A patient with Prinzmetal (variant) angina is best managed with which of the following drug classes?
- A Non-selective beta-blockers such as propranolol
- B Cardioselective beta-blockers such as metoprolol
- C Dihydropyridine calcium channel blockers such as nifedipine or amlodipine ✓
- D Class IA antiarrhythmics such as quinidine
Correct answer: C. Dihydropyridine calcium channel blockers such as nifedipine or amlodipine
Explanation
Prinzmetal's angina is caused by coronary artery vasospasm; calcium channel blockers (CCBs), particularly dihydropyridines (nifedipine, amlodipine), are first-line treatment because they directly relax coronary vascular smooth muscle via L-type calcium channel blockade. Non-selective beta-blockers are contraindicated as they leave alpha-adrenoceptor-mediated vasoconstriction unopposed, potentially exacerbating coronary spasm. Nitrates are also effective but CCBs are the mainstay.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.