose (patient taking diuretic): 5 mg PO 24 hourly
Maintenance dose: 20 mg PO 24 hourly
Max dose: 80 mg/day 
Moexipril
 Initial dose (patient not on diuretic): 7.5 mg PO 24 hourly
Initial dose (patient taking diuretic): 3.75 mg PO 24 hourly 
Maintenance dose: 7.5-30 mg PO 24 hourly 
(May give dose divided 12 hourly if control is inadequate with single daily dose) 
 Perindopril1 Initial dose: 4-5 mg PO 24 hourly
May increase to 8-10 mg PO 24 hourly after 2 weeks of treatment
Max dose: 8-10 mg/day
Quinapril  Initial dose (patient not on diuretic): 10 mg PO 24 hourly
Initial dose (patient taking diuretic): 5 mg PO 24 hourly
Maintenance dose: 20-40 mg PO 12-24 hourly
Max dose: 80 mg/day 
Ramipril
 Initial dose: 1.25-2.5 mg PO 24 hourly
Maintenance dose: 2.5-5 mg PO 24 hourly
Max dose: 10 mg/day 
Trandolapril  Initial dose (patient not on diuretic): 1 mg PO 24 hourly 
Initial dose (patient taking diuretic): 0.5 mg PO 24 hourly
Maintenance dose: 1-2 mg PO 24 hourly
Max dose: 4 mg/day 
Combination Products
Perindopril/Amlodipine/Atorvastatin  Perindopril 5 mg/Amlodipine 5 mg/Atorvastatin 10 mg
Perindopril 5 mg/Amlodipine 5 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 5 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 10 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 10 mg/Atorvastatin
40 mg
1 tab PO 24 hourly		 Adverse Reactions
  • GI effects (constipation, dyspepsia, nausea/vomiting, diarrhea); CNS effects (headache, dizziness, paresthesia, asthenia); Musculoskeletal effects (myalgia, arthralgia, back pain, joint and ankle swelling); Metabolic effects (hyperglycemia, abnormal LFT, increased blood creatine kinase); CV effects (palpitations, hypotension); Respiratory effects (nasopharyngitis, cough, dyspnea); Other effects (hypersensitivity, epistaxis, flushing, edema, visual impairment, tinnitus, rash, pruritus)
Special Instructions
  • Use with caution in patients with collagen vascular disease, on immunosuppressant therapy, Allopurinol or Procainamide
  • Increased risk of hypotension, hyperkalemia, decreased renal function; interstitial lung disease on long-term therapy
  • Monitor glycemic control and LFTs periodically
  • Avoid in patients with hypersensitivity, liver disease, severe hypotension, hemodynamically unstable HF, history of angioedema, significant bilateral renal artery stenosis; on Sacubitril/Valsartan
*If possible, discontinue diuretics 2-3 weeks before initiating therapy with ACE Inhibitors. Otherwise, monitor patient closely during therapy.
^Combinations of ACE inhibitor and thiazide diuretic, and ACE inhibitor and calcium antagonist are available. Please see the latest MIMS for specific formulations and prescribing information.
1Combination with Bisoprolol is available. Please see the latest MIMS for specific formulations and prescribing information. 

Angiotensin II Antagonists


Drug Dosage Remarks
Azilsartan medoxomil Initial dose: 
40 mg PO 24 hourly
May increase up to 80 mg PO 24 hourly		 Adverse Reactions
  • Usually mild and transient: CNS effects (dizziness, headache); CV effect (dose-related orthostatic hypotension which may occur particularly in patients with volume depletion); Renal impairment
  • Rare effects: Rash, angioedema, elevated LFTs, myalgia
Special Instructions
  • Patients with volume depletion (eg high-dose diuretic therapy) may experience hypotension and should be started on low dose
  • Use with caution in patients with renal artery stenosis, renal impairment or hepatic impairment
  • Avoid in patients with bilateral renal artery stenosis or primary hyperaldosteronism
  • Serum K should be monitored especially in the elderly, patients with renal impairment and K-sparing diuretics should be avoided
Candesartan Initial dose: 8 mg PO 24 hourly
Maintenance dose:  8-16 mg PO 24 hourly
Max dose: 32 mg/day 
Eprosartan
 Maintenance dose: 400-800 mg PO 24 hourly or divided 12 hourly
Max dose: 800 mg/day
Irbesartan
 Initial dose: 150 mg PO 24 hourly
Maintenance dose: 150-300 mg PO 24 hourly
Losartan 50 mg PO 24 hourly
May increase to 100 mg PO 24 hourly or divided 12 hourly
Olmesartan medoxomil Initial dose: 20 mg PO 24 hourly
May increase to 40 mg PO 24 hourly
Telmisartan
 20-40 mg PO 24 hourly
Max dose: 80 mg/day 
Valsartan Initial dose: 80 mg PO 24 hourly
May increase to 160 mg PO 24 hourly
Max dose: 320 mg/day 

