[{"from": "human", "value": "Please give me some details about this molecule. [C][O][C][=C][Branch2][Ring1][=Branch1][C][=Branch1][P][=C][Branch1][Branch1][C][=C][Ring1][=Branch1][C][N][C][C][N][C][C][Ring1][=Branch1][O][C][O][C]"}, {"from": "gpt", "value": "The molecule 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, activate sodium-hydrogen and sodium-calcium antiport systems. The increased intracellular calcium decreases contractility. 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.  Trimetazidine is not FDA approved. However, it has been approved in France since 1978."}]