Does anybody take Vastarel (also known as Trimetazidine) and how does this work in treating angina?

[Tos92]

Recently been prescribed with Vastarel, along with some other cocktail of medications. This is the first I’ve heard of this drug and was wondering whether others have found it effective in their treatment of angina?

Thank you x

[Milkfairy Heart Star]

That's an unusual choice if you have vasospastic angina.Trimetazidine is used more often to treat stable angina

It helps increase the coronary flow reserve in patients which helps patients with microvascular dysfunction rather than transient coronary vasospasms.

It also lowers the oxygen demands of the heart muscle.

The usual treatment offered for vasospastic angina are calcium channel blockers, long acting nitrates, nicorandil, a statin and antiplatelet.

Sometimes an Angiotensin converting enzyme (ACE) inhibitors or Angiotensin receptor blockers (ARBs) can help.

Ranolazine is another option, though again better for treating microvascular dysfunction

Are you any further along with finding a Cardiologist who understands Myocardial bridges and coronary vasospasms?

[Captain_Birdseye in reply to Milkfairy]

There was a study done a few years ago regarding using trimetazidine along with conventional treatment for MVA... it was a small cohort, but they concluded that the drug significantly improved quality of life and exercise tolerance in patients with MVA.

academic.oup.com/eurjpc/art...

Perhaps this is an off label use.

[Milkfairy Heart Star in reply to Captain_Birdseye]

Thanks for that.

Vasospastic angina is a different but related vasomotor disorder to microvascular angina.

Vasospastic angina is due to the the transient contrictions of the coronary arteries. The treatment given is to try and relax the blood vessels and improve the function of the endothelium.

Microvascular angina has a different pathological process. The small blood vessels are unable to dilate or stay dilated in response to extra demands like exercise.

Treatment options include medications to improve the coronary flow reserve.

The problem many of us living with vasospastic angina face is finding a Cardiologist who has an indepth knowledge of how to treat us.

Often the distinction between the two conditions can get lost, which can lead to inappropriate medications being prescribed.

Beta blockers for example can help with microvascular angina however they can make coronary vasospasms worse.

[Tos92 in reply to Milkfairy]

I was prescribed the Vastarel due to being reluctant to try a long acting nitrate in oral form due to my myocardial bridging. The cardiologist which I saw was my original cardiologist who treated me for my NSTEMI (or maybe MINOCA) in Dubai last year and has prescribed the Vastarel to lower oxygen demand on the heart tissue/muscle.

I didn’t get on well with Ranolazine.

I wouldn’t say I’m further along in finding a cardiologist that understands in the U.K. however, it seems my angiogram more or less confirms coronary artery spasms. My cardiologist in Dubai was not keen at all to let me go on the iCorMICA trial due to not being able to control the outcome of using acetylcholine on vasospasms during the procedure. He said it may be a dangerous procedure and asked me to deter away from that.

I will give the Vastarel a go and see if it helps.

[Milkfairy Heart Star in reply to Tos92]

I don't think that Prof Colin Berry would have been able to obtain ethical approval to carry out either his orginal CorMicA or the current iCorMicA study if it was thought to be unsafe.

Nor would hospitals such as Barts, St Thomas's Hospital and the Royal Free agree to take part in the study either.

There are some very good knowledgeable Cardiologists in the UK who care for patients living with vasospastic angina.

I have a wonderfully supportive Cardiologist in London and been reviewed by tertiary specialists over the years.

Good luck with the medication changes.

[Milkfairy Heart Star in reply to Tos92]

Tos92

Are you aware of Dr Jennifer Tremmel a world expert in treating patients with myocardial bridges?

I believe she is suggesting that it is okay to take nitrates if you have a myocardial bridge.

You can hear her speaking about myocardial bridges in this webinar.

internationalheartspasmsall...

[Tos92 in reply to Milkfairy]

Hi Milkfairy

Yes, I have seen this. Still a little bit skeptical as there doesn’t seem to be any substantial medical literature on using nitrates to treat myocardial bridges.

I may consider it in the near future once beginning my new course of medications.

Thank you :).

[Milkfairy Heart Star in reply to Tos92]

Just out of interest, is your GP happy to follow the treatment advice of your Dubai Cardiologist?

Are you able to get repeat prescriptions from your GP?

[Tos92 in reply to Milkfairy]

My GP is aware and is grateful for any input as they’ve not known what to do with me since my NSTEMI. They haven’t been confident advising, so they are willing to take the opinion of my cardiologist.

Yes, they will be available on repeat if I feel that they are helping with the symptoms.

[Milkfairy Heart Star in reply to Tos92]

That's a relief , you don't have to battle with your GP to get a repeat prescription.

[Hidden]

Dear You,

I have just been placed on Nicorandil which I think is a similar drug, I was told that it was to help with the angina pains that I still have.

Started Monday and feeling the basic side effects, headache, sick and bad sleep at the moment, but { fingers crossed } the ache of the angina seems to be less, but it is early days.

The side effect list is horrendous { but arn't they all } so judging by that I have got off lightly.

Good luck with it, anything is worth trying.

Take care.

[Tos92 in reply to Hidden]

Thank you Hidden :).

[Crystal614]

Hi, I have been taking Trimetazidine for 6 years. It was prescribed for Microvascular angina and it was one of the first drugs that was prescribed for me by my cardiologist. I called it the miracle pill as it significantly improved the angina. However over the last few months angina has worsened and I have been seen twice in the emergency department. My Troponin was slightly raised and I am waiting for an appointment to discuss with the cardiologist. I have been told previously that the disease had progressed and was now affecting me at rest. I have had MVA for 9 years. Just have to see what cardiologist says. I am on a several tablets to help but I need to increase dosages, the problem is BP is a little on the low side, GP has also prescribed Nicorandil but I am concerned about possible side effects of this drug so I am reluctant to take it.

[Milkfairy Heart Star in reply to Crystal614]

I am sorry to hear your microvascular angina is getting worse.

I have now had Vasospastic angina for nearly 11 years, though I had symptoms for much longer.

I have the opposite problem. I am now getting chest pain on exertion as well as at rest.

I have been on nicorandil 30mgs twice a day for many years.

I am careful with my oral hygiene and see a Dental Hygienist regularly.

What worries you about taking Nicorandil?

[Crystal614 in reply to Milkfairy]

Hi Milkfairy, I have been having some chest pain/heaviness in my chest with exertion as well. I know all tablets can have side effects but I remember my cardiologist once saying that Nicorandil can cause ulcers. I mentioned this to my GP and he said the same as well so that's why I've not tried them yet. The plan was to just try half a tablet (5mg) once a day then twice a day and so on and for me to keep an eye on my BP. I would prefer a low dose of Nitrate patch but that has been passed to the Cardiologist to deal with. Silly really, now I have to wait for an appointment to discuss! If only the weather would warm up that may help as well.

[Milkfairy Heart Star in reply to Crystal614]

I can't wait for the warmer weather. It's been a long cold winter.

I am find the GTN patches help, hopefully your Cardiologist will prescribe them for you.

[Crystal614 in reply to Milkfairy]

Thanks Milkfairy. Hopefully it will get sorted soon.

[Tos92 in reply to Crystal614]

I’m sorry to hear your MVA is progressing. I hope you find a combination of medications that work for you soon.

[Crystal614]

Thanks.