Mildronate (Meldonium Dihydrate)

Mildronate (meldonium) is used in cardiovascular and metabolic conditions where myocardial energy efficiency is impaired.

• Angina pectoris: reduces frequency and severity of chest pain episodes.
• Heart failure: improves functional capacity and reduces symptoms of dyspnea.
• Peripheral arterial disease: alleviates intermittent claudication and enhances walking distance.
• Ischemic stroke: supports neurological recovery by improving cerebral energy metabolism.
• Chronic fatigue: mitigates fatigue levels and enhances exercise tolerance.

• Meldonium inhibits γ‑butyrobetaine hydroxylase, the enzyme responsible for the final step of carnitine biosynthesis. By lowering intracellular carnitine, the drug shifts myocardial substrate utilization from fatty‑acid oxidation toward glucose oxidation, which requires less oxygen per unit of ATP produced. This metabolic reprogramming enhances cellular energy efficiency, reduces ischemic injury, and provides cardioprotective effects in tissues exposed to reduced blood flow.

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

Common Side Effects

• Nausea: mild stomach upset reported in some patients.
• Headache: transient cranial discomfort.
• Dizziness: occasional light‑headedness.
• Insomnia: difficulty initiating sleep.
• Gastrointestinal discomfort: abdominal pain or dyspepsia.
• Metallic taste: altered taste sensation.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Arrhythmia: abnormal heart rhythm that may need monitoring.
• Elevated liver enzymes: signs of hepatic stress.
• Hypotension: significant drop in blood pressure.
• Stevens‑Johnson syndrome: rare skin and mucous membrane disorder.
• Rhabdomyolysis: muscle breakdown with potential kidney injury.

When prescribing Mildronate, clinicians should consider several safety precautions to minimize risk.

• Renal impairment: monitor renal function and adjust use as needed.
• Hepatic disease: use with caution in patients with liver dysfunction.
• Pregnancy: safety not established; avoid unless benefit outweighs risk.
• Elderly patients: observe for hypotension and dizziness due to altered metabolism.
• Concomitant anti‑ischemic drugs: assess for additive cardiovascular effects.
• Store at below 25°C: keep in the original pack, protect from moisture.

Mildronate can interact with other medicines, requiring attention to potential pharmacodynamic and pharmacokinetic effects.

Major Interactions (Avoid)

• Strong vasodilators: may cause excessive hypotension.
• Other metabolic modulators (e.g., trimetazidine): risk of over‑shifting myocardial substrate use.
• High‑dose catecholamines: possible antagonism of intended cardiac effects.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: monitor heart rate and blood pressure for additive effects.
• Anticoagulants: watch for altered bleeding risk.
• Diuretics: observe electrolyte balance and renal function.
• Antiplatelet agents: assess for combined impact on platelet function.