Angirel MR Special Precautions

Trimetazidine hydrochloride (ANGIREL MR) can cause or worsen Parkinsonian symptoms (tremor, akinesia, hypertonia), which should be regularly investigated, especially in elderly patients. In doubtful cases, patients should be referred to neurologist for appropriate investigations.
The occurrence of movement disorders such as Parkinsonian symptoms, restless leg syndrome, tremors, gait instability should lead to definitive withdrawal of Trimetazidine.
These cases have a low incidence and are usually reversible after treatment discontinuation. The majority of the patients recovered within 4 months after Trimetazidine hydrochloride (ANGIREL MR) withdrawal. If Parkinsonian Symptoms persist more than 4 months after drug discontinuation, a neurologist opinion should be sought.
Falls may occur, related to gait instability or hypotension, in particular in patients taking antihypertensive treatment.
Caution should be exercised when prescribing Trimetazidine hydrochloride (ANGIREL MR) to patients in whom an increased exposure is expected: moderate renal impairment, elderly patients older than 75 years old.
Effects on ability to drive and use machines: Trimetazidine hydrochloride (ANGIREL MR) does not have hemodynamic effects in clinical studies, however cases of dizziness and drowsiness have been observed in post-marketing experience, which may affect ability to drive and use machines.