VASTAREL MR TABS 30S

What Is VASTAREL MR?

Vastarel MR contains Trimetazidine, a unique anti-ischaemic medicine that works through a completely different mechanism from all other heart medicines. Rather than affecting heart rate or blood pressure like beta-blockers, nitrates, or calcium channel blockers, Trimetazidine works at the cellular energy level inside the heart muscle itself.

Vastarel MR (Trimetazidine) works by partially inhibiting fatty acid oxidation, shifting the heart's energy metabolism away from fat (which uses more oxygen) towards glucose (which uses less oxygen for the same energy output).

This metabolic switch makes the heart more efficient and more resistant to damage during periods of reduced blood flow (ischaemia), without affecting heart rate or blood pressure. The modified-release formulation provides stable levels throughout the day with twice-daily dosing.

What Is It Used For?

Vastarel MR is prescribed as an add-on treatment for patients with stable angina pectoris, the chest pain or pressure caused by reduced blood flow to the heart muscle during physical activity or stress, whose symptoms are not fully controlled by standard antianginal medicines (beta-blockers, nitrates, or calcium channel blockers).

Vastarel MR (Trimetazidine) is not used on its own as a replacement for these standard treatments but rather as a metabolic complement that helps the heart cope better with reduced oxygen supply.

In Kenya, it is prescribed by cardiologists and internists for patients with chronic stable angina, particularly those with diabetes (where the metabolic mechanism of Trimetazidine is especially beneficial), and those who cannot tolerate higher doses of haemodynamic antianginals due to low blood pressure or bradycardia. It has also been explored in heart failure management as a metabolic adjunct.

Usual Dose

35mg twice daily, one tablet in the morning and one in the evening with meals.

With Food

Take with meals to improve gastrointestinal tolerability.

Swallow Whole

Swallow the modified-release tablet whole, do not crush or chew it.

Consistency

Take at the same times each day for consistent blood levels and anti-ischaemic protection.

Missed Dose

Take as soon as remembered with food. If nearly time for the next dose, skip the missed one. Never double dose.

Duration

Long-term continuous therapy as part of the overall antianginal regimen. Do not stop without consulting your cardiologist.

Common Side Effects

·       Nausea or stomach discomfort (take with food to minimise)

·       Dizziness

·       Headache

·       Abdominal pain

Uncommon Side Effects

·       Vomiting

·       Diarrhoea or constipation

·       Skin rash, itching, or urticaria

·       Fatigue

·       Increased liver enzymes

Serious Side Effects, Seek Immediate Medical Attention

·       Parkinsonian symptoms (tremor, rigidity, gait disturbance), associated with long-term use, particularly in elderly patients. Stop and seek medical evaluation if movement disorders appear

·       Restless legs syndrome, worsening with long-term use

·       Falls and gait disorders in elderly patients due to Parkinsonism

·       Severe hepatic dysfunction (rare)

·       PARKINSONISM: Trimetazidine blocks dopamine receptors and can cause or worsen Parkinsonian movement symptoms, tremor, slow movement, rigidity, and gait difficulty. If these develop, stop Vastarel MR and inform your cardiologist. This is particularly relevant in elderly patients.

·       RENAL FUNCTION: Reduce dose and monitor carefully in moderate renal impairment (eGFR 30–60 ml/min). Avoid in severe renal impairment.

·       ELDERLY: Higher risk of Parkinsonian side effects and falls, use with caution and monitor for movement changes regularly.

·       NOT MONOTHERAPY: Vastarel MR is an add-on antianginal, it does not replace beta-blockers, nitrates, or other standard treatments for angina.

·       REGULATORY STATUS: Some regulatory agencies have restricted Trimetazidine use due to the Parkinsonism risk, prescribers should be aware of current guidance.

No significant pharmacokinetic drug interactions documented for Trimetazidine.

Dopamine antagonists (metoclopramide, haloperidol, domperidone): Additive risk of extrapyramidal/Parkinsonian effects, avoid combination where possible.

Cardiac medications (beta-blockers, nitrates, calcium channel blockers, antiplatelets): No adverse pharmacokinetic interactions, Trimetazidine is used as an add-on to these without interference.

·       Store below 25°C in a cool, dry place.

·       Keep in original blister packaging.

·       Protect from moisture and light.

·       Keep out of reach of children.

Vastarel MR is a prescription-only medicine (POM) in Kenya. It is prescribed by cardiologists and internists as part of a comprehensive antianginal regimen. Available at Pharmily with a valid prescription.

Vastarel MR (Trimetazidine 35mg MR) is the Servier originator anti-ischaemic metabolic agent, verify the prescriber is a cardiologist or internist and the indication is stable angina adjunct therapy. The Parkinsonism risk is the dominant pharmacovigilance concern, document screening at dispensing for pre-existing movement disorders or Parkinson's disease (absolute contraindication).

In elderly patients, proactively counsel on monitoring for tremor, gait changes, and rigidity, and advise carers to report these. The dopamine antagonist interaction (metoclopramide, haloperidol, domperidone) is clinically relevant, check the full medication list for concurrent antiemetics or antipsychotics.

Regulatory note: the EMA has restricted Trimetazidine to second-line use after standard antianginals; confirm it is being prescribed appropriately as adjunct, not monotherapy. The MR tablet must not be crushed, document at dispensing.

Q1: What is Vastarel MR used for?

A: Vastarel MR is used to reduce angina attacks, the chest pain or tightness caused by reduced blood flow to the heart. It works at the cellular level to make the heart more efficient with less oxygen, and is added to existing heart medicines for better symptom control.

Q2: How is Vastarel MR different from other angina medicines like beta-blockers or nitrates?

A: Beta-blockers and nitrates reduce the heart's workload by slowing the heart rate or dilating blood vessels. Vastarel MR works differently, it shifts the heart's energy source to make it more efficient during reduced blood flow, without affecting heart rate or blood pressure. This makes it uniquely complementary.

Q3: Can Vastarel MR replace my other heart medicines?

A: No, Vastarel MR is an add-on treatment, not a replacement. You must continue all other prescribed antianginal medicines alongside it. Do not stop any heart medicine without consulting your cardiologist.

Q4: What are the movement-related side effects I should watch for?

A: Some patients on long-term Trimetazidine, particularly the elderly, develop Parkinsonian symptoms: trembling hands, muscle stiffness, slow shuffling walk, or difficulty with balance. If you notice any of these changes, stop Vastarel MR and see your cardiologist promptly.

Q5: How long will I need to take Vastarel MR?

A: Vastarel MR is a long-term treatment for chronic stable angina. Your cardiologist will review it at regular appointments. Do not stop it without medical advice.