Therapy of Angina Pectoris with Low-Dose Perhexiline

We conducted a double-blind, crossover study into the effect of 100 mg of perhexiline maleate twice daily on the response to exercise of 15 patients with proven ischemic heart disease. Patients were evaluated by bicycle ergometry, on three occasions, before treatment and after 2 weeks of treatment with placebo or perhexiline. Patients were able to exercise for a longer period as shown by comparing perhexiline to pretreatment (mean change, 54.9%; p less than 0.001) and placebo values (38.9%; p less than 0.001). An increase in work performed while taking perhexiline was demonstrated when compared to pretreatment (mean change, 29.7%; p less than 0.001) and placebo (26.3%; p less than 0.001). An increase in heart rate at maximal exercise was observed when compared to pretreatment (mean change, 9.7%; p less than 0.01) and placebo (8.8%; p less than 0.01). A reduction in heart rate for a given workload was obtained when compared to pretreatment (mean change, 7.0%; p less than 0.005) and placebo (2.9%; p less than 0.01). An increase in resting systolic blood pressure while taking perhexiline was shown when compared to pretreatment (mean change, 12.8%; p less than 0.02) and placebo measurements (8.5%; p less than 0.05). Perhexiline in a dose of 200 mg daily is effective against angina pectoris and significantly increases exercise tolerance. The likelihood of side effects may be decreased by using this dosage regimen.