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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

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