Merck Manual

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Drugs Used to Treat Coronary Artery Disease*

Drugs Used to Treat Coronary Artery Disease*

Examples

Some Side Effects

Comments

Angiotensin-converting enzyme (ACE) inhibitors

Benazepril

Captopril

Enalapril

Fosinopril

Lisinopril

Moexipril

Perindopril

Quinapril

Ramipril

Trandolapril

Cough, usually dry and metallic

Rash

Rarely, a severe allergic reaction (angioedema)

Possibly worsening of kidney function when people already have kidney disease or when the artery to one of the kidneys is greatly narrowed

These drugs lower blood pressure and treat heart failure and prevent kidney damage in people with high blood pressure or diabetes. They also benefit people who have had heart attacks.

People who have high blood pressure, heart failure, or prior heart attacks and who are treated with an ACE inhibitor live longer than people who do not take an ACE inhibitor.

Angiotensin II receptor blockers (ARBs)

Candesartan

Eprosartan

Irbesartan

Losartan

Olmesartan

Telmisartan

Valsartan

Similar to ACE inhibitors, but cough is much less common

These drugs have equivalent effects and benefits to those of ACE inhibitors. In people with severe high blood pressure or heart failure, these drugs may be used in combination with an ACE inhibitor.

Other drugs

Ranolazine

Dizziness, headache, constipation, and nausea

This drug is used to treat people who continue to have symptoms of angina despite treatment with other drugs.

This drug may be more effective in women than in men.

Anticoagulants

Argatroban

Bivalirudin

Dalteparin

Enoxaparin

Fondaparinux

Heparin

Tinzaparin

Warfarin

Bleeding, especially when used with other drugs that have a similar effect (such as aspirin and other nonsteroidal anti-inflammatory drugs)

These drugs prevent blood from clotting. They are used to treat people who have unstable angina or who have had a heart attack.

Antiplatelet drugs

Aspirin

Clopidogrel

Prasugrel

Ticagrelor

Ticlopidine

Bleeding, especially when used with other drugs that have a similar effect (such as anticoagulants)

With aspirin, stomach irritation

With ticlopidine and less so with clopidogrel, a small risk of reducing the white blood cell count

These drugs prevent platelets from clumping and blood clots from forming. They also reduce the risk of a heart attack. They are used to treat people who have stable or unstable angina or who have had a heart attack.

Aspirin is taken as soon as a heart attack is suspected. People with an allergy to aspirin may take clopidogrel or ticlopidine as an alternative.

Beta-blockers

Acebutolol

Atenolol

Bisoprolol

Carvedilol

Metoprolol

Spasm of airways (bronchospasm)

Abnormally slow heart rate (bradycardia)

Heart failure

Cold hands and feet

Insomnia

Fatigue

Shortness of breath

Depression

Raynaud syndrome

Vivid dreams

Hallucinations

Sexual dysfunction

With many beta-blockers, an increase in the triglyceride level and a decrease in the HDL level

These drugs reduce the workload of the heart and the risk of a heart attack and sudden death. They are used to treat people who have stable or unstable angina or syndrome X or who have had a heart attack.

Calcium channel blockers

Amlodipine

Diltiazem

Felodipine

Nifedipine (sustained-release only)

Verapamil

Dizziness

Fluid accumulation (edema) in the ankles

Flushing

Headache

Heartburn

Enlarged gums

Abnormal heart rhythms (arrhythmias)

With verapamil, constipation

With short-acting, but not long-acting, calcium channel blockers, possible increased risk of death due to heart attack, especially in people who have unstable angina or who have had a heart attack recently

These drugs prevent blood vessels from narrowing and can reverse artery spasm. Diltiazem and verapamil reduce the heart rate. Calcium channel blockers are used to treat people who have stable angina.

Glycoprotein IIb/IIIa inhibitors (a type of antiplatelet drug)

Abciximab

Eptifibatide

Tirofiban

Bleeding, especially when used with other drugs that have a similar effect (such as anticoagulants or thrombolytic drugs)

Reduction of the platelet count

These drugs prevent platelets from clumping and blood clots from forming. They may be used to treat people who have unstable angina or who are undergoing percutaneous coronary intervention after a heart attack.

Nitrates

Isosorbide dinitrate

Isosorbide mononitrate

Nitroglycerin

Flushing

Headache

Temporarily fast heart rate (tachycardia)

These drugs relieve angina, prevent episodes of angina, and reduce the risk of a heart attack and sudden death. (However, risk reduction is much less than that with beta-blockers.) They are used to treat people who have stable or unstable angina or syndrome X. For these drugs to remain effective over the long term, people need to go 8 to 12 hours without taking the drug each day.

Opioids

Morphine

Low blood pressure when a person stands

Constipation

Nausea

Vomiting

Confusion (especially in older people)

In some people who have had a heart attack, these drugs are used to relieve anxiety and pain if the pain persists despite use of other drugs.

Statins†

Atorvastatin

Fluvastatin

Lovastatin

Pravastatin

Rosuvastatin

Simvastatin

Occasionally, muscle aches and pains, but rarely severe muscle pain (myositis)

Rarely, liver damage, but not more commonly than in people who are not taking the drug

These drugs lower cholesterol levels and help to heal damaged arteries, decreasing the chance of having a first or repeated heart attack or stroke.

Thrombolytic drugs

Alteplase

Anistreplase

Reteplase

Streptokinase

Tenecteplase

Rarely, bleeding within the brain (intracerebral hemorrhage) or the digestive tract

These drugs dissolve blood clots. They are used to treat people who have had a heart attack.

* Doctors may use different combinations of drugs depending on the type of coronary artery disease the person has.

† Also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors.