Medications Used to Treat Coronary Artery Disease*

Examples	Some Side Effects	Comments
Angiotensin-converting enzyme (ACE) inhibitors
Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril	Cough, usually dry and metallic Rash Rarely, a severe allergic reaction (angioedema) Possibly worsening of kidney function when people already have kidney disease or when the artery to one of the kidneys is greatly narrowed	These medications lower blood pressure and treat heart failure and prevent kidney damage in people with high blood pressure or diabetes. They also benefit people who have had heart attacks. People who have high blood pressure, heart failure, or prior heart attacks and who are treated with an ACE inhibitor live longer than people who do not take an ACE inhibitor.
Angiotensin II receptor blockers (ARBs)
Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan	Similar to ACE inhibitors, but cough is much less common	These medications have equivalent effects and benefits to those of ACE inhibitors. In people with severe high blood pressure or heart failure, these medications may be used in combination with an ACE inhibitor.
Other medications
Ranolazine	Dizziness, headache, constipation, and nausea	This medication is used to treat people who continue to have symptoms of angina despite treatment with other drugs.
Ivabradine	Blurred vision, chest discomfort, slow or fast heartbeat,headache, dizziness or fainting	This medication is used to treat symptoms of angina in some people who cannot take beta-blockers.
Anticoagulants
Argatroban Apixaban Bivalirudin Dabigatran Dalteparin Enoxaparin Fondaparinux Heparin Rivaroxaban Tinzaparin Warfarin	Bleeding, especially when used with other medications that have a similar effect (such as aspirin and other nonsteroidal anti-inflammatory drugs)	These medications prevent blood from clotting. They are used to treat people who have unstable angina or who have had a heart attack.
Antiplatelet medications
Aspirin Clopidogrel Prasugrel Ticagrelor Ticlopidine	Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants) With aspirin, stomach irritation With ticlopidine and less so with clopidogrel, a small risk of reducing the white blood cell count	These medications prevent platelets from clumping and blood clots from forming. They also reduce the risk of a heart attack. They are used to treat people who have stable or unstable angina or who have had a heart attack. Aspirin is taken as soon as a heart attack is suspected. People with an allergy to aspirin may take clopidogrel or ticlopidine as an alternative.
Beta-blockers
Atenolol Bisoprolol Carvedilol Metoprolol	Spasm of airways (bronchospasm) Abnormally slow heart rate (bradycardia) Heart failure Cold hands and feet Insomnia Fatigue Shortness of breath Depression Raynaud syndrome Vivid dreams Hallucinations Sexual dysfunction With many beta-blockers, an increase in the triglyceride level and a decrease in the level of high density lipoprotein (HDL), which is the "good" cholesterol	These medications reduce the workload of the heart and the risk of a heart attack and sudden death. They are used to treat people who have stable or unstable angina or microvascular angina or who have had a heart attack.
Calcium channel blockers
Amlodipine Diltiazem Felodipine Nifedipine (sustained-release only) Verapamil	Dizziness Fluid accumulation (edema) in the ankles Flushing Headache Heartburn Enlarged gums Abnormal heart rhythms (arrhythmias) With verapamil, constipation With short-acting, but not long-acting, calcium channel blockers, possible increased risk of death due to heart attack, especially in people who have unstable angina or who have had a heart attack recently	These medications prevent blood vessels from narrowing and can reverse artery spasm. Diltiazem and verapamil reduce the heart rate. Calcium channel blockers are used to treat people who have stable angina.
Glycoprotein IIb/IIIa inhibitors (a type of antiplatelet medication)
Abciximab Eptifibatide Tirofiban	Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants or thrombolytic medications) Reduction of the platelet count	These medications prevent platelets from clumping and blood clots from forming. They may be used to treat people who have unstable angina, particularly those who are undergoing percutaneous coronary intervention after a heart attack.
Nitrates
Isosorbide dinitrate Isosorbide mononitrate Nitroglycerin	Flushing Headache Temporarily fast heart rate (tachycardia)	These medications relieve angina, prevent episodes of angina, and reduce the risk of a heart attack and sudden death. (However, risk reduction is much less than that with beta-blockers.) They are used to treat people who have stable or unstable angina or microvascular angina. For these medications to remain effective over the long term, people need to go 8 to 12 hours without taking the medication each day.
Opioids
Morphine	Low blood pressure when a person stands Constipation Nausea Vomiting Confusion (especially in older adults)	In some people who have had a heart attack, these medications are used to relieve anxiety and pain if the pain persists despite use of other medications.
PCSK-9 inhibitors
Alirocumab Evolocumab	Few serious side effects	These medications are used to lower LDL-C, which is the "bad" cholesterol, in patients not at target LDL-C levels. They are used alone or in combination with other lipid-lowering medications (eg, statins, ezetimibe) for the treatment of adults with primary hyperlipidemia (including familial hypercholesterolemia), including people who have trouble tolerating other medications that lower cholesterol
Statins†
Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin	Occasionally, muscle aches and pains, but rarely severe muscle pain (myositis) Rarely, liver damage, but not more commonly than in people who are not taking the medication	These medications lower cholesterol levels and help to heal damaged arteries, decreasing the chance of having a first or repeated heart attack or stroke.
Thrombolytic drugs
Alteplase Anistreplase Reteplase Streptokinase Tenecteplase	Rarely, bleeding within the brain (intracerebral hemorrhage) or the digestive tract	These medications dissolve blood clots. They are used to treat people who have had a heart attack.
* Doctors may use different combinations of medications depending on the type of coronary artery disease the person has.
† Also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors.

