Rimecor

Rimecor (also known by its trade name Trimetazidine) is a medicine that is commonly used to treat angina pectoris (chest pain), especially in patients with coronary heart disease. Trimetazidine belongs to a group of drugs called myocardial metabolic modulators, which have their effect by improving energy metabolism in the heart muscle cells.

The main action of trimetazidine is to improve myocardial metabolism and increase its oxygen-carrying capacity without increasing oxygen consumption. This reduces or prevents ischemic damage to the heart muscle and reduces symptoms of angina pectoris.

It is important to note that trimetazidine is not a first-line treatment for angina pectoris and its use can only be recommended after appropriate evaluation of the patient by a physician.

Indications Rimecora

1. Angina pectoris (coronary heart disease): Rimecor is used to reduce symptoms of angina such as chest pain or blood pressure.
2. Prevention of ischemic lesions: In patients with ischemic heart disease the drug may be used for prevention of ischemic lesions of the heart muscle, especially in case of insufficient efficacy of other drugs or when it is impossible to use them.
3. Other Cardiovascular Conditions: Sometimes Rimecor may be used for other cardiovascular conditions, but this should be determined by the physician on an individual patient basis.

Release form

1. Modified-release tablets: These tablets usually contain 35 mg of trimetazidine and are intended to be taken orally once or twice a day, depending on your doctor's advice. Modified-release provides a gradual release of the active ingredient, which helps to maintain a stable level of the drug in the blood for a long time.
2. Tablets or pills: May also be available as immediate-release tablets or pills, usually containing 20 mg of trimetazidine. These forms of the drug are taken 2 to 3 times a day as directed by your doctor.

Pharmacodynamics

1. Inhibition of fatty acid metabolism: Trimetazidine is an inhibitor of fatty acid metabolism that acts on mitochondrial metabolism. It prevents the conversion of fatty acids to acetyl-CoA, resulting in decreased fatty acid oxidation and increased glucose oxidation in the mitochondria.
2. Increased energy metabolism: Due to its mechanism of action, trimetazidine increases glucose utilization in the myocardium, which helps to increase the energy metabolism of the heart muscle.
3. Improved cardiovascular function: Trimetazidine improves cardiovascular function by reducing the duration and severity of ischemic episodes and improving exercise tolerance in patients with coronary heart disease.
4. Prevention of ischemic damage: Trimetazidine use may help prevent ischemic damage to the heart, especially in conditions associated with unstable angina.
5. Vasodilator action: Although trimetazidine is not a typical vasodilator, but its ability to increase energy metabolism and improve cardiac function may also affect the regulation of vascular tone.

Pharmacokinetics

1. Absorption: Trimetazidine is generally well absorbed from the gastrointestinal tract after oral administration.
2. Metabolism: The drug is metabolized in the liver, where it undergoes glutathione conjugation and oxidative processes with the formation of active metabolites.
3. Elimination: Trimetazidine is mainly eliminated from the body in the form of metabolites by the kidneys. Its elimination half-life is about 7-8 hours.
4. Drug interaction: Trimetazidine may interact with other drugs, changing their pharmacokinetic parameters. It is especially important to pay attention to drugs that can also reduce the threshold of extremely dangerous cardiac arrhythmias (e.g., amidarone, antiarrhythmic drugs of class Ia and III).
5. Indications for use: Trimetazidine should be used with caution in patients with impaired renal and hepatic function, as well as those taking other drugs that may increase the risk of cardiac arrhythmias.

Dosing and administration

For modified-release tablets (35 mg):

• Adults: It is generally recommended to take 35 mg (one tablet) once daily with a meal in the morning. Tablets should be swallowed whole without chewing or crushing to preserve the modified-release properties of the active ingredient.

For immediate-release tablets or pills (20 mg):

• Adults: The recommended dose is 20 mg (one tablet) three times daily with meals. This helps to optimize absorption and reduce the risk of gastrointestinal side effects.

Special Instructions:

• It is necessary to strictly follow the doctor's recommendations regarding dosage and course of treatment.
• Rimecor is intended for long-term use and treatment should be discontinued only as directed by a physician.

