The combination of a
HMG CoA reductase inhibitor like a
statin, such as
simvastatin, with a pFox inhibitor such as
trimetazidine (“Simetazidine”) is particularly advantageous for treatment of end-stage complications, such as acute coronary syndrome (ACS) and chronic
angina, especially in type II diabetics. The
combination therapy is also useful in the treatment and / or prevention of chronic
heart failure (CHF) and
peripheral arterial disease (PAD). The combination of a
nitric oxide (NO) mechanism with increased
NO production with pFox inhibition simultaneously treats both the effect and the cause of
angina. One or more
oral hypoglycemic compounds (biguanides,
insulin sensitizers, such as thiazolidinediones, α-
glucosidase inhibitors,
insulin secretagogues, and
dipeptidyl peptidase IV inhibitors),
protein kinase C (PKC) inhibitors, and acetyl-CoA carboxylase inhibitors can also be used in combination with the
HMG CoA reductase inhibitors and / or pFox inhibitors, especially in type II diabetics, to control glucose levels and treat
endothelial dysfunction. The drugs can be given in combination (e.g. a single tablet) or in separate dosage forms, administered simultaneously or sequentially. In the preferred form the
statin is given in a
dose of between 5 and 80 mg / day in two separate doses, and the pFox inhibitor is administered in a sustained or extended dosage formulation at a
dose of 20 mg three times a day or 35 mg two times a day. The
dose of the
oral hypoglycemic, PKC inhibitor, or acetyl-CoA carboxylase inhibitor varies with the type of
drug used.