Cardimet

Indications

Trimetazidine is used in adults with stable angina pectoris (chest pain caused by reduced blood flow to the heart) as an add-on treatment when other angina medicines, such as beta blockers or calcium channel blockers, do not control symptoms well enough or are not tolerated.

How It Works

Trimetazidine helps heart muscle cells use oxygen more efficiently. It shifts the cells' energy production from burning fats to burning glucose, which needs less oxygen. This protects the heart muscle when its blood supply is reduced, without changing heart rate or blood pressure.

Dosage and Administration

Usual adult dose: one 35 mg modified-release tablet twice a day, morning and evening, with meals, or 20 mg three times a day for the immediate-release form. Swallow modified-release tablets whole with water; do not crush or chew. In people with moderate kidney problems or aged over 75, the doctor may reduce the dose, for example to 35 mg once a day. Your doctor will review the benefit after about 3 months.

Interactions

No clinically important drug interactions are well documented. It can be used with other heart medicines such as Aspirin, beta blockers, nitrates and statins. Tell your doctor about all medicines you take, especially medicines for Parkinson's disease or medicines that can cause tremor or movement problems.

Contraindications

• Allergy to Trimetazidine.
• Parkinson's disease, parkinsonian symptoms, tremor, restless legs syndrome or other related movement disorders.
• Severe kidney impairment (creatinine clearance below 30 ml per minute).

Side Effects

Common side effects include dizziness, headache, stomach pain, diarrhoea, indigestion, nausea, vomiting, rash, itching and weakness. Less often, palpitations, low blood pressure on standing, flushing or falls may occur. Movement problems such as tremor, stiffness, unsteady walking and restless legs can occur, especially in older people; these usually go away after stopping the medicine.

Get urgent medical help if you have chest pain that is worse or lasts longer than usual, fainting, a severe allergic reaction with swelling of the face or throat or breathing difficulty, or a widespread blistering rash.

Pregnancy and Lactation

As a precaution, avoid Trimetazidine during pregnancy. It is not known whether it passes into breast milk, so breastfeeding is not recommended during treatment.

Precautions and Warnings

• It is not a treatment for an acute angina attack or unstable angina, and does not replace a heart attack treatment; keep your rescue medicine (such as Glyceryl Trinitrate) as advised.
• Stop and tell your doctor if you develop tremor, stiffness or other movement problems.
• It may cause dizziness or drowsiness; take care when driving.
• Older people and those with kidney problems need a lower dose and closer follow-up.

Overdose

Information on overdose is limited. Symptoms may include dizziness, low blood pressure and movement problems. Seek medical help; treatment is based on symptoms.

Therapeutic Class

Anti-anginal agent; metabolic modulator (partial fatty acid oxidation inhibitor).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.