Trimetazidine

How it works

It is thought to optimise cardiac energy metabolism by partially inhibiting fatty acid oxidation and shifting metabolism towards glucose oxidation, improving the ischaemic myocyte's energy balance without altering heart rate or blood pressure.

Prescribing in practice

• It is contraindicated in Parkinson's disease and other movement disorders, and can induce or worsen parkinsonian symptoms, tremor and restless legs, which are reversible on stopping.
• It is reserved as second-line add-on therapy rather than a first-line antianginal.
• Use with caution and consider dose adjustment in renal impairment and in the elderly, as detailed in the SPC.

Monitoring

Review periodically for movement disorders and reassess the need for continued treatment, stopping if motor symptoms appear.

Counselling the patient

• Report any new tremor, unsteadiness, slowness of movement or restless legs.
• It is used alongside, not instead of, your other angina medicines.
• Do not stop your other heart medicines unless advised.

Evidence & guidelines

Trimetazidine is positioned as second-line add-on antianginal therapy following an MHRA-aligned European review that restricted its indication and contraindicated it in movement disorders.