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Angina - stable - Management
How should I manage drugs to improve symptom control?

People currently on monotherapy:

  • Ensure that the person is taking the maximum licensed or highest tolerated dose.
  • If the person is taking a beta-blocker:
    • Add a long-acting dihydropyridine calcium-channel blocker (CCB), such as amlodipine, modified-release nifedipine, or modified-release felodipine.
    • If a dihydropyridine CCB is contraindicated or not tolerated, add a nitrate; nicorandil; or ivabradine (if their heart rate is > 60 bpm).
  • If the person is taking an anti-anginal drug other than a beta-blocker, and is not known to be intolerant of a beta-blocker and has no contraindications:
    • Consider adding a beta-blocker.
      • Do not combine a beta-blocker with a rate-limiting CCB (diltiazem or verapamil).
  • If the person is taking an anti-anginal drug other than a beta-blocker, and a beta-blocker is contraindicated or not tolerated:
    • If taking a CCB, add a nitrate or nicorandil.
    • If taking a nitrate, add a CCB or nicorandil.
    • If taking nicorandil, add a CCB or a nitrate.
    • If taking ivabradine, add a dihydropyridine CCB, a nitrate, or nicorandil (consider seeking specialist advice).

For people on dual therapy:

  • Ensure that the person is taking the maximum licensed or highest tolerated dose of each drug.
  • If symptom control is poor on the maximum licensed or tolerated doses of two drugs, refer to a cardiologist (for advice on further drug management and assessment for revascularization).
    • Consider starting a third anti-anginal drug while awaiting referral.

In depth

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