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                         PROMISSORY NOTE

                                                 May 5, 1999

     FOR  VALUE  RECEIVED,  CV  THERAPEUTICS,  INC.,  a  Delaware
corporation ("Borrower"), hereby promises to pay to the order  of
QUINTILES  TRANSNATIONAL  CORP.,  a  North  Carolina  corporation
("Lender"),  in lawful money of the United States of  America  in
immediately  available funds, the aggregate principal  amount  of
all  Advances  (as  defined below) made  by  Lender  to  Borrower
pursuant to the Loan Agreement (as defined below) and endorsed on
the  grid attached hereto, which is a part of this Note, together
with  accrued  and unpaid interest thereon.  The  interest  shall
accrue  on  the  unpaid principal amount of each Advance  at  the
rates  and  in  the manner provided in the Loan  Agreement.   The
unpaid principal amount of, and accrued interest on, each Advance
is  due  and  payable to Lender on the date which is twenty  four
(24)  months  after the date on which such Advance was  made,  as
provided in the Loan Agreement.  Borrower may prepay this Note in
full  or  in  part at any time without penalty.  Any  capitalized
terms  used  but  not  defined herein  shall  have  the  meanings
ascribed to them in the Loan Agreement.

     Each  Advance  made by Lender to Borrower, and all  payments
made  on  account  of  the.  principal amount  hereof,  shall  be
recorded by Lender and endorsed on the grid attached hereto which
is  a  part of this Note.  Failure to so record and endorse  such
Advances  and  payments,  however, shall  not  affect  Borrower's
obligations in respect of such Advances.

     This  Note  is the First Year Sales Note referenced  in  the
Loan  Agreement between Borrower and Lender dated as of the  date
of this Note (as same may be amended from time to time, the "Loan
Agreement"), and is entitled to the benefits thereof.   The  Loan
Agreement,  among other things, (i) provides for  the  making  of
certain  First  Year  Sales Advances ("Advances")  by  Lender  to
Borrower   from  time  to  time,  the  indebtedness  of  Borrower
resulting  from  each  such  Advance  being  a  principal  amount
evidenced  by this Note, (ii) provides that this Note is  secured
by,  and Borrower has granted a security interest in, certain  of
its assets as set forth in that certain Security Agreement, dated
as  of the same date as this Note, and (iii) provides that Lender
may, under certain circumstances set forth in Section 2.07 of the
Loan Agreement, convert the outstanding principal balance of  and
all  accrued  interest on this Note, in whole or  in  part,  into
shares  of Common Stock in accordance with the provisions of  the
Loan Agreement.

     In  case  an Event of Default shall occur and be continuing,
the  unpaid  principal amount of, and accrued interest  on,  this
Note may be declared to be due and payable in the manner and with
the effect provided in the Loan Agreement.

     Borrower hereby waives presentment, demand, notice,  protest
and  all  other  demands  and  notices  in  connection  with  the
delivery, acceptance, performance and enforcement of this Note.

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             Signature Page to First Year Sales Note

     This  Note  shall  be  governed  by  and  be  construed   in
accordance with the laws of the State of Delaware without  regard
to the conflicts of law rules of such state.

                                BORROWER:

                                CV THERAPEUTICS, INC.

                                By:     /s/ Louis Lange
                                Name:   Louis G. Lange
                                Ttitle: Chairman & CEO

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               ADVANCES AND PAYMENTS OF PRINCIPAL

        Date      Amount     Amount of       Unpaid    Notation
                    of       Principal     Principal    Made By
                 Advance      Paid or       Balance
                              Prepaid