Antiischemic efficacy of trimetazidine used in combination with propranolol in patients with stable angina pectoris

Antiishemic efficacy of single doses of propranolol (40 mg), trimetazidine (20 mg) and their combination was assessed by paired bicycle exercise tests in a double blind randomized placebo controlled study on 10 patients with stable class II-III angina and proven ischemic heart disease. Addition of t rimetazidine to propranolol was especially effective in patients with low s ensitivity to propranolol. The hypothesis underlying synergistic interactio n of these drugs is presented. Lowered sensitivity to propranolol is appare ntly characteristic for patients with some special features of glucolytic p rocesses in the myocardium which emerge in response to ischemia. Propranolo l in this setting causes some unfavorable changes in the myocardium, which are corrected by <<metabolic>> drugs, such as trimetazidine.