• The efficacy and safety of Rimecor (Trimetazidine) in children and adolescents have not been established, therefore it is not recommended to use it in this age group without consulting a doctor.

Important:

• If side effects occur or if the condition does not improve, you should consult a doctor.
• Trimetazidine may interact with other medications, so it is important to tell your doctor about any medications you are taking.
• If a dose is missed, do not double the next dose, but take the missed dose as soon as possible and then continue treatment as usual.

Use Rimecora during pregnancy

The use of Rimecor (trimetazidine) during pregnancy should be used only for strict medical reasons and under medical supervision. Data on the safety of trimetazidine during pregnancy are limited and its use should be justified by the expected benefit to the mother compared to the potential risks to the fetus.

Before you start using Rimecor during pregnancy or if you are planning to become pregnant, it is important to discuss this with your doctor. He or she will assess the potential risks and benefits of treatment, taking into account your health condition and pregnancy.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to trimetazidine or other components of the drug should not use Rimecor.
2. Heart failure: Trimetazidine use may increase symptoms of heart failure, therefore it should be used with caution in patients with this condition.
3. Gastrointestinal disorders: Trimetazidine may cause a variety of gastrointestinal side effects and should therefore be used with caution in patients with gastrointestinaldisorders.
4. Pregnancy and lactation: Safety of trimetazidine use during pregnancy or lactation has not been established, therefore its use in these cases should be carried out under medical supervision.
5. Renal insufficiency: In patients with impaired renal function Rimecor should be used with caution, as it may accumulate in the body and increase side effects.
6. Left ventricular hypertrophy: The use of trimetazidine in patients with left ventricular hypertrophy may be contraindicated because it may increase diastolic dysfunction.

Side effects Rimecora

1. Gastrointestinal disorders: Stomach disorders such as nausea, vomiting, diarrhea, dyspepsia (digestive disorders), or abdominal pain may occur.
2. Systemic Reactions: Headache, weakness, fatigue, dizziness, or fainting may occur.
3. Nervous system: In rare cases, nervous disorders such as depression, insomnia, anexia (anxiety) or headaches may occur.
4. Allergic reactions: Allergic reactions such as skin rash, itching, urticaria or angioedema may occur.
5. Cardiovascular reactions: In rare cases, heart rhythm disturbances or changes in blood pressure may occur.

Overdose

1. Hypotension: Overdose may result in a severe drop in blood pressure, which may cause dizziness, fainting and even loss of consciousness.
2. GI disorders: Nausea, vomiting, diarrhea or other GI disorders may occur.
3. Central Nervous System (CNS): Central nervous system related symptoms such as dizziness, weakness, drowsiness, or insomnia may occur.
4. Cardiac disorders: Arrhythmias, including tachycardia or bradycardia, may occur.
5. Other symptoms: Symptoms related to individual organs and systems, such as allergic reactions or respiratory problems, may also occur.

Interactions with other drugs

1. Antiarrhythmic drugs: In combination with class Ia (e.g., quinidine) and class III (e.g., amidarone) antiarrhythmic agents, trimetazidine may increase the effects on the cardiac electrical system, which increases the risk of cardiac arrhythmias.
2. Drugs that prolong the QT interval: Trimetazidine may prolong the duration of the QT interval on ECG. Therefore, it should be used with caution when administered concomitantly with other drugs that may also prolong the QT interval, such as antiarrhythmic drugs (e.g., sotalol, disopyramide) and some antidepressants (e.g., citalopram).
3. Cimetidine: Cimetidine, a proton pump inhibitor, may increase the blood concentration of trimetazidine, which may increase its therapeutic effect and risk of side effects.
4. Drugs metabolized through the cytochrome P450 system: Trimetazidine may affect the enzymes of the cytochrome P450 system in the liver and alter the metabolism of other drugs such as amitriptyline and cyclosporine. This may result in an increase or decrease in blood concentrations of these drugs, requiring appropriate dosage adjustments.
5. Blood pressure-lowering drugs: The use of trimetazidine in combination with other antihypertensive agents, such as β-adrenoblockers or angiotensin-converting enzyme inhibitors (ACEIs), may lead to an additional decrease in blood pressure.