Chest pain due to decreased flow of blood to the muscles in the heart is medically known as angina pectoris. Treatment for the condition includes the use of Trimetazidine, and is often used in patients who have not responded well to other anti-anginal medications. The drug is also recommended for patients who are tolerant to other treatments due to possible side effects. Following subsections offer a detailed look at the drug, including possible undesirable outcomes and drug interactions. This gives patients full clarity about the medication, answer the question – what is Trimetazidine used for?
Overview of the drug
Belonging to the category of anti-ischemic agents, the drug is available as an oral tablet and is also administered intravenously in some instances. In addition to use in treating angina, trimetazidine has also been investigated for potential benefits in other conditions, including heart failure and vertigo.
Trimetazidine is available in different formulations, including:
- Oral tablets: In doses of 20 mg or 35 mg, these tablets are usually taken two or three times per day, depending on the formulation and the condition being treated.
- Modified-release tablets: This slowly releases the medication into the bloodstream over a longer period of time. These tablets are usually taken once or twice per day, depending on the formulation.
- Oral capsules: This contains a modified-release formulation of the medication, and are usually taken once or twice per day.
- Oral suspension: This liquid form of the medication is usually used in children or patients who have difficulty swallowing tablets.
- Intravenous injection: The IV injection formulation is used to treat acute coronary syndrome in hospitalized patients, and is usually given over a period of 30 minutes.
The appropriate formulation of Trimetazidine depends on the condition being treated, the severity of the condition, and other factors such as patient age and medical history.
The dosage of Trimetazidine varies depending on the formulation of the medication and the condition being treated. The recommended dosage for most formulations of Trimetazidine is:
- Oral tablets: 20 mg to 35 mg twice or thrice per day.
- Modified-release tablets: 35 mg once or twice per day.
- Oral capsules: 35 mg once or twice per day.
- Oral suspension: Based on the patient’s weight and is usually calculated as 0.3 mg per kg of body weight per day, split over two or three doses.
- Intravenous injection: 10 mg administered over 30 minutes, followed by 20 mg taken orally twice per day.
Mechanism of action of Trimetazidine
The exact mechanism of action of the drug is not fully understood, but is believed to work by modulating the metabolism of the heart muscle cells. Specifically, the anti-ischemic agent works by inhibiting the mitochondrial long-chain 3-ketoacyl-CoA thiolase enzyme, resulting in a shift in cellular metabolism from fatty acid oxidation to glucose oxidation.
This permits the heart muscle cells to produce energy efficiently during periods of reduced blood flow, such as during angina attacks. As a result of this improved energy production, and reduction in the risk of cell damage, Trimetazidine helps improve the symptoms of angina and reduce the frequency of attacks. Additionally, the drug also possesses antioxidant effects, reducing the production of toxic substances within the cells, protecting the heart muscle cells from damage.
The drug is proven to be effective in reducing the symptoms of angina and improving exercise tolerance in patients with stable angina. It is typically used as part of a combination treatment plant with other anti-anginal medications.
What are the side effects of Trimetazidine?
While the drug is generally well-tolerated, with most patients free from possible undesirable effects, the possibility of effects cannot be ruled out entirely. Commonly reported side effects of Trimetazidine include:
- Abdominal pain
The above effects are typically mild in nature and resolve within a few days. Apart from the above effects, there is also the possibility of adverse effects, that are rare in occurrence, including:
- Allergic reactions – with symptoms including rashes, itching, swelling, and difficulty breathing
- Abnormal heart rhythm or palpitations
- Low blood pressure
- Severe muscle pain or weakness
These serious side effects warrant urgent medical attention with discontinuation of the medication and replacement with alternative drug formulations.
Drug interactions of Trimetazidine
The drug is considered to have a low potential for drug interactions, and is regarded as safe to use along with most other medications. However, it is important to intimate the treating specialist about all medications, supplements, and herbal products in use to identify possible triggers for interactions. Medications listed below that may interact with Trimetazidine, may increase/decrease its efficacy, or increase the risk of side effects.
- Cimetidine and drugs of same category that have an impact on liver enzymes, may increase the levels of Trimetazidine in the blood, increasing the risk of side effects
- Beta-blockers and calcium channel blockers, may increase the effects of Trimetazidine on heart rate and blood pressure
- Digoxin, may increase the effects of Trimetazidine on heart rate and blood pressure
- Drugs that prolong the QT interval, including certain antibiotics, antipsychotics, and antidepressants, may increase the risk of abnormal heart rhythm when used with Trimetazidine
- Consumption of grapefruit juice while taking Trimetazidine, is to be avoided, as this may increase the levels of the medication in the blood, increasing the possibility of side effects.
Unsuitability of the medication for certain categories of individuals
It is now time to look at categories of individuals unsuitable to take the medication, in the backdrop of the information in answer to the question – what is Trimetazidine used for?
While the drug is generally well-tolerated by most patients, patients with certain conditions are not to take Trimetazidine:
#1 Hypersensitivity to the medication: Patients with past allergic reactions to the drug or any of its ingredients.
#2 Parkinson’s disease: Patients with Parkinson’s as the drug may worsen the symptoms.
#3 Severe kidney or liver disease: Patients with severe kidney or liver disease are not to take the drug due to inability to properly metabolize Trimetazidine.
#4 Children: Studies have not been conducted to establish the safety and efficacy of Trimetazidine in children.
#5 Pregnancy and breastfeeding: Studies have not been conducted to establish the safety of the drug in pregnant women and breastfeeding mothers.