When to prescribe & Why Medication Class Medication & Dose Advice
First-line treatment for stable angina beta blocker or a calcium channel blocker or both

bisoprolol 5–10 mg od max 20 mg od 

atenolol 100 mg od or 50mg bd

diltiazem see BNF

verapamil see BNF

amlodipine 5-10 mg od

felodipine 5 -10 mg om, 2.5-10mg om for elderly

monitor vital signs (heart rate and BP) and 

  • bisoprolol & atenolol -  dyspnoea, exercise intolerance, cough
  • amlodipine & felodipine - oedema


Second-line treatment (if betablocker and calcium chanel blocker unsuitable) monotherapy with a long-acting nitrate or ivabradine or nicorandil or ranolazine

isosorbide mononitrate see BNF

isosorbide dinitrate see BNF

glyceryl trinitrate see BNF

ivabradine 2.5–5 mg twice daily for 3–4 weeks, then increased if necessary up to 7.5 mg twice daily, dose to be increased gradually

nicorandil 5–10 mg bd then if tolerated increase to max 40mg bd 

ranolazine 375 mg bd for 2–4 weeks, then 500 mg bd then 750 mg 

ivabradine: heart rate at rest should not be allowed to fall below 50 beats per minute, discontinue treatment if no improvement in symptoms within 3 months.
Treatment for people with stable angina and diabetes 

angiotensin-converting enzyme (ACE) inhibitors

ramipril 2.5 mg once daily for 1–2 weeks, then increased to 5 mg once daily for a further 2–3 weeks, then increased to 10 mg once daily


  • U&E 2 weeks after initialisation and 2 weeks after every dsage increase
  • new cough
Treating episodes of angina short acting nitrate spray  glyceryl trinitrate spray 400–800 microgram

repeat the dose after 5 minutes if the pain has not gone

call an emergency ambulance if the pain has not gone 5 minutes after taking a second dose

Prevention of episodes of angina short acting nitrate spray  glyceryl trinitrate spray 400–800 micrograms

administer spray under the tongue and then close mouth

use it immediately before any planned exercise or exertion

side effects such as flushing, headache and light-headedness may occur

sit down or find something to hold on to if feeling light-headed

Secondary prevention of cardiovascular disease 

aspirin 75mg


anti- hypertensives


take into account the risk of bleeding and comorbidities

offer statin as per lipid guidelines

offer hypertensive medication as per hypertesive guidelines


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