Objective To evaluate the clinical efficacy and safety of Compound Danshen Dripping Pill (CDDP) and Isosorbide Mononitrate (ISMN) in the treatment of unstable angina pectoris (UAP) in the elderly. Materials and Methods CNKI, Wanfang, VIP, CBM, and PubMed databases were searched for appropriate articles without language limitations on keywords. RevMan 5.3 software was used to perform the meta-analysis. Results This analysis compared CDDP with ISMN of 21 randomized controlled trials (RCTs) that involved a total of 2356 patients with UAP. When the treatment lasted for four weeks, the clinical effective rate was OR = 3.97, 95% CI = 2.97, 5.30, and P < 0.00001, the ECG efficiency was OR = 3.43, 95% CI = 2.13, 5.53, and P < 0.00001, and incidence of adverse reactions was OR = 0.73, 95% CI = 0.52, 1.04, and P = 0.08 > 0.05. When the treatment lasted for eight weeks, clinical efficiency rate was OR = 4.22, 95% CI = 2.37, 3.79, and P < 0.00001, incidence of adverse reactions was OR = 0.58, 95% CI = 0.26, 1.27, and P = 0.17 > 0.05, whole blood low-cut blood viscosity was SMD = -0.61 and 95% CI -1.60, 0.38, whole blood high-cut blood viscosity was SMD = -0.38 and 95% CI -0.97, 0.21, and blood cells specific volume was SMD = -0.80 and 95% CI -2.61, 1.01. Conclusion Based on this meta-analysis, the CDDP was superior to ISMN with UAP in the elderly. However, there is still a need to further verify the clinical efficacy and safety of CDDP with more strictly designed RCTs with large sample and multiple centers in the future.