Tryme-MR Special Precautions

This medication is not a curative treatment for angina attacks, nor indicated as an initial treatment for unstable angina or myocardial infarction, nor in the pre-hospital phase or during the first days of hospitalization. In the event of an angina attack, the coronaropathy should be re-evaluated and an adaptation of the treatment considered (medicinal treatment and possibly revascularisation). Trimetazidine 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 a neurologist for appropriate investigations. The occurrence of movement disorders such as parkinsonians symptoms, restless leg syndrome, tremors, gait instability should lead to definitive withdrawal of Trimetazidine. These cases have a low prevalence and are usually reversible after treatment discontinuation. The majority of the patients recovered within 4 months after Trimetazidine 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 to patients in whom an increase exposure is expected: Moderate renal impairment; Elderly patients older than 75 years old.