Examples

Some Side Effects

Comments

Angiotensin-converting enzyme (ACE) inhibitors

Benazepril

Captopril

Enalapril

Fosinopril

Lisinopril

Moexipril

Perindopril

Quinapril

Ramipril

Trandolapril

Cough, usually dry and metallic

Rash

Rarely, a severe allergic reaction (angioedema)

Possibly worsening of kidney function when people already have kidney disease or when the artery to one of the kidneys is greatly narrowed

These medications lower blood pressure and treat heart failure and prevent kidney damage in people with high blood pressure or diabetes. They also benefit people who have had heart attacks.

People who have high blood pressure, heart failure, or prior heart attacks and who are treated with an ACE inhibitor live longer than people who do not take an ACE inhibitor.

Angiotensin II receptor blockers (ARBs)

Candesartan

Eprosartan

Irbesartan

Losartan

Olmesartan

Telmisartan

Valsartan

Similar to ACE inhibitors, but cough is much less common

These medications have equivalent effects and benefits to those of ACE inhibitors. In people with severe high blood pressure or heart failure, these medications may be used in combination with an ACE inhibitor.

Other medications

Ranolazine

Dizziness, headache, constipation, and nausea

This medication is used to treat people who continue to have symptoms of angina despite treatment with other drugs.

Ivabradine

Blurred vision, chest discomfort, slow or fast heartbeat,headache, dizziness or fainting

This medication is used to treat symptoms of angina in some people who cannot take beta-blockers.

Anticoagulants

Argatroban

Apixaban

Bivalirudin

Dabigatran

Dalteparin

Enoxaparin

Fondaparinux

Heparin

Rivaroxaban

Tinzaparin

Warfarin

Bleeding, especially when used with other medications that have a similar effect (such as aspirin and other nonsteroidal anti-inflammatory drugs)

These medications prevent blood from clotting. They are used to treat people who have unstable angina or who have had a heart attack.

Antiplatelet medications

Aspirin

Clopidogrel

Prasugrel

Ticagrelor

Ticlopidine

Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants)

With aspirin, stomach irritation

With ticlopidine and less so with clopidogrel, a small risk of reducing the white blood cell count

These medications prevent platelets from clumping and blood clots from forming. They also reduce the risk of a heart attack. They are used to treat people who have stable or unstable angina or who have had a heart attack.

