Trimetazidine is a piperazine derivative indicated for the symptomatic treatment of stable angina pectoris in patients inadequately controlled or intolerant to first line therapies. Trimetazidine has been studied as a treatment for angina pectoris since the late 1960s. Acidic conditions, caused by anaerobic metabolism and fatty acid oxidation, in response to myocardial ischemia, trimetazidine use activate sodium-hydrogen and sodium-calcium antiport systems. The increased intracellular calcium decreases contractility. trimetazidine hcl Structure. It is hypothesized that trimetazidine inhibits 3-ketoacyl coenzyme A thiolase, which decreases fatty acid oxidation but not glucose metabolism, preventing the acidic conditions that exacerbate ischemic injury. However, evidence for this mechanism is controversial.