Mezitan (Trimetazidine Dihydrochloride)

• Mezitan (trimetazidine) is employed in the management of coronary ischemic conditions to improve myocardial energy efficiency.
• Angina pectoris: reduces the frequency and severity of chest pain episodes during physical activity.
• Chronic stable angina: enhances exercise tolerance and delays onset of ischemic symptoms.
• Ischemic heart disease: supports overall cardiac function by optimizing metabolic substrate utilization.
• Coronary microvascular dysfunction: improves myocardial perfusion efficiency, helping to alleviate anginal discomfort.
• Exercise‑induced myocardial ischemia: decreases lactate accumulation, allowing patients to sustain higher workloads with fewer symptoms.

• Trimetazidine acts at the cellular level by inhibiting the mitochondrial long‑chain 3‑ketoacyl‑CoA thiolase, a key enzyme in fatty‑acid β‑oxidation. This inhibition reduces fatty‑acid utilization and promotes glucose oxidation, which requires less oxygen per unit of ATP generated. The shift toward more efficient glucose metabolism enhances myocardial energy production under ischemic conditions, helping to preserve cardiac contractile function without altering heart rate or blood pressure.

Trimetazidine may be associated with a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Nausea
• Headache
• Dizziness
• Gastrointestinal discomfort
• Constipation

Serious or Rare Side Effects

• Severe allergic reactions (anaphylaxis)
• Hepatic enzyme elevation
• Extrapyramidal symptoms resembling Parkinsonism

When prescribing trimetazidine, clinicians should consider several precautionary measures to ensure patient safety.

• Assess cardiac status: evaluate severity of ischemic disease before initiation.
• Monitor renal function: adjust use in patients with severe renal impairment.
• Use caution in elderly: increased susceptibility to dizziness and hypotension.
• Check for hypersensitivity: discontinue if allergic reactions occur.
• Store at room temperature: keep in original packaging, protect from moisture and light.

Trimetazidine can interact with other medications, requiring attention to potential additive effects.

Major Interactions (Avoid)

• Co‑administration with other metabolic modulators (e.g., ranolazine) may diminish therapeutic benefit.
• Use with strong CYP2D6 inhibitors: may increase plasma levels, though data are limited.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: monitor heart rate and blood pressure.
• Calcium channel blockers: observe for enhanced anti‑ischemic effect.
• Antidiabetic agents: watch for altered glucose control.
• Antihypertensives: assess for additive blood pressure reduction.