Pharmacotherapy of Vasospastic Angina

J Cardiovasc Pharmacol Ther. 2016 Sep;21(5):439-51. doi: 10.1177/1074248416640161. Epub 2016 Apr 13.


Vasospastic angina is a diagnosis of exclusion that manifests with signs and symptoms, which overlap with obstructive coronary artery disease, most often ST-segment elevation myocardial infarction. The pharmacotherapy that is available to treat vasospastic angina can help ameliorate angina symptoms. However, the etiology of vasospastic angina is ill-defined, making targeted pharmacotherapy difficult. Most patients receive pharmacotherapy that includes calcium channel blockers and/or long-acting nitrates. This article reviews the efficacy and safety of the pharmacotherapy used to treat vasospastic angina. High-dose calcium channel blockers possess the most evidence, with respect to decreasing angina incidence, frequency, and duration. However, not all patients respond to calcium channel blockers. Nitrates and/or alpha1-adrenergic receptor antagonists can be used in patients who respond poorly to calcium channel blockers. Albeit, evidence for use of nitrates and alpha1-adrenergic receptor antagonists in vasospastic angina is not as robust as calcium channel blockers and can exacerbate adverse effects when added to calcium channel blocker therapy. Despite having a clear benefit in patients with obstructive coronary artery disease, the benefit of beta-adrenergic receptor antagonists, statins, and aspirin remains unclear. More data are needed to elucidate whether or not these agents are beneficial or harmful to patients being treated for vasospastic angina. Overall, the use of pharmacotherapy for the treatment of vasospastic angina should be guided by patient-specific factors, such as tolerability, adverse effects, drug-drug, and drug-disease interactions.

Keywords: calcium channel blockers; long-acting nitrates; vasospasm; vasospastic (Prinzmetal’s) angina.

Publication types

  • Review

MeSH terms

  • Adrenergic alpha-1 Receptor Antagonists / therapeutic use
  • Angina Pectoris, Variant / diagnosis
  • Angina Pectoris, Variant / drug therapy*
  • Angina Pectoris, Variant / etiology
  • Angina Pectoris, Variant / physiopathology
  • Animals
  • Calcium Channel Blockers / therapeutic use
  • Coronary Vasospasm / diagnosis
  • Coronary Vasospasm / drug therapy*
  • Coronary Vasospasm / etiology
  • Coronary Vasospasm / physiopathology
  • Coronary Vessels / drug effects*
  • Coronary Vessels / physiopathology
  • Humans
  • Nitrates / therapeutic use
  • Risk Factors
  • Treatment Outcome
  • Vasoconstriction / drug effects*
  • Vasodilator Agents / adverse effects
  • Vasodilator Agents / therapeutic use*


  • Adrenergic alpha-1 Receptor Antagonists
  • Calcium Channel Blockers
  • Nitrates
  • Vasodilator Agents

Supplementary concepts

  • Prinzmetal's variant angina