Antiplatelet Agents


Drug Dosage Remarks
Aspirin 75-325 mg PO 24 hourly 
 Adverse Reactions
  • GI effects (GI upset which may be minimized by administering with food and with use of enteric-coated formulation, also GI irritation including erosion, ulceration, etc); Hematologic effects (increase in bleeding time, decrease in platelet adhesiveness, hemorrhage); Hypersensitivity reactions
Special Instructions
  • Contraindicated in patients with active pathological bleeding (eg peptic ulcer, intracranial hemorrhage), known allergy, hemophilia, hemorrhagic disorders, severe renal or hepatic impairment
  • Ensure that benefit outweighs the risk prior to use in combination with Warfarin, Heparin, thrombolytics, NSAIDs and other drugs that increase the risk of bleeding
Clopidogrel
 75 mg PO 24 hourly  Adverse Reactions
  • Hematologic effects (hemorrhage, purpura, epistaxis, blood dyscrasias, including neutropenia, thrombotic thrombocytopenic purpura have occurred); Dermatologic effects (rash, pruritus); GI effects (abdominal pain, nausea/vomiting, dyspepsia, constipation)
Special Instructions
  • Contraindicated in patients with active bleeding or severe liver impairment
  • Concurrent use of drugs known to inhibit CYP2C19 (eg Omeprazole, Esomeprazole, Cimetidine, Fluconazole, Ketoconazole, Voriconazole, Etravirine, Felbamate, Fluoxetine, Fluvoxamine and Ticlopidine) should be avoided
    • Separating the time of administration between the drugs does not reduce the chance of interaction
  • If possible, discontinue use 5-7 days prior to elective surgery
Triflusal
 600 mg PO 24 hourly or in divided doses 
or
900 mg PO 24 hourly in divided doses 
 Adverse Reactions
  • GI effects (dyspepsia, abdominal pain, nausea/vomiting, flatulence, constipation); Other effects (headache, anorexia)
Special Instructions
  • Contraindicated in patients with active bleeding and those with salicylate hypersensitivity
  • Use with caution in patients with renal or hepatic impairment

