From the Research
For patients on hemodialysis, the standard dosing of ranolazine can generally be maintained without significant adjustment, with a typical starting dose of 500 mg twice daily, which can be increased to 1000 mg twice daily as needed for symptom control, as supported by the most recent study 1.
Key Considerations
- Ranolazine is primarily metabolized by the liver and is not significantly removed by hemodialysis, so no specific dose reduction or timing relative to dialysis sessions is required 2, 1.
- However, it's essential to monitor patients closely for side effects, particularly in those with severe renal impairment, as ranolazine can interact with other drugs and affect QT interval 3, 4.
- The medication should be taken with or without food and swallowed whole, not crushed or chewed.
- While ranolazine doesn't require major adjustments for hemodialysis patients, it's crucial to assess overall cardiovascular status and concomitant medications.
Dosing and Administration
- The typical starting dose is 500 mg twice daily, which can be increased to 1000 mg twice daily as needed for symptom control 1.
- Patients with severe renal impairment or those older than 80 years may require closer monitoring and potentially lower doses to minimize the risk of adverse effects 4.
Important Interactions and Precautions
- Ranolazine can interact with other drugs, such as tacrolimus, and affect QT interval, so close monitoring of these patients is necessary 3.
- Healthcare practitioners should be aware of the potential for neurologic adverse effects, such as dysarthria, dysmetria, and hallucinations, particularly in patients with renal impairment or advanced age 4.