Moduxin Mr (Trimetazidine Dihydrochloride)

Trimetazidine is used in the anti‑ischemic therapeutic area to improve myocardial energy metabolism in coronary artery disease.

• Stable angina pectoris: reduces the frequency of angina attacks and improves exercise tolerance.
• Chronic coronary syndrome: helps alleviate chest discomfort during daily activities.
• Ischemic heart disease: supports myocardial function by enhancing ATP production under ischemic conditions.

• Trimetazidine selectively inhibits the mitochondrial long‑chain 3‑ketoacyl‑CoA thiolase, reducing fatty‑acid β‑oxidation in cardiac myocytes. This metabolic shift favors glucose oxidation, which requires less oxygen per ATP generated, thereby improving cellular energy efficiency during ischemia. By preserving intracellular ion balance and limiting lactate accumulation, the drug further protects the heart from ischemic injury.

Trimetazidine may be associated with several adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Headache: transient pain often reported.
• Dizziness: sensation of light‑headedness, especially on standing.
• Gastrointestinal discomfort: abdominal pain or dyspepsia.
• Fatigue: feeling of reduced energy.
• Skin rash: mild erythema or itching.

Serious or Rare Side Effects

• Severe allergic reactions: anaphylaxis, swelling of face or throat.
• Extrapyramidal symptoms: tremor, rigidity, or parkinsonian features.
• Liver enzyme elevation: significant increase in transaminases indicating hepatic stress.
• Hematologic abnormalities: rare cases of leukopenia or thrombocytopenia.
• Cardiac arrhythmias: uncommon but potentially life‑threatening rhythm disturbances.

When prescribing Trimetazidine, clinicians should observe the following precautions to ensure safe use.

• Cardiac monitoring: assess patient’s angina status and ECG periodically.
• Renal impairment: use with caution in severe renal dysfunction; dose adjustment may be required.
• Elderly patients: monitor for dizziness or hypotension due to increased sensitivity.
• Allergic reactions: discontinue immediately if signs of hypersensitivity such as rash or swelling appear.
• Store at room temperature: keep tablets in the original container, protect from moisture and direct sunlight.

Trimetazidine can interact with other medicines; awareness of major and moderate interactions helps avoid adverse outcomes.

Major Interactions (Avoid)

• Concomitant use with other anti‑ischemic agents that cause profound hypotension (e.g., high‑dose nitrates) may increase risk of low blood pressure.
• Combination with drugs that strongly inhibit mitochondrial enzymes (e.g., certain antiretrovirals) may potentiate metabolic effects.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may enhance anti‑anginal effect, requiring clinical monitoring.
• Calcium channel blockers: monitor for additive effects on heart rate and blood pressure.
• Selective serotonin reuptake inhibitors: observe for possible increase in dizziness.