Beta-Blockers


Drug Dosage Remarks
Acebutolol Initial dose: 200 mg PO 12 hourly or 400 mg PO 24 hourly
Maintenance dose: 200-600 mg PO 12 hourly
Max dose: 1,200 mg/day divided 12 hourly		 Adverse Reactions
  • CNS effects (fatigue, depression, dizziness, confusion, sleep disturbances); CV effects (HF, heart block, bradycardia, coldness of extremities, male impotence); Respiratory effects (bronchospasm in susceptible patients and drugs with beta1 selectivity should be used with caution in these patients); GI effects (nausea/vomiting, diarrhea, constipation); Metabolic effects (can produce hyper- or hypoglycemia, changes in serum cholesterol and triglycerides)
Special Instructions
  • Contraindicated in severe bradycardia, preexisting high degree of AV block, sick sinus syndrome and severe, unstable LV failure
  • Use with caution in patients with bronchospasm, asthma or obstructive airway diseases
  • Use with caution in 1st-degree block, depression, patients with PAD and patients on Insulin
  • Beta-blockers may mask the symptoms of hyperthyroidism and hypoglycemia and may aggravate psoriasis
  • Patients on long-term treatment should not discontinue abruptly; should discontinue gradually over 1-2 weeks
Atenolol1 50-100 mg PO 24 hourly 
Max dose: 200 mg/day 
Betaxolol
 10-20 mg PO 24 hourly
Max dose: 40mg/day 
Bisoprolol2
 5-10 mg PO 24 hourly 
Max dose: 20 mg/day
Carvedilol3 Initial dose: 12.5 mg PO 12 hourly x 2 days 
Then increase to 25 mg PO 12 hourly 
May increase dose every 2 weeks thereafter, if required up to: 
Max dose: 100 mg/day
Celiprolol Initial dose: 200 mg PO 24 hourly
May increase dose to 400 mg PO 24 hourly
Labetalol
 Initial dose: 100 mg PO 12 hourly 
May increase dose after 2 weeks to 200-400 mg PO 12 hourly
Max dose: 2400 mg/day 
Metoprolol3 Regular-release: 50-100 mg PO 8-12 hourly 
Maintenance dose: 100-200 mg PO 24 hourly
Max dose: 400 mg/day
Extended-release: 50-200 mg PO 24 hourly
Max dose: 400 mg/day or 95-190 mg PO 24 hourly up to 380 mg PO 24 hourly 
Nadolol
 Initial dose: 40 mg PO 24 hourly 
May gradually increase dose every 7 days until adequate response is achieved
Maintenance dose: 40-80 mg PO 24 hourly
Max dose: 160-240 mg/day
Pindolol 2.5-5 mg PO 8 hourly 
Maintenance dose: 15-40 mg/day PO in divided doses 
Max dose: 40 mg/day
Propranolol Regular-release:
Initial dose: 40 mg PO 8-12 hourly 
May increase to 120-240 mg/day PO
Max dose: 320 mg/day
Extended-release:
Initial dose: 80 mg PO 24 hourly 
May increase to 160 mg PO 24 hourly
Max dose: 320 mg/day 
Sotalol
 Initial dose:  80-160 mg PO 24 hourly or divided 12 hourly
May increase dose gradually at 2-3 day intervals to 80-160 mg PO 12 hourly
1Combination with Nifedipine is available. Please see the latest MIMS for specific formulations and prescribing information. 
2Combination with Perindopril is available. Please see the latest MIMS for specific formulations and prescribing information. 
3Combination with Ivabradine is available. Please see the latest MIMS for specific formulations and prescribing information. 

Calcium Antagonists*


Drug Dosage Remarks
Benzothiazepine
Diltiazem Regular-release:
Initial dose: 30-60 mg PO 6-8 hourly 
May increase to 360 mg/day PO in divided doses 
Max dose: 480 mg/day 
Extended-release (24 hourly):
120-180 mg PO 24 hourly 
Max dose: 360-540 mg/day or 100-300 mg PO 24 hourly 
Extended-release (12 hourly): 90 mg PO 12 hourly 		 Adverse Reactions
  • CV effects (depression of cardiac function, hypotension, worsening HF, edema, flushing, bradycardia); GI effects (constipation, abdominal pain); CNS effects (headache, dizziness)
  • HR-modulating Ca antagonists (eg Diltiazem, Gallopamil and Verapamil): AV dissociation, AV block, bradycardia and sinus node dysfunction
  • Short-acting dihydropyridine agents should be avoided because they have the potential to enhance risk of adverse cardiac events
Special Instructions
  • Contraindicated in patients with overt decompensated HF, though vasoselective dihydropyridines (eg Amlodipine, Felodipine) are tolerated in patients with a decreased LVEF
  • HR-modulating Ca antagonists are contraindicated in patients with bradycardia, sinus node dysfunction and AV nodal block
Dihydropyridines
Amlodipine1 Initial dose: 5 mg PO 24 hourly 
Max dose: 10 mg/day

Adverse Reactions

  • CV effects (depression of cardiac function, hypotension, worsening HF, edema, flushing, bradycardia, short-acting dihydropyridine agent, eg Nifedipine, can induce tachycardia and palpitations); GI effects (constipation, abdominal pain); CNS effects (headache, dizziness)
  • HR-modulating Ca antagonists (eg Diltiazem, Gallopamil and Verapamil): AV dissociation, AV block, bradycardia and sinus node dysfunction
  • Levamlodipine: Tachycardia, cough, breathing difficulty, vertigo, headache, facial puffiness, cheerlessness 
  • Short-acting dihydropyridine agents should be avoided because they have the potential to enhance risk of adverse cardiac events

