Nitrates relieve angina probably by lowering tone in peripheral arteries and veins and reducing cardiac work.1 2 They are effective but they may cause troublesome palpitations, headache and flushing and their effect is short-lived. β-Receptor blockers have a prolonged action, and they prevent the tachycardia of emotion and exercise. While they too are effective they can precipitate or worsen heart failure and exacerbate bronchial asthma. The ideal anti-anginal drug has thus not yet been found. Perhexiline maleate (Pexid - Merrell) has recently been introduced for angina. It is not related chemically to nitrates or β-blockers and the manufacturer’s claims suggest it might have advantages over both.
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