Trimetazidine
Other antianginals
Other antianginals
A metabolic antianginal that shifts heart energy use from fatty acids to glucose. Add-on for stable angina; avoided in parkinsonism.
Quick facts
- Group
- Other antianginals
- Target
- Long-chain 3-ketoacyl-CoA thiolase (mitochondrial)
- Used for
- Add-on treatment
- Key effects
- Stomach or oesophageal burning · Dizziness · Weakness
- Monitor
- New tremor · Kidney function · Angina frequency
- ATC
- C01EB15
No doses: the clinician sets them by the current guideline.
Mechanism of action
Trimetazidine inhibits long-chain 3-ketoacyl-CoA thiolase, the last enzyme of mitochondrial fatty-acid beta-oxidation. Heart muscle then burns more glucose and less fat. Glucose oxidation needs less oxygen for each unit of ATP, so the ischaemic myocardium makes energy more efficiently. It does not change heart rate, blood pressure, contractility or coronary flow, which is why it can be added to haemodynamic antianginals.
- Inhibits long-chain 3-ketoacyl-CoA thiolase
- Less fatty-acid oxidation, more glucose oxidation
- Less oxygen used per ATP in ischaemic muscle
- No change in heart rate or blood pressure
Indications
- Add-on treatment of stable angina when first-line drugs are not enough or not tolerated Stable angina →
Adverse effects
Common
- Stomach or oesophageal burning, nausea
- Dizziness, headache
- Weakness
Contraindications
- Parkinson disease, parkinsonian symptoms, tremor, restless legs syndrome or related movement disorders
- Severe kidney impairment
Key interactions
- Other antianginals (beta-blockers, calcium-channel blockers, nitrates)
- Used together as add-on therapy; trimetazidine itself does not lower heart rate or blood pressure.
What is monitored
- New tremor, stiffness, slowness or unsteady gait; it is stopped permanently if they appear
- Kidney function, especially in older people
- Angina frequency
Administration and safety
- Oral, as add-on to standard antianginal drugs.
- The dose is reduced in moderate kidney impairment and in older people.
- Not a treatment for vertigo, tinnitus or visual problems; these uses were withdrawn in Europe.
Pregnancy and breastfeeding
Information on use in pregnancy is limited.
Nursing care
- Before: ask about Parkinson disease, tremor or restless legs and check kidney function.
- During: ask about new tremor, stiffness or falls and report them.
- Teach the patient to keep taking first-line angina medicines and to carry short-acting nitrate if prescribed.
- Record how often angina occurs.
Pharmacokinetics
- Absorption
- Oral tablets (immediate or modified release).
- Elimination
- Mostly excreted in the urine; elimination is slower in kidney impairment and in older people.
Test yourself
Think of the answer, then tap the question to see it.
Which enzyme does trimetazidine inhibit?
Long-chain 3-ketoacyl-CoA thiolase, the last step of fatty-acid beta-oxidation.
Why can trimetazidine be added in a patient with low blood pressure and slow heart rate?
It acts on myocardial metabolism and does not lower heart rate or blood pressure.
Which group of patients must not receive trimetazidine?
Patients with Parkinson disease or other movement disorders (and severe kidney impairment).
Connections
← Back to the class: Other antianginals
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Trimetazidine in Practice: Review of the Clinical and Experimental Evidence (American Journal of Therapeutics, via PubMed Central, 2016); Trimetazidine Use in Parkinson's Disease: Is It a Resolved Problem? (eNeuro, via PubMed Central, 2021); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.