Trimetazidine in the Family Doctor Practice: a Single Look at the Problem

Questions of medicine interchangeability are the most difficult questions on the pharmaceutical market. Over the past few years, these expenses have increased five times. That is why there often comes the question of patient's adherence to the prescribed therapy. The problem of the interchangeability of drugs is currently being discussed quite actively at various levels, both in our country and abroad. It has both a purely therapeutic and quite relevant economic background. Materials and methods. According to the world statistics, 48% of the population die from cardiovascular diseases, high blood pressure causes 51% of stroke deaths and the rate mortality from coronary heart disease is 45% of cases (according to WHO data for 2016). In the therapy of IHD, the following antianginal drugs are used: nitrates, beta-adrenoblockers, calcium antagonists, antithrombotic drugs (acetylsalicylic acid, clopidogrel). Currently, an important place in the IHD treatment takes metabolism drugs aimed at improving the myocardium oxygen utilization in conditions of ischemia. A fairly convincing evidence base for the effectiveness of trimetazidine in the treatment of patients with stable IHD has been accumulated, so trimetazidine was included both in the recommendation of the committee of experts of the All-Ukrainian Scientific Society of Cardiology and in the recommendation of the European Society of Cardiology for the diagnosis and treatment of stable angina as a full-blown drug for the IHD treatment. Results and discussion. Assignment of trimetazidine generic tridetazidine (Tricuktan MB) at a daily dose of 35 mg twice a day to patients with ischemic heart disease with stable angina exertion increases the physical tolerance of long-acting nitrates, reduces the development of resistance to them. The main metabolic effects of trimetazidine include: 1) inhibition of SFA oxidation; 2) enhancement of glucose oxidation and increase in ATP synthesis; 3) normalization of transmembrane ionic streams; 4) reduction in the free radicals formation, under-oxidized metabolic products; 5) decrease in intracellular acidosis. These effects ensure the ability of trimetazidine to improve the metabolism of membrane phospholipids, to reduce the passive permeability of membranes, and to increase their resistance to hypoxic damage in conditions of myocardial hibernation, which is manifested in the enhancement of the action of prolonged nitrates. Conclusions. The use of this drug improves the clinical course of angina and increases the antianginal effectiveness of prolonged nitrates for long-term use. In the future, it is necessary to study the effectiveness of trimetazidine in treatment of patients after invasive heart and other diseases of internal organs.