Angina combination therapy

If /1-blockers are ineffective or not tolerated, then monotherapy with a calcium channel antagonist or combination therapy may be instituted. Reflex tachycardia from nitrates can be blunted with /1-blocker therapy, making this a useful combination. Patients with severe angina, rest angina,... 

Nifedipine is used for preventing and relieving angina pectoris attacks, for hypertension, and as an ingredient in combination therapy for chronic cardiac insufficiency. Synonyms of this drug are adalat, corinfar, procardia, and nifecor. 

Their antihypertensive efficacy is comparable to that of (3-adrenergic blockers and angiotensin-converting enzyme (ACE) inhibitors. The choice of a calcium channel blocker, especially for combination therapy, is largely influenced by the effect of the drug on cardiac pacemakers and contractility and coexisting diseases, such as angina, asthma, and peripheral vascular disease. 

Warren V, Goldberg E. Intractable angina pectoris. Combined therapy with propranolol and permanent per-venous pacemaker. JAMA 1976 235(8) 841-2. 

Subramanian B, Bowles MJ, Davies AB, Raftery EB. Combined therapy with verapamil and propranolol in chronic stable angina. Am J Cardiol 1982 49(l) 125-32. 

Toyosaki N, Toyo-oka T, Natsume T, Katsuki T, Tateishi T, Yaginuma T, Hosoda S. Combination therapy with diltiazem and nifedipine in patients with effort angina pectoris. Circulation 1988 77(6) 1370-5. 

Acceptance of statistical uncertainty when offset by patient recovery contributed to the use of combination therapy in Germany. Physicians prescribed Dociton alongside older treatments for angina, such as Amyl Nitrates. Even after Dociton had been on the market for eight years, a 1973 review essay admonished physicians to begin therapy by treating behavioral and lifestyle... 

Beta-adrenergic blocking agents are effective for the prophylactic therapy of exertional angina pectoris by reducing heart rate and the force of myocardial contraction. However, verapamil, nifedipine, and diltiazem are also effective for the prophylactic treatment of stable exertional angina. The combination therapy with beta-blockers and calcium-entry blockers is well tolerated, effective, and safe. 

Discuss the advantages and disadvantages of combination therapy with a beta-blocker and nitrate in angina. 

McCourty JC, Silas JH, Tucker GT, Lennard MS. The effect of combined therapy on the pharmacokinetics and pharmacodynamics of verapamil and propranolol in patients with angina pectoris. BrJ Clin Pharmacol (1988) 25, 349-57. 

Combination therapy with 3-blockers and nitrates has continued. Combined therapeutic effects have reduced the positive inotropic and chronotropic effects of nitroglycerin and the vasoconstrictive action of 3-blockers. Beneficial synergistic effects upon reduced cardiac work, ojy/gen requirements, and improved flow to ischemic areas of the myocardium have been observed. Combinations of alprenolol or propranolol and isosorbide dinitrate significantly increased work tolerance and delayed pain and ST-depression in some angina patients. The individual drugs were less effective. However, in another study, isosorbide dinitrate was ineffective alone or in combination with propranololIn the same study, propranolol induced heart failure in some patients where no clinical deterioration had been detected earlier. 

Cohen M, Adams PC, Parry G, Xiong J, Chamberlain D, Wieczorek 1 et al. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users. Primary end points analysis from the ATACS trial. Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Circulation 1994 89(l) 81-8. 

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