Special Instructions

  • Contraindicated in patients with overt decompensated HF, though vasoselective dihydropyridines (eg Amlodipine, Felodipine) are tolerated in patients with a decreased LVEF
  • HR-modulating Ca antagonists are contraindicated in patients with bradycardia, sinus node dysfunction and AV nodal block
  • Levamlodipine: Avoid concomitant use with Isoprinoline and Dopamine

 
Benidipine 4 mg PO 12 hourly
Felodipine Initial dose: 5 mg PO 24 hourly 
Max dose: 10 mg/day 
Levamlodipine  2.5 mg PO 24 hourly
May be increased up to 5 mg 24 hourly if necessary 
Nicardipine
 Regular-release: 
Initial dose: 20 mg PO 8 hourly
Maintenance dose: 30 mg PO 8 hourly 
May increase to 60-120 mg/day in divided doses
Extended-release: 40 mg PO 12 hourly  
Nifedipine
 Regular-release: 
Initial dose: 5-10 mg PO 8 hourly 
May increase to 20 mg PO 8 hourly 
Extended-release (24 hourly): 
Initial dose: 20-30 mg PO 24 hourly 
May increase to 90-120 mg PO 24 hourly 
Extended-release (12 hourly): 10-40 mg PO 12 hourly 
Nisoldipine
 10 mg PO 24 hourly
May increase to 20-40 mg PO 24 hourly 
Phenylalkylamines
Bepridil 200 mg PO 24 hourly
Max dose: 400 mg/day
Gallopamil Regular-release: 25-50 mg PO 6-12 hourly 
Max dose: 200 mg/day
Extended-release: 100 mg PO 12-24 hourly
Verapamil Regular-release: 80-120 mg PO 8 hourly 
Extended-release: 120-480 mg/day PO divided 12-24 hourly 
Max dose: 480 mg/day
*Combinations of calcium antagonist and ACE inhibitor, calcium antagonist and angiotensin II antagonist, and calcium antagonist and beta-blocker are available. Please see the latest MIMS for specific formulations and prescribing information.
1Combination with Atorvastatin is available. Please see the latest MIMS for specific formulations and prescribing information.

Cardiac Drugs


Drug Dosage Remarks
Amino Acid Derivative
L-carnitine 660 mg PO 8 hourly Special Instructions
  • Should be taken with food
  • Contraindicated in patients with hypersensitivity to L-carnitine

Nitrates (Oral - Long-Acting)


Drug Dosage Remarks
Glyceryl trinitrate 
(Nitroglycerin, GTN, NTG)		 Modified-release cap/tab:
2.5-6.5 mg PO 6-8 hourly
Extended-release tab: 
Initial dose: 2.6 mg PO 12 hourly
May increase to 2-3 tabs PO 12 hourly or
2.5 mg PO 8-12 hourly or
5 mg PO 12 hourly 		 Adverse Reactions
  • CNS effects (headache which usually decreases with long-term administration, lightheadedness, dizziness, syncope); rarely CV effects (bradycardia, hypotension); GI effects (nausea/vomiting, bowel incontinence, xerostomia)
  • Nitrate tolerance usually develops with long-term use and dosing with adequate nitrate-free interval is recommended
Special Instructions
  • Dosing to overcome nitrate tolerance: Recommend giving last dose of short-acting agents at 7 PM; administer 2x/day rather than 4x/day; administer extended-release prep once in the morning
  • Avoid in patients with severe hypotension, hypovolemia, marked anemia, HF due to obstruction or raised intracranial pressure due to head trauma or hemorrhage
  • Use with caution in patients with severe renal or hepatic dysfunction, hypothyroidism, malnutrition or hypothermia
    • Use with caution in post-MI with endothelial dysfunction and if BP drops following use
  • Co-administration with phosphodiesterase type 5 inhibitors (eg Sildenafil, Vardenafil, Tadalafil) is contraindicated
Isosorbide dinitrate Regular-release: 2.5-40 mg PO 6-12 hourly 
Extended-release: 20 mg PO 8-12 hourly 
or 40 mg PO 12-24 hourly 
or 120 mg PO 24 hourly 
(Dose will depend on formulation)
Isosorbide 5-mononitrate
(Isosorbide mononitrate)
 Regular-release:
Initial dose: 10 mg PO 12 hourly
May increase to 20-40 mg PO 8-12 hourly depending on formulation
Max dose: 120 mg/day
Extended-release: 30-120 mg PO 24 hourly depending on formulation

