Drugs and Medicines Used in Disorders of The Heart
Diltiazem (Dilzem 30 mg, Dilzem SR 90 mg)
Its action on the heart rate is less than verapamil. It decreases blood pressure to a lesser extent than nifedipine. It relieves spasms of coronary arteries. It is also useful in PAT (Paoxysmal Atrial Tachycardia).
Dosage: Initially a dose of 30 to 60 mg, 3 times daily, before meals and at bedtime is advised. It should be increased gradually to the optimum dose of 60 mg, 3 or 4 times daily. Slow Release preparations are used twice a day.
Adverse Effects: Constipation is a common adverse effect. Headache, vertigo, weakness, nervousness, gastric upsets, and allergy in the form of itching, flushing or rash, and decreased pumping action of the heart (congestive heart failure) may occur. Rebound angina, heart blocks and cardiac arrest (rarely) may occur following a sudden withdrawal of diltiazem.
Precautions
Use it cautiously with beta-blockers and other drugs which may depress the heart.
Cimetidine increases its effect by reducing its excretion. Adjust the dose accordingly.
Use it cautiously in patients with compromised renal function.
Nitrates
Potassium Channel Openers
Nicorandil (Nicoran 5 mg. 10 mg)
It acts like organic nitrates and is useful in stable angina, unstable angina and due to prevention of ischaemia (lack of oxygen supply). Blood flow to heart muscles increases with use of this drug. It is given in a usual dose of5-1O mg, 3 times a day.
Adverse effects are flushing and palpitation, weakness, mouth ulcer, nausea and vomiting. It should be avoided with nitrates or nifedipine.
Myocardial (Heart Muscle Cell) Protectors
Trimetazidine (Flavedon, Trivedon 20 mg)
It does not change contractions, heart rate or blood pressure but reduces angina frequency and increases work capacity by improving metabolism and energy utilization in heart muscles. Adverse effects are mild-gastric upset, fatigue, giddiness and muscle pain. It is an expensive drug.
Oxyfedrine (Ildamen 8 mg)
This drug improves metabolism so that oxygen deprivation (ischaemia) does not occur. It is used in a dose of 8 mg , 3 times a day. Taste disturbance is a usual side effect of it.
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