Angina medication comparison: nitrates, beta‑blockers, CCBs, ranolazine
Chest pain from angina feels scary, and picking the right medicine matters. This page lays out the main drug options, what they do fast, common side effects, and real‑world tips you can use when talking with your doctor.
Main drug classes and when doctors usually pick them
Nitrates (short‑acting nitroglycerin, long‑acting isosorbide mononitrate): These relieve chest pain fast by widening blood vessels. Use short‑acting nitroglycerin for attacks. Long‑acting nitrates help prevent symptoms in chronic angina. Watch for headache, low blood pressure, and dizziness. Never combine nitrates with PDE‑5 inhibitors (sildenafil, tadalafil) — that can cause dangerous drops in blood pressure.
Beta‑blockers (metoprolol, atenolol): These slow heart rate and reduce how hard the heart works, so they lower angina episodes and improve exercise tolerance. Common effects include tiredness, slow pulse, and cold hands. People with asthma or severe COPD may need other options because beta‑blockers can tighten airways.
Calcium channel blockers (amlodipine, diltiazem, verapamil): CCBs relax blood vessels and can lower heart rate (some types). Doctors often use them if beta‑blockers aren’t tolerated, or with nitrates for symptom control. Expect swelling in the ankles, flushing, or constipation with some drugs.
Ranolazine: This one works differently — it changes heart cell metabolism to reduce angina without big effects on blood pressure or heart rate. It’s often added when standard meds don’t fully control symptoms. Side effects can include dizziness and constipation; it also interacts with several other drugs, so your doctor will check.
Other heart medicines: ACE inhibitors or ARBs (if you have heart disease or high blood pressure), antiplatelet drugs (aspirin) to lower heart attack risk, and statins to manage cholesterol. These don’t relieve an attack immediately but reduce long‑term risk.
Practical tips when comparing options
1) Match goals to the drug. Need instant relief for attacks? Carry nitroglycerin. Trying to cut daily symptoms? Consider a beta‑blocker, long‑acting nitrate, or CCB.
2) Think about side effects that matter to you. If you’re active and tired easily, a beta‑blocker might feel limiting. If you get bad headaches, nitrates could be hard to tolerate.
3) Know major interactions. Don’t use nitrates with erectile dysfunction meds. Tell your doctor about all prescriptions, supplements, and herbal products to avoid surprises.
4) Track results. Keep a simple diary: when pain happens, what you took, and whether it helped. That helps your clinician adjust therapy faster.
If you want more detail on long‑term nitrate therapy, or how these choices affect daily life, check our full article on long‑term nitrate therapy for chronic angina. Talk to your doctor before changing meds — but use this guide to ask better questions and get the treatment that fits your life.