Nitrates (Oral - Short-Acting)


Drug  Available Strength
 Dosage Remarks
Glyceryl trinitrate 
(Nitroglycerin, GTN, NTG) 

 300, 400, 500, 600 mcg sublingual (SL) tab Acute anginal attack: 300-600 mcg SL every 5 minutes until cessation of pain or side effects occur 
Max dose: 3 doses within 15 minutes
Prophylaxis: 300-600 mcg SL 5-10 minutes prior to activity 		 Adverse Reactions
  • CNS effects (headache, lightheadedness, dizziness, syncope); rarely CV effects (bradycardia, hypotension); GI effects (nausea/vomiting, bowel incontinence, xerostomia)
Special Instructions
  • Avoid in patients with severe hypotension, hypovolemia, marked anemia, HF due to obstruction or raised intracranial pressure due to head trauma or hemorrhage
  • Use with caution in patients with severe renal or hepatic dysfunction, hypothyroidism, malnutrition or hypothermia
  • Co-administration with phosphodiesterase inhibitors (eg Sildenafil) is contraindicated within 24-hours interval after taking a nitrate preparation
Acute attacks:
  • Instruct patient to sit down and use medication at first sign of angina attack
  • Patient should be made aware that dose may be repeated in 5-10 minutes with max of 3 doses given
  • Patient should seek emergency medical treatment if pain does not subside
400 mcg/dose SL spray
 Acute anginal attack:
1-2 sprays (400-800 mcg) SL 
May repeat with 1 spray every 5 minutes until cessation of pain or side effects occur 
Max dose: 3 doses within 15 minutes
Prophylaxis: 1-2 sprays SL 5-10 minutes prior to activity 
Isosorbide dinitrate
 5, 10 mg SL tab Acute anginal attack:
2.5-10 mg SL every 5-10 minutes until cessation of pain or side effects occur
Max dose: 3 doses within 15-30 minutes
Prophylaxis: 2.5-10 mg SL 2-4 hourly or prior to activity
1.25 mg/dose buccal spray
 Acute anginal attack: 1-3 sprays (1.25-3.75 mg) into the buccal cavity; waiting 30 seconds between sprays.
Do not inhale medication 
Prophylaxis: 1-3 sprays (1.25-3.75 mg) into the buccal cavity prior to activity; waiting 30 seconds between sprays.
Do not inhale medication.

Nitrates (Topical - Long-Acting)


Drug  Available Strength
 Dosage Remarks
Glyceryl trinitrate 
(Nitroglycerin, GTN, NTG) 

 5 mg/24 hr patch (0.2 mg/hr/day)
10 mg/24 hr patch (0.4 mg/hr/day)		 5-20 mg/24 hr (1-2 patches) applied 24 hourly usually in the morning
To prevent tolerance: 
Patch-free period of 8-12 hours, usually at night every 24 hours is recommended  		 Adverse Reactions
  • CNS effects (headache which usually decreases with long-term administration, lightheadedness, dizziness, syncope); rarely CV effects (bradycardia, hypotension); GI effects (nausea/vomiting, bowel incontinence, xerostomia)
  • Nitrate tolerance usually develops with long-term use and dosing with adequate nitrate-free interval is recommended
  • Topical prep: Contact dermatitis, local irritation and erythema
Special Instructions
  • Dosing to overcome nitrate tolerance: Recommend giving last dose of short-acting agents at 7 PM; administer 2x/day rather than 4x/day; administer extended-release prep once in the morning
  • Avoid in patients with severe hypotension, hypovolemia, marked anemia, HF due to obstruction or raised intracranial pressure due to head trauma or hemorrhage
  • Use with caution in patients with severe renal or hepatic dysfunction, hypothyroidism, malnutrition or hypothermia
    • Use with caution in post-MI with endothelial dysfunction and if BP drops following use
  • Co-administration with phosphodiesterase type 5 inhibitors (eg Sildenafil, Vardenafil, Tadalafil) is contraindicated
2% ointment Apply 1-2 inches 3-4 hourly as necessary onto skin of chest, thigh or arm 

