Introduction : Our study was designed to prove the anti-anginal effect and adverse effects of molsidomine instead of nitrates on the patients with ischemic heart disease. Subjects and Methods : From January to June in 1999, total 58 patients who were diagnosed as ischemic heart disease (exclude AMI, variant angina) was included. We checked vital signs, liver function test, creatine phosphokinase, creatinine, calcium, ECG, echocardiography, urinalysis, treadmill test of all patients before starting molsidomine. Then 51 patients prescribed molsidomine 2mg tid, 5 patients 2mg bid, and 2 patients 4mg tid. After 8 weeks above laboratories were rechecked. The efficacy was determined as excellent, good, fair, poor response. Excellent response was decided when symptoms improved over 2 stage of Canadian Class, good when symptoms improved 1stage. fair when symptoms not changed, and poor response was decided when symptoms aggravated or adverse effects occurred. Results : Patient received molsidomine for mean 10.4 weeks. 7 patients received less than 8 weeks due to adverse effects and aggravated symptoms. The efficacy was excellent in 7 patients, good 34 patients, fair 10 patients, and poor in 7 patients. ECG was changed from nonspecific ST change to normal in 7 patients who showed good efficacy. In 7 patients who showed poor response, 6 patients stopped medication due to adverse effects, as hypotension in one, headache and dizziness in one, hepatotoxicity in two(one was liver cirrhosis), insomnia in one, rash in one, and G.I trouble in one. After stopped medication, all adverse effects except hypotension were recovered. Conclusions : Despite some adverse effects occurred, Molsidomine could be used as anti anginal drug safely, and had relatively good effects. So we concluded that molsidomine can be used in patients of ischemic heart disease except hypotensive patients.