From the Guidelines
Ranexa (ranolazine) is contraindicated in patients with hepatic impairment or liver cirrhosis due to the risk of QT interval prolongation and potential accumulation of the drug. This is based on the most recent and highest quality study available, which emphasizes the importance of avoiding ranolazine in patients with liver disease 1.
Key Contraindications
- Hepatic impairment or liver cirrhosis: Ranolazine is contraindicated in these patients due to the risk of QT interval prolongation and potential accumulation of the drug 1.
- Patients taking digoxin: Ranolazine increases digoxin concentration and should be used with caution in these patients 1.
Important Considerations
- QT interval prolongation: Ranolazine can prolong the QT interval, and its effects on QT-interval prolongation are dose-dependent 1.
- Drug interactions: Patients taking certain medications, such as digoxin, should use ranolazine with caution due to potential drug interactions 1. It is essential to carefully evaluate each patient's medical history and current medications before prescribing ranolazine to ensure safe and effective use.
From the FDA Drug Label
4 CONTRAINDICATIONS
Ranolazine Extended-Release Tablets is contraindicated in patients: • Taking strong inhibitors of CYP3A [see Drug Interactions ( 7.1)] • Taking inducers of CYP3A [see Drug Interactions ( 7.1)] • With liver cirrhosis [see Use in Specific Populations ( 8.6)]
The contraindications to Ranexa (ranolazine) are:
- Taking strong inhibitors of CYP3A
- Taking inducers of CYP3A
- Patients with liver cirrhosis 2
From the Research
Contraindications to Ranexa (Ranolazine)
There are no direct contraindications to Ranexa (ranolazine) mentioned in the provided studies. However, some studies provide information on the use of ranolazine in patients with certain conditions:
- Ranolazine is extensively metabolized by cytochrome P450 (CYP) 3A enzymes and, to a lesser extent, by CYP2D6 3
- Ranolazine pharmacokinetics are unaffected by sex, congestive heart failure, and diabetes mellitus, but the area under the plasma concentration-time curve (AUC) increases up to 2-fold with advancing degree of renal impairment 3, 4
- In patients with mild to severe renal impairment, the AUC of ranolazine is increased by 1.72- to 1.97-fold compared to healthy subjects 4
- There is no direct information on the use of ranolazine in patients with liver disease, but one study suggests that ranolazine treatment may lead to a significant reduction in liver function tests in patients with nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD) 5
Special Considerations
Some considerations for the use of ranolazine in certain patient populations include:
- Patients with renal impairment: dose adjustment may be necessary due to increased AUC 3, 4
- Patients with liver disease: although there is limited information, one study suggests that ranolazine may be beneficial in reducing liver function tests in patients with NAFLD and CAD 5
- Patients taking other medications: ranolazine may interact with other medications, such as CYP3A inhibitors, which can increase ranolazine exposure 3