Trimetazidine is a metabolic modulator, primarily used in the management of ischemic heart disease. It is classified as an anti-ischemic agent, aimed at improving the efficiency of the heart muscle, particularly during periods of limited oxygen supply, such as during angina attacks. Trimetazidine works by optimizing the energy metabolism of heart cells, ensuring that they can function even when oxygen levels are reduced.

Dosage Forms and Strengths:

Trimetazidine is available in the following dosage forms:

• Modified-release tablets: 35 mg
• Immediate-release tablets: 20 mg

The extended-release form allows for twice-daily dosing, while the immediate-release form is generally taken three times daily.

Brand and Generic Names:

• Brand Names: Vastarel MR, Preductal MR, Trizyd MR, Trimex, Trimetacor.
• Generic Name: Trimetazidine

Indications for Use:

Trimetazidine is primarily indicated for the treatment of:

• Angina Pectoris: As an adjunct treatment to reduce the frequency of angina attacks in patients with stable coronary artery disease.
• Tinnitus and Vertigo: It is sometimes used to manage symptoms related to inner ear disorders like tinnitus (ringing in the ears) and vertigo (dizziness).

Though its main application is in managing stable angina, it can also improve overall heart function in individuals suffering from ischemic conditions.

Mechanism of Action:

Trimetazidine works by modifying the way the heart utilizes energy during ischemic conditions. In a normal state, heart cells use fatty acids as their primary fuel source. However, during ischemia (when the oxygen supply is insufficient), this process becomes inefficient and can lead to cellular damage. Trimetazidine shifts the energy production from fatty acids to glucose, a more oxygen-efficient process. This ensures that the heart muscle maintains its function with less oxygen. It does not dilate blood vessels or directly alter heart rate, but instead enhances myocardial efficiency by preserving intracellular ATP levels.

Administration and Dosage:

• For Stable Angina:

  • Modified-release tablets: The recommended dosage is 35 mg twice daily (morning and evening) during meals.
  • Immediate-release tablets: 20 mg taken three times a day with meals.

• For Tinnitus and Vertigo:

  • The dosing regimen for these conditions is similar to that of stable angina, depending on the form of the medication being used.

Trimetazidine should not be used to treat acute angina episodes, as it does not provide immediate relief. It is prescribed as part of long-term management for stable conditions.

Effects and Precautions:

• Effects:

  • Positive Effects: Trimetazidine helps to reduce the frequency of angina attacks, improves exercise tolerance, and can decrease the need for nitrates in patients with ischemic heart disease. It may also alleviate symptoms of tinnitus and vertigo in some individuals.
  • Side Effects: Common side effects include dizziness, headache, gastrointestinal discomfort, and asthenia (weakness). Less common but serious side effects include parkinsonian symptoms such as tremors, rigidity, and bradykinesia, especially in older patients. These symptoms are reversible upon discontinuation of the drug.

• Precautions:

  • Elderly patients: Older individuals, particularly those with Parkinson's disease or related disorders, should be monitored closely due to the risk of developing movement disorders.
  • Kidney impairment: In patients with moderate renal impairment (creatinine clearance between 30-60 ml/min), the dose should be adjusted to 35 mg once daily in the morning.
  • Pregnancy and Lactation: The safety of Trimetazidine during pregnancy and breastfeeding has not been well established, so its use should be avoided unless clearly necessary.
  • Contraindications: Trimetazidine is contraindicated in individuals with severe renal impairment and in those with Parkinson's disease or other movement disorders.

Conclusion:

Trimetazidine is a valuable agent in the management of chronic stable angina, offering benefits by improving the heart's efficiency under ischemic conditions. It provides a novel approach to heart treatment by optimizing energy metabolism rather than altering heart rate or blood vessel function. While generally well-tolerated, its use requires careful consideration in certain populations, such as the elderly and those with renal impairment. For patients suffering from ischemic heart conditions, Trimetazidine offers a non-hemodynamic option for long-term symptom relief, making it a useful addition to the therapeutic arsenal for stable angina management.