What medications are usually avoided in patients experiencing vasospastic angina?

In patients experiencing vasospastic angina, beta-blockers are typically avoided due to their mechanism of action, which can potentially exacerbate vasospasm. Vasospastic angina is characterized by transient episodes of chest pain caused by coronary artery spasm. Beta-blockers work by blocking beta-adrenergic receptors, which can lead to unopposed α-receptor stimulation. This unopposed stimulation may result in increased vasoconstriction of the coronary arteries, worsening the episodes of angina rather than alleviating them.

In contrast, calcium channel blockers are often used in the treatment of vasospastic angina because they directly promote vasodilation of coronary arteries and help prevent spasms. ACE inhibitors are generally considered neutral or beneficial in the setting of coronary artery disease and are not typically linked with worsening vasospastic episodes. Anticoagulants are not typically relevant in the context of vasospastic angina and are more associated with other cardiovascular events such as thrombosis rather than the management of vasospasm.