Metagard (Tablets) Instructions for Use

Marketing Authorization Holder

Ipca Laboratories Ltd. (India)

ATC Code

C01EB15 (Trimetazidine)

Active Substance

Trimetazidine (Rec.INN registered by WHO)

Dosage Form

Metagard

Coated tablets, 20 mg: 20, 30, or 60 pcs.

Dosage Form, Packaging, and Composition

10 pcs. – blister packs (2) – cardboard boxes.
10 pcs. – blister packs (6) – cardboard boxes.
10 pcs. – blister packs (3) – cardboard boxes.

Clinical-Pharmacological Group

Drug improving metabolism of the myocardium and neurosensory organs under ischemic conditions

Pharmacotherapeutic Group

Antihypoxant

Pharmacological Action

An agent that normalizes the energy metabolism of cells subjected to hypoxia or ischemia. It prevents the decrease in intracellular ATP content, ensures the normal functioning of membrane ion channels, transmembrane transfer of potassium and sodium ions, and the preservation of cellular homeostasis.

Trimetazidine slows down the oxidation of fatty acids by selectively inhibiting long-chain 3-ketoacyl-CoA thiolase, which leads to an increase in glucose oxidation and the restoration of coupling between glycolysis and oxidative decarboxylation and has been shown to provide protection of the myocardium from ischemia. The switching of fatty acid oxidation to glucose oxidation underlies the antianginal action of trimetazidine.

Trimetazidine maintains the energy metabolism of the heart and neurosensory organs during periods of ischemia; reduces the degree of intracellular acidosis and the extent of changes in the transmembrane ion flow that occurs during ischemia; reduces the level of migration and infiltration of polymorphonuclear neutrophils in ischemic and reperfused heart tissues, reduces the size of myocardial damage; while it does not affect hemodynamics.

Pharmacokinetics

Trimetazidine is rapidly and almost completely absorbed from the gastrointestinal tract. V_d is 4.8 L/kg. It easily passes through histohematic barriers. Plasma protein binding is about 16%.

T_1/2 is 4.5-5 hours. It is excreted by the kidneys, mainly unchanged.

Indications

Long-term therapy of coronary artery disease: prevention of attacks of stable angina pectoris as part of mono- or combination therapy.

ICD codes

Dosage Regimen

Administer the tablets orally with a glass of water during meals.

The standard maintenance dose is 20 mg three times daily, equating to a total daily dose of 60 mg.

Alternatively, for patient convenience, a twice-daily regimen of 35 mg per dose may be used, providing a total daily dose of 70 mg.

Adhere strictly to the prescribed dosing schedule; do not alter the dose or frequency without medical consultation.

For patients with moderate renal impairment (creatinine clearance 30-60 mL/min), the recommended dose is 20 mg twice daily (40 mg total daily dose).

This medication is contraindicated in patients with severe renal impairment (creatinine clearance below 30 mL/min).

Exercise caution when prescribing to patients over 75 years of age and those with severe hepatic impairment.

The duration of therapy is determined individually based on the clinical response and the patient’s condition.

This is a long-term prophylactic treatment and is not indicated for the acute relief of angina attacks.

Adverse Reactions

From the digestive system: frequently – abdominal pain, diarrhea, dyspepsia, nausea, vomiting; frequency unknown – constipation.

From the nervous system: frequently – dizziness, headache; infrequently – paresthesia; frequency unknown – symptoms of parkinsonism (tremor, akinesia, increased tone), instability in the Romberg position and unsteady gait, restless legs syndrome (usually reversible after discontinuation of therapy), insomnia, drowsiness.

From the hearing organ and labyrinthine disorders: frequency unknown – vertigo.

From the skin and subcutaneous tissues: frequently – skin rash, itching, urticaria; frequency unknown – acute severe cutaneous adverse reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome) and acute generalized exanthematous pustulosis, which can be fatal.

Allergic reactions frequency unknown – angioedema.

From the cardiovascular system: rarely – palpitations, extrasystole, tachycardia, marked decrease in blood pressure, orthostatic hypotension (may be accompanied by general weakness, dizziness, or loss of balance, especially when taking antihypertensive drugs simultaneously), flushing.

From the hematopoietic system: frequency unknown – agranulocytosis, thrombocytopenia, thrombocytopenic purpura.

From the liver and biliary tract: frequency unknown – hepatitis.

Other: frequently – asthenia.

Contraindications

Hypersensitivity to trimetazidine; Parkinson’s disease, symptoms of parkinsonism, tremor, restless legs syndrome and other related movement disorders; severe renal failure (creatinine clearance less than 30 ml/min); children and adolescents under 18 years of age; pregnancy, lactation (breastfeeding).

With caution

Patients with moderate renal failure (creatinine clearance 30-60 ml/min), patients with severe hepatic failure (10 to 15 points on the Child-Pugh scale); patients over 75 years of age.

Use in Pregnancy and Lactation

Trimetazidine is contraindicated for use during pregnancy and lactation (breastfeeding).

Use in Hepatic Impairment

Should be used with caution in patients with severe hepatic impairment (10 to 15 points on the Child-Pugh scale).

Use in Renal Impairment

Contraindicated in severe renal failure (creatinine clearance less than 30 ml/min). Should be used with caution in patients with moderate renal failure (creatinine clearance 30-60 ml/min).

Pediatric Use

Contraindicated in children and adolescents under 18 years of age.

Geriatric Use

Should be used with caution in patients over 75 years of age.

Special Precautions

Not intended for the relief of angina attacks and is not indicated for the initial course of therapy for unstable angina or myocardial infarction at the prehospital stage or in the first days of hospitalization.

Influence on the ability to drive vehicles and mechanisms

During the use of trimetazidine, patients should exercise caution when driving vehicles and mechanisms, as well as when engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.