Allopurinol is a safe and inexpensive xanthine oxidase inhibitor-like drug that has been used for decades in the treatment of gout. High doses of allopurinol also appear to be an effective anti-ischemic agent for patients with angina, according to the results of a randomized, placebo-controlled study. In the double-blind crossover study, which included 65 patients, allopurinol significantly prolonged the overall median time to ST-segment depression (the study’s primary endpoint) in patients, according to results from a standard exercise trial, according to a paper published online June 8 in The Lancet by Dr. Dundee University, Scotland, and colleagues — a point estimate of this value (absolute difference between allopurinol and placebo) resulted in 43s, a 19% prolongation of this time. The drug also significantly prolonged the median time to exercise and chest pain onset in patients with point estimates of 58s and 38s, respectively. The time to ST-segment depression in patients in the placebo and treatment groups was prolonged from a baseline value of 232s to 249s and 298s, respectively, and the total time to exercise in patients in both groups was prolonged from a baseline value of 301s to 307s and 393s, respectively. The time to symptom onset was prolonged from a baseline value of 234 s to 272 s and 304 s in both groups. patients were between 18 and 85 years of age and all had angiographically confirmed coronary artery disease with positive exercise stress test results and a history of chronic stable angina for at least 2 months prior to study entry. These patients were randomly assigned to take allopurinol or placebo daily for a total of 6 weeks of treatment. The investigators wrote, adding that the magnitude of the anti-ischemic effect demonstrated by allopurinol in the study was similar to that observed previously with other anti-anginal drugs. For example, the improved effects reported in previous studies by amlodipine, nitrates, phosphodiesterase inhibitors, ivabradine, and atenolol and ranolazine were 13%, 11%, 14%, 13.5%, and 15%, respectively, compared with placebo, they reported. ”Allopurinol may now be considered a potential drug for the treatment of angina,” the researchers wrote, adding that there are numerous advantages over other existing anti-anginal drugs, including low cost, a good long-term safety record of more than 40 years of use in patients with gout, and better patient tolerance; allopurinol does not It does not lower patients’ blood pressure or heart rate and does not cause side effects such as headaches or fatigue, which are common when patients are on nitrates and beta-blockers, they noted. Further studies are needed to better characterize “the exact role of allopurinol in the treatment of angina,” but it is a particularly attractive drug for developing countries where the use of more expensive treatments is limited, they concluded. Stable angina, the most common early manifestation of coronary artery disease, can trigger acute coronary syndromes, especially in high-risk groups, and the incidence of residual symptoms and reduced quality of life caused by the disease is high even in patients with good treatment status. Despite this, the disease has received little attention compared with unstable angina and other acute coronary syndromes, said Dr. D., Golden Jubilee National Hospital, West Denbighshire, Scotland, and the Scottish Advanced Heart Failure Service System, in an editor’s note. Although more work is needed to confirm the efficacy of allopurinol and to better understand the drug’s mechanism of action, the drug appears to have emerged as one of many compounds that pose a challenge in the anti-angina treatment paradigm, they said. ”Although prevention of coronary artery disease remains important, preventing myocardial cell ischemia is the logical and pragmatic approach when it comes to preventing patient disability that may be caused by several mechanisms,” they added.