Low dose imipramine improves chest pain but not quality of life in patients with angina and normal coronary angiograms

Aims We investigated patients with chest pain and normal coronaryangiograms to determine whether low dose imipramine prescribedas add-on therapy to conventional anti-anginals reduced theincidence of chest pain and whether this led to an overall improvementin quality of life. Methods and results We performed a randomized, double-blind, cross-over trial ofimipramine 50mg daily vs placebo in 18 women (median age 53years; range 35–72) with chest pain and normal coronaryangiograms who were suffering at least two anginal episodesper week despite conventional anti-anginal medication. Eachtreatment phase lasted 5 weeks and the incidences of chest painand side effects were carefully recorded. Quality of life wasmonitored using a validated health profile questionnaire scoringperceived distress in six domains (pain, energy, mobility, sleep,emotional reactions and social isolation). The total numberof chest pain episodes was significantly less during activetreatment compared to placebo [11 (3–22) vs 21 (16–28)—median(interquartile range); P=0·01]. However, a high incidence(83%) of side effects was reported during active treatment andthree patients had to be withdrawn from the study as a consequence.No significant improvement was detected in any of the six qualityof life domains when imipramine was compared to placebo. Conclusion Imipramine reduces the incidence of chest pain in patients withchest pain and normal coronaries who remain symptomatic despiteconventional anti-anginal therapy. The failure to demonstrateassociated improvements in quality of life may have been dueto the high incidence of side effects.