Beta-blockers

Beta-blockers such as atenolol or bisoprolol are used for the prevention of angina or treatment of hypertension. Beta-blockers commonly cause fatigue, hypotension and a feeling of coldness or numbness in the extremities.

These undesirable effects can be enough for a patient to feel negative about their medication, leading to nonadherence. Patients can be advised to wear gloves and socks to help reduce the feeling of coldness in their extremities.

Nitrates

Nitrate treatments used for angina are isosorbide mononitrate and glyceryl trinitrate. Tolerance to nitrates can develop, but twice daily dosing at set intervals can minimise this. Standard-release nitrate preparations use an asymmetric dosing interval (e.g. at 8am and 4pm or 2pm and 10pm) that can help minimise tolerance.

Other treatments

Other treatments used for angina include nicorandil and ivabradine. Nicorandil can cause gastrointestinal ulceration (including aphthous ulcers and anal ulceration). Regular purchasing of over-the-counter (OTC) antacids or mouth ulcer preparations may raise concerns that the patient is experiencing adverse effects from nicorandil – this provides an opportunity to suggest an intervention MUR.

Ivabradine treatment may have common adverse effects of brief spots or flashes of light and blurred vision. ACE inhibitors are prescribed first line in patients with hypertension who are younger than 55 years of age and not of black African or Caribbean ethnic origin. Hypertension is a risk factor for CVD.

Angiotensin II receptor antagonists such as losartan, irbesartan, candesartan or valsartan may be used. These do not cause the dry cough adverse effect that is associated with ACE inhibitors.