Goto-Semba R, Fujii Y, Ueda T, Oshita C, Teragawa H. Increased frequency of angina attacks caused by switching a brand-name vasodilator to a generic vasodilator in patients with vasospastic angina: Two case reports. World J Cardiol 2018; 10(3): 15-20 [PMID: 29588810 DOI: 10.4330/wjc.v10.i3.15]
Corresponding Author of This Article
Hiroki Teragawa, FACC, FACP, FAHA, MD, PhD, Chief Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroteraga71@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Mar 26, 2018; 10(3): 15-20 Published online Mar 26, 2018. doi: 10.4330/wjc.v10.i3.15
Increased frequency of angina attacks caused by switching a brand-name vasodilator to a generic vasodilator in patients with vasospastic angina: Two case reports
Remi Goto-Semba, Department of Education and Training, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Yuichi Fujii, Tomohiro Ueda, Chikage Oshita, Hiroki Teragawa, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Goto-Semba R, Fujii Y, Ueda T and Oshita C contributed to the acquisition of data; Goto-Semba R and Teragawa H contributed to writing; Teragawa H revised the manuscript.
Informed consent statement: The patients involved in this study gave their written informed consent authorizing use and disclosure of their protected health information.
Conflict-of-interest statement: None of the authors have any conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroki Teragawa, FACC, FACP, FAHA, MD, PhD, Chief Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroteraga71@gmail.com
Telephone: +81-82-2621171 Fax: +81-82-2621499
Received: November 24, 2017 Peer-review started: November 24, 2017 First decision: December 27, 2017 Revised: January 12, 2018 Accepted: February 6, 2018 Article in press: February 6, 2018 Published online: March 26, 2018 Processing time: 119 Days and 3 Hours
ARTICLE HIGHLIGHTS
Case characteristics
The frequency of angina attacks increased after switching a brand-name vasodilator to a generic vasodilator in two patients with vasospastic angina (VSA).
Both patients had dyslipidemia, but the laboratory tests for lipid levels were within normal limits because they were being treated for dyslipidemia.
Imaging diagnosis
Coronary angiography and the spasm provocation test showed bilateral coronary spasm in both cases. These findings are indicative of severe VSA.
Treatment
After switching back from the generic vasodilators to the brand-name vasodilators, the frequency of angina attacks decreased to baseline in both patients.
Related reports
According to meta-analyses, the clinical effects of generic and brand-name drugs used in cardiovascular disease are similar, but it is unclear whether this is the case for patients with higher severity of VSA.
Term explanation
VSA is characterized by the transient vasoconstriction of the epicardial coronary artery, leading to myocardial ischemia. VSA causes not only rest angina but also exertional angina, acute coronary syndrome and ischemic cardiac arrest.
Experience and lessons
Generic vasodilators may not sufficiently prevent angina attacks in patients with a high severity of VSA. Thus, when treating VSA patients with medication-refractory anginal symptoms, it is important that cardiologists confirm the type (brand-name or generic) of vasodilator drugs used.
