Increased frequency of angina attacks caused by switching a brand-name vasodilator to a generic vasodilator in patients with vasospastic angina: Two case reports

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).

Clinical diagnosis

VSA.

Differential diagnosis

Organic coronary stenosis, microvascular angina, chest pain syndrome and gastroesophageal reflux disease.

Laboratory diagnosis

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.