Combined beta-adrenergic and calcium-entry blockade in angina pectoris

Article Abstract:

Angina pectoris, chest pain resulting from lack of oxygen reaching the heart muscle, can be treated with single or combination drugs. When the use of one drug is not effective in reducing the severity and number of attacks, combinations of beta-adrenergic blocking and calcium-entry-blocking drugs can be tried. A review of recent studies indicates that there are no added benefits to combination drug therapy. In patients with normal or mildly impaired left ventricular function, the combination therapy does help reduce the frequency of attacks of angina and increase tolerance to exercise, but so does increasing the dose of a single drug. Combined therapy is more likely to produce adverse effects than single drug therapy, simply because the number of side effects is combined. Patients with conduction system disease or moderate to severe left ventricular function are not good candidates for combined therapy. Complications and even death rates may be increased in this group. Only patients with persistent symptoms after maximum doses of a single drug should use the combined treatment.

Analysis, Complications and side effects, Dosage and administration, Adrenergic beta blockers, Adrenergic beta-antagonists, Drug interactions, Nifedipine, Calcium channel blockers, column, Verapamil, Diltiazem

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End of the oldest controversy in medicine: are we ready to conclude the debate on digitalis?

Article Abstract:

The results of the 6-year study of the use of digoxin for heart failure by the Digitalis Investigation Group show that the drug does not prolong survival but may provide symptom relief. This may effectively end the debate over this drug, which has been used for over 200 years. Proponents say it can alleviate symptoms while opponents claim the drug can be toxic and may cause arrhythmias. Digitalis is still relatively cheap, but newer drugs can reduce mortality rates and provide symptom relief. They include ACE inhibitors and beta blockers. As these drugs are used more often, the use of digoxin will fade.

Editorial, Heart failure, Digoxin

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Nitrate therapy for stable angina pectoris

Article Abstract:

Nitrates are effective in preventing and treating stable angina but long-term use can lead to tolerance. Nitrates are converted in the body to nitric oxide, which can dilate blood vessels. Nitroglycerin, isosorbide mononitrate and isosorbide dinitrate are most commonly used. They can be taken sublingually, or under the tongue, orally or in the form of a transdermal patch. Sustained-release forms can protect against angina for up to 12 hours but are more likely to lead to tolerance. In this condition, the body no longer responds to the drug and higher doses must be used.

Nitroglycerin, Isosorbide mononitrate, Isosorbide dinitrate

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