Trimetazidine

Short Details of Trimetazidine and relative drugs

1. Trikat MR [phone]

2. The human heart weighs less than 1 pound . However, a man’s heart, on average, is 2 ounces heavier than a woman’s heart.

3. Everyday Heart Beats 100,000 times Pumps 7,000 liters of blood through the body Needs 6 kg of ATP

4. introduction Trikat MR (Trimetazidine Tablets) is used to treat angina pectoris or chest pain caused by coronary disease in adult patient, in combination with other medicines. Angina Pectoris is pain arising from the heart muscle when it does not receive enough oxygen Trikat MR protects the heart cells from the effects of a reduced oxygen supply during an episode of angina.

5. EPIDEMIOLOGY of angina The prevalence of angina in community studies increases sharply with age and sex 0.1-1% in women aged 45-54 10-15% in women aged 65-74

6. EPIDEMIOLOGY of angina 2 - 5% in men aged 45-54 10 - 20% in men aged 65.. According to an estimate 20,000 — 40,000 individuals in of the population per million suffer from angina.

7. Angina pectoris is a syndrome characterized by sudden severe pressing substernal chest pain or heaviness radiating to the neck, jaw, back and arms     The primary cause is an imbalance between myocardial oxygen demand and oxygen supplied by coronary vessels, due to: Decrease in myocardial oxygen delivery Increase in myocardial oxygen demand Both What is angina

8. What is angina Angina is not a disease, a symptoms of an underlying heart problem, normally coronary heart disease (CHD). There are different types of angina. •Stable Angina / Angina Pectoris •Unstable Angina •Variant ( Prinzmetal ) Angina

9. What is angina Stable Angina / Angina Pectoris Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs.

10. What is angina Unstable Angina Unstable angina or sometimes referred to as acute coronary syndrome causes unexpected chest pain, and usually occurs while resting.

11. What is angina Variant ( Prinzmetal ) Angina Unlike typical angina – which is often triggered by exertion or emotional stress - Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.

12. Causes of Angina The major causes of Angina:  High cholesterol levels  High blood pressure  Smoking  Diabetes  Inactivity  Unhealthy diet  Overweight or obesity  Older age (The risk increases for men after 45 years of age and for women after 55 years of age.)  Family history of heart disease

13. Angina Treatment goal The goals of treatment in angina pectoris are to relieve the symptoms, slow the progression of disease, and reduce the possibility of future events, especially MI and premature death.

14. Antianginal and Anti-ischemic Therapy Nitrates B-blockers Calcium Antagonists ACE Inhibitors Metabolic Agents

15. Nitrates Nitrates, increase the flow of blood and oxygen to the heart. While dilation of the arteries lowers the pressure in the arteries against which the heart must pump. As a consequence of both effects, the heart works less and requires less blood and oxygen.

16. BETA-BLOCKERS Beta blockers primarily block β1 and β2 receptors and thereby the effects of norepinephrine and epinephrine. By blocking the effects of norepinephrine and epinephrine, beta blockers reduce heart rate, reduce blood pressure by dilating blood vessels.

17. Calcium channel blockers Calcium channel blockers or CCBs reduce the pressure in the arteries. This makes it easier for the heart to pump blood, by reducing the heart's need for oxygen, calcium channel blockers relieve or prevent angina. Calcium channel blockers decrease the excitability of heart muscle and are therefore used for treating certain types of abnormally rapid heart rhythms.

18. Angiotensin converting enzyme inhibitors Angiotensin converting enzyme inhibitors (ACE inhibitors) are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed.

19. Metabolic Agent Maximize the use of oxygen to make more ATP available Metabolically acting agents protect from ischemia by increasing glucose metabolism relative to that of fatty Acids.

20. Agents like beta blockers , CCBs and nitrates have their limitations. Beta blockers-absolute or relative contraindication in asthma ,COPD and peripheral vascular disease. Nitrates- long term use associated with tolerance Unmet needs of therapies

21. Trimetazidine inhibits beta-oxidation of fatty acids by blocking long-chain 3-ketoacyl-CoA thiolase , which enhances glucose oxidation. In an ischaemic cell, energy obtained during glucose oxidation requires less oxygen consumption than in the beta-oxidation process. Trikat mr Mode of Action

22. Lowers fatty acid oxidation, increase glucose & lactate oxidation Selective KAT-3 inhibitor Optimize use of oxygen, reduce acidity in tissue, improve cardiac function & contractility during ischemia while maintaining cell membrane homeostasis Mode of Action Trikat mr

23. Glucose oxidation 1 molecule creates 6.4 molecules of ATP FFA Oxidation creates only 5.6 ATP Molecules. Trikat mr

24. The recommended adult dose is one tablet of 35 mg of Trikat MR twice daily during meals. Not recommended in children aged below 18 years. Trikat mr Dosage

25. This medicine is contraindicated in patients with Parkinson Disease, Parkinsonian Symptoms, Tremors, Restless Leg Syndrome, and other related movement disorders and in cases of Severe Renal Impairment Trikat mr Contraindications

26. Common : Dizziness, Headache, Abdominal Pain, Diarrhea, Indigestion, Feeling Sick, Vomiting, Rash, Itching, Feeling Of Weakness. Trikat mr Side Effects

27. Trikat mr Side Effects Rare: Fast Or Irregular Heartbeats (Also Called Palpitations), Extra Heartbeats, Faster Heartbeat, Fall In Blood Pressure On Standing-up Which Causes Dizziness, Light Headiness Or Fainting, Malaise (Generally Feeling Unwell), Dizziness, Fall, Flushing..