Aspirin is taken as soon as a heart attack is suspected. People with an allergy to aspirin may take clopidogrel or ticlopidine as an alternative.

Beta-blockers

Atenolol

Bisoprolol

Carvedilol

Metoprolol

Spasm of airways (bronchospasm)

Abnormally slow heart rate (bradycardia)

Heart failure

Cold hands and feet

Insomnia

Fatigue

Shortness of breath

Depression

Raynaud syndrome

Vivid dreams

Hallucinations

Sexual dysfunction

With many beta-blockers, an increase in the triglyceride level and a decrease in the level of high density lipoprotein (HDL), which is the "good" cholesterol

These medications reduce the workload of the heart and the risk of a heart attack and sudden death. They are used to treat people who have stable or unstable angina or microvascular angina or who have had a heart attack.

Calcium channel blockers

Amlodipine

Diltiazem

Felodipine

Nifedipine (sustained-release only)

Verapamil

Dizziness

Fluid accumulation (edema) in the ankles

Flushing

Headache

Heartburn

Enlarged gums

Abnormal heart rhythms (arrhythmias)

With verapamil, constipation

With short-acting, but not long-acting, calcium channel blockers, possible increased risk of death due to heart attack, especially in people who have unstable angina or who have had a heart attack recently

These medications prevent blood vessels from narrowing and can reverse artery spasm. Diltiazem and verapamil reduce the heart rate. Calcium channel blockers are used to treat people who have stable angina.

Glycoprotein IIb/IIIa inhibitors (a type of antiplatelet medication)

Abciximab

Eptifibatide

Tirofiban

Bleeding, especially when used with other medications that have a similar effect (such as anticoagulants or thrombolytic medications)

Reduction of the platelet count

These medications prevent platelets from clumping and blood clots from forming. They may be used to treat people who have unstable angina, particularly those who are undergoing percutaneous coronary intervention after a heart attack.

Nitrates

Isosorbide dinitrate

Isosorbide mononitrate

Nitroglycerin

Flushing

Headache

Temporarily fast heart rate (tachycardia)

These medications relieve angina, prevent episodes of angina, and reduce the risk of a heart attack and sudden death. (However, risk reduction is much less than that with beta-blockers.) They are used to treat people who have stable or unstable angina or microvascular angina. For these medications to remain effective over the long term, people need to go 8 to 12 hours without taking the medication each day.

Opioids

Morphine

Low blood pressure when a person stands

Constipation

Nausea

Vomiting

Confusion (especially in older adults)

In some people who have had a heart attack, these medications are used to relieve anxiety and pain if the pain persists despite use of other medications.

PCSK-9 inhibitors

Alirocumab

Evolocumab

Few serious side effects

These medications are used to lower LDL-C, which is the "bad" cholesterol, in patients not at target LDL-C levels. They are used alone or in combination with other lipid-lowering medications (eg, statins, ezetimibe) for the treatment of adults with primary hyperlipidemia (including familial hypercholesterolemia), including people who have trouble tolerating other medications that lower cholesterol

Statins†

Atorvastatin

Fluvastatin

Lovastatin

Pravastatin

Rosuvastatin

Simvastatin

Occasionally, muscle aches and pains, but rarely severe muscle pain (myositis)

Rarely, liver damage, but not more commonly than in people who are not taking the medication

These medications lower cholesterol levels and help to heal damaged arteries, decreasing the chance of having a first or repeated heart attack or stroke.

Thrombolytic drugs

Alteplase

Anistreplase

Reteplase

Streptokinase

Tenecteplase

Rarely, bleeding within the brain (intracerebral hemorrhage) or the digestive tract

These medications dissolve blood clots. They are used to treat people who have had a heart attack.

* Doctors may use different combinations of medications depending on the type of coronary artery disease the person has.

† Also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors.

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