Antianginal efficacy of perhexiline maleate in patients refractory to beta-adrenoreceptor blockade

Abstract

We performed a double-blind controlled crossover trial of perhexiline maleate versus identical placebo in daily doses of 100–400 mg in 20 male patients who were severely limited with angina pectoris despite therapy with beta-adrenoreceptor blockers. All patients had documented coronary artery disease and were awaiting coronary artery bypass grafting. Beta-blocker therapy was continued unchanged. A significant response compared to placebo was evident after 100 mg of perhexiline, and incremental therapeutic effects were evident up to 400 mg. The mean weekly angina rate fell from 18.2 ± 2.8 basal to 6.2 ± 1.5 on 200 mg ( P < 0.05) to 2.8 ± 0.9 on 400 mg perhexiline ( P < 0.05). Nitroglycerin consumption fell in parallel. The mean exercise duration increased from 261 ± 57 sec to 384 ± 75 sec ( P < 0.05). Five patients became asymptomatic on perhexiline, and the number of pain-free days increased 100% ( P < 0.01) compared to placebo. No patient experienced hypotension or heart failure. This study shows that the addition of perhexiline to beta-adrenoreceptor antagonists in patients with severe angina pectoris is effective and represents an alternative therapy.