Other Anti-Anginal Drugs


Drug Dosage Remarks
3-KAT Inhibitor
Trimetazidine Regular-release: 20 mg PO 8 hourly 
Modified-release: 35 mg PO 12 hourly 
Prolonged-release: 60-80 mg PO 24 hourly		 Adverse Reactions
  • Rarely, GI effects (nausea/vomiting), tiredness, headache, vertigo, sleep disorder, orthostatic hypotension, skin rash
Special Instructions
  • Should be taken with food
  • Contraindicated in patients with known hypersensitivity, pregnancy and lactation
If Channel Inhibitor
  
Ivabradine1 Initial dose: 
5 mg PO 12 hourly 
May increase dose after 3-4 weeks to 7.5 mg PO 12 hourly 
Titrate dose depending on patient’s HR 		 Adverse Reactions
  • Luminous phenomena in visual field (phosphenes); CNS effects (blurred vision, headache, dizziness); CV effects (bradycardia, 1st-degree AV block, ventricular extrasystole) 
Special Instructions
  • Should be taken with food; avoid excessive consumption of grapefruit juice
  • Use with caution in patients with atrial fibrillation, 2nd-degree AV block, CHF, stroke, retinitis pigmentosa, galactose intolerance, hypotension, congenital QT syndrome, moderate hepatic insufficiency, severe renal impairment
  • Contraindicated in patients with bradycardia, cardiogenic shock, acute MI, severe hypotension, severe hepatic insufficiency, sick sinus syndrome, SA block, severe HF, pacemaker, unstable angina, 3rd-degree AV block
  • Avoid use with azole antifungals, macrolides, HIV protease inhibitors, Diltiazem, Verapamil, Rifampicin, barbiturates, Phenytoin, St John’s wort
Other Vasodilator
  
Molsidomine
 1-4 mg PO 6-12 hourly or
2-4 mg IV as a single dose 
May give additional 2 mg IV if necessary
Max dose: 40 mg/day 		 Adverse Reactions
  • CV effects (arterial hypotension, orthostatic hypotension); Hypersensitivity effects (pruritus, rash); CNS effects (headache, vertigo); GI effects (anorexia, nausea)
Special Instructions
  • Use with caution in patients with liver insufficiency
  
Potassium Channel Activator
  
Nicorandil
 Initial dose: 10 mg PO 12 hourly
Maintenance dose: 10-20 mg PO 12 hourly
Max dose: 30 mg 12 hourly 		 Adverse Reactions
  • CNS effects (headache which is usually transitory, weakness); CV effects (vasodilation, flushing, hypotension, increase in HR); GI effects (nausea/vomiting, oral ulcerations)
Special Instructions
  • Avoid in patients with cardiogenic shock, LV failure with low filling pressures and hypotension
  • Use with caution in patients with low SBP, hypovolemia or acute pulmonary edema
  
Sodium Channel Inhibitor
  
Ranolazine
 375 mg PO 12 hourly 
Titrate dose to 500 mg PO 12 hourly after 2-4 weeks
Max dose: 1,500 mg/day
or
500 mg PO 12 hourly 
May increase to 1,000 mg PO 12 hourly as needed 
Max dose: 2,000 mg/day  		 Adverse Reactions
  • CNS effects (dizziness, headache, vertigo); GI effects (constipation, nausea/vomiting, abdominal pain, dry mouth); CV effects (syncope, bradycardia, palpitations, hypotension, peripheral edema); Other effects (tinnitus, dyspnea, hematuria)
Special Instructions
  • Use with caution in patients with renal disease, in patients with history of malignant neoplasms and adenomatous polyps
  • Contraindicated in patients with significant hepatic impairment
  • Avoid co-administration with azoles, macrolides, Nefazodone, Nelfinavir, Rifampicin, Phenytoin, Phenobarbital, Carbamazepine, St John’s wort
  
1Combination with Metoprolol or Carvedilol is available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.