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Linked Pharmacotherapy
Baseline therapy:
Consider aspirin, statin, and ACEi therapy in all patients. Sublingual nitroglycerin as
needed.
Smoking cessation and lifestyle changes.
Antianginal Rx
First line: Beta blocker (eg, carvedilol 6.25 mg BID uptitrated)
Second line: CCB substituted (non DHP [eg, verapamil 40 mg BID titrated]) where
beta blockers are not tolerated or ineffective.
Third line: Add-in therapy
CCB-DHP (eg, amlodipine) — only for those on beta blockers
Nicorandil* (5 mg BID, uptitrated)
Ranolazine (375 mg BID, uptitrated)
Baseline therapy:
If atherosclerosis or endothelial impairment, aspirin and statin should be considered.
Sublingual nitroglycerin as needed.
Smoking cessation and lifestyle changes.
Antianginal Rx
First line: CCB (eg, verapamil 40 mg BID uptitrated)
Second line: Add long-acting nitrate (eg, isosorbide monotitrate 10 mg BID)
Third line: Change nitrate to nicorandil* (eg, nicorandil 5 mg BID)
Baseline therapy:
Consider aspirin, statin and ACEi therapy in all patients. Sublingual nitroglycerin as
needed.
