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
|
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 |
monitor
|
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 statin anti- hypertensives |
take into account the risk of bleeding and comorbidities offer statin as per lipid guidelines offer hypertensive medication as per hypertesive guidelines |