> 2 Cardiovascular system > 2.6 Nitrates, calcium-channel blockers, and other antianginal drugs > 2.6.3 Other antianginal drugs

2.6.3 Other antianginal drugs

General guidance

Click here for NICE Guidance on chronic stable angina

Nicorandil has similar efficacy to other antianginal drugs in controlling symptoms but there is little evidence about its efficacy in combination with other antianginal drugs or on mortality.
Ranolazine will be initiated in secondary care for patients not tolerating or responding to standard therapies. Patients will have a six week walk test and if assessed as suitable to continue then prescribing will be undertaken by primary care.

Recommended drugs

Nicorandil ££

Ranolazine £££

Ivabradine ££££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

Chronic heart failure – ivabradine - NICE TAG TA267

1.1 Ivabradine is recommended as an option for treating chronic heart failure for people:

with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and
who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and
who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and
with a left ventricular ejection fraction of 35% or less.

1.2 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists.

1.3 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse.

https://www.nice.org.uk/guidance/ta267