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P A R T 8
Drugs acting on the cardiovascular system
TABLE 46.1
DRUGS IN FOCUS Antianginal agents
Drug name
Dosage/route
Usual indications
Nitrates
glyceryl trinitrate
(Anginine, Nitro-Dur,
Nitrolingual)
5 mcg/minute via IV infusion pump every
3–5 minutes; one tablet SL every 5 minutes
for acute attack, up to three tablets
in 15 minutes; 0.4-mg metered dose
translingual, up to three doses in 15 minutes
for acute attacks
Prevention: one tablet (0.3–0.6 mg)
sublingually 5–10 minutes before activities
that might precipitate an attack: 2.5–9 mg
PO of SR tablet q 8–12 hours; doses as
high as 26 mg PO q.i.d. have been used;
1.25 cm q 8 hours for topical aplication, up
to 10–12.5 cm (2.5 cm=15 mg) have been
used; one pad (60–75 mg) have been used;
one pad transdermal system per day; 1 mg
q 3–5 hours while awake for transmucosal
system
Nitrate of choice for treatment of acute
angina attack; prevention of anginal
attacks
isosorbide dinitrate
(Isordil, Sorbidin)
2.5–5 mg sublingual (SL); 5-mg chewable
tablet; 5–20 mg PO; maintenance 10–40 mg
PO q 6 hours or 40–80 mg PO sustained
release q 8–12 hours
Acute prophylaxis: 5–10 mg SL or chewable
tablets q 2–3 hours
Taken before chest pain begins in
situations in which exertion or stress can
be anticipated for prevention of angina
in adults; taken daily for management of
chronic angina
isosorbide mononitrate
(Duride, Imdur)
2.5–5 mg SL; 5-mg chewable tablet; 5–20 mg
PO; maintenance 10–40 mg PO q 6 hours
or 40–80 mg PO sustained release q
8–12 hours
Acute prophylaxis: 5–10 mg SL or chewable
tablets q 2–3 hours
Taken before chest pain begins in
situations in which exertion or stress can
be anticipated for prevention of angina
in adults; taken daily for management of
angina
Beta-blockers
metoprolol (Betaloc,
Minax)
100 mg/day PO as single dose, extended-
release tablet; 100–400 mg/day PO in two
divided doses regular release
Treatment of angina in adults; prevention
of reinfarction within 3–10 days after
myocardial infarction (MI)
propranolol (Inderal)
10–20 mg PO t.d.s. to q.i.d., titrate based on
response; 160 mg/day is often needed for
maintenance
Long-term management of angina and
prevention of reinfarction in people
1–4 weeks after MI
Calcium channel blockers
amlodipine (Norvasc)
5 mg/day PO; reduce dose with hepatic
impairment or in geriatric persons
Treatment of chronic, stable angina and of
variant angina in adults
diltiazem (Cardizem)
180–360 mg/day PO in three or four divided
doses; 120–180 mg PO b.d. sustained
release
Treatment of angina in adults
nifedipine (Adalat, Nyefax)
10–20 mg PO t.d.s.
Treatment of angina in adults
perhexiline (Pexsig)
Initially, 100 mg PO daily, up to 400 mg/day PO Treatment of moderate to severe angina in
adults who have not responded to other
treatment
verapamil (Cordilox SR,
Isoptin)
320–480 mg/day PO
Treatment of angina in adults; treatment of
tachyarrhythmias
Potassium channel opener
nicorandil (Ikorel)
10-20 mg PO b.d.
Treatment of chronic stable angina pectoris
