Angina. Is Pexid a good choice?

[Joergen-Andersen]

  Some days ago I posted a message regarding Pexid in sci,med.cardiology
  I have however only had one reply by email, which described it,s
  toxidity to the nervous system, which the person had found via a
  search engine, that encouraged me to search again and I got following
  result
  
  Perhexiline maleate
      Pexid (Sigma Pharmaceuticals)
      100 mg tablets
      Indication: angina
      This drug was introduced to Australia in 1978 (see 'New drugs'
  Aust Prescr 1978;2:108), but has not been generally available
      for a few years. The product is being reintroduced for patients
  who have contraindications, or have not responded to, other
      treatments for angina. As perhexiline has serious adverse effects,
  its use will be restricted to reducing the frequency of attacks
      in patients who have intractable angina, but cannot have coronary
  bypass surgery.
      Adverse effects occur in 65% of patients and approximately 8% have
  to stop treatment. The severe adverse effects are
      peripheral neuropathy, papilloedema, hypoglycaemia and weight
  loss. Changes in liver enzymes occur frequently and some
      patients develop liver damage which can be fatal. All patients
  should be examined monthly and have regular monitoring of
      plasma concentrations, glucose and liver function.
  
  http://www.medfac.unimelb.edu.au/ap/volume19/issue2/ap19-2-4.html

  As outlined in Articles 2, 11 and 3 ('Half-life'
  Aust Prescr 1988;11:57-9), the approach to  steady state is determined
  by the half-life and the use, or not, of a loading dose. It is usually
  best to wait and assay at steady state unless
   there are concerns about toxicity. This does not
  apply to drugs such as amiodarone and
  perhexiline with very long half-lives and which
  can cause severe toxicity - steady state may
  take months to be reached and dose
  adjustments need to be made along the way.
  With all drugs, if a sample is taken before
  steady state is reached, allowance needs to be
  made for this in interpreting the concentration.
  http://www.medfac.unimelb.edu.au/ap/volume20/issue1/ap20-1-6.html

  
  My dosage is 100mg twice daily I have been on the drug since dec 96
  I'm coping well at the moment. My last hospitalization was in feb this
  year with unstable angina, No bloodtest regime has been arranged,
  which surprises me having read the above. I see my GP bimonthly.
  Would anybody in this group have any information and with regard to
  this drug?
  -------------------------------
  The Message above is a copy of a post I submitted in sci.med.pharmacy, unfortunenate I have not had any response.
  My concern is do I unnessary take a drug which is too toxid?I am aware that the cardiologist at Monash have taken my
  condition into consideration, but there does not seem to be much information available
  on the net, which means that there perhaps are better alternatives.
  I take number of other medications as well
  Aspirin half daily Atenolol 50mg Norvasc 10mg
  Imdur 120mg at night Zoton 30mg twice daily and
  as mentioned Pexid 100mg twice daily
  I am going to question my GP in the near future, with regard to
  bloodtest. As far as Monash goes they have been very diligent
  as far as information about drugs, bar Pexid.
  After my Angioplasties did they put me on Ticlid for a month and
  imformed my GP to arrange weekly blood tests, I would imagine Ticlid
  is a lot safer than Pexid, but I could be wrong and just be a nervous nellie.
  I'm also planning to either stop or cut down on Pexid. Would it be a good
  idea, or should I wait until some test been. The drug apparently will hang
  about for a while, so I might get some other adverse effect.
  Hoping Yoy will be able enlighten
  many regards Joergen

[CCF CARDIO MD APS]

_
Dear Joergen,  It is a general principal that you maximize the drugs that have been used for years and have few if any side effects, in this regard you are not aon the mazimal dose of beta blocker(atenolo).  This may
be because your heart rate is already in the 50's and any incrrease in the drug might lower that to the point of danger for you.  Quite recently there have been new surgical and now even percutaneous procedures devised just for the treatment
of intractable angina.  The name is TMR(transmyocardial revascularization) and involves making channels in to the heart muscle with laser type devices that allow blood to flow in to those areas that are starved for oxygen but are non bypassable with the traditional methods(namely bypass surgery and balloon angioplasty).
Even more recently there are studies of a kind of gene therapy for those with intractabe angina; this involves placing a substance called growth factor in to your heart area that stimulates your body to create new blood vessels (called angiogenesis).  Here at the Cleveland Clinic we are enrolling patients just like you who have intractable angina for
evaluation to have one or the other performed.  If you are interested in being evaluated as such you can call 1-800-CCF-CARE and ask for an appointment with the Chairman of the Catheterization lab, Dr.Ellis who is the principal investigator (incharge) of this trial that I mentioned.  If none of these options were available I might say to you that you should continue any drug that helps your pain without being more detrimental than helpful.
This of course is a decision to be made by you and your physician.  However since there are these new promising therapies that have minimal risk for bad outcomes as compared to this drug you speak of , I suggest you speak with your cardiologist or internist about these new techniques which although do not at present have proven benefit, are very much promising and almost certainly less risky than this Pexil you speak of above.  
Good Luck  Information provided in the Heart Forum is intended for general informational purposes only.
Actual diagnosis and treatment can only be made by your physician(s).