From the Guidelines
Ranolazine is not an anti-platelet agent, but rather an anti-anginal medication used to treat chronic stable angina. Ranolazine works by inhibiting the late sodium current in cardiac cells, which improves oxygen efficiency in the heart without significantly affecting heart rate or blood pressure 1. Unlike anti-platelet agents such as aspirin, clopidogrel, or ticagrelor that prevent platelets from sticking together and forming clots, ranolazine does not directly affect platelet function or aggregation.
Key Points
- Ranolazine is typically prescribed at doses of 500-1000 mg twice daily for patients with chronic angina who have not responded adequately to other anti-anginal medications 1.
- The most recent guidelines from the European Heart Journal in 2024 recommend long-acting nitrates or ranolazine as add-on therapy in patients with inadequate control of symptoms while on treatment with beta-blockers and/or CCBs, or as part of initial treatment in properly selected patients 2.
- While some studies have suggested ranolazine may have minor effects on platelet reactivity, these are not clinically significant enough to classify it as an anti-platelet agent, and it should not be used for anti-platelet purposes in clinical practice.
Clinical Considerations
- Ranolazine is usually well tolerated, with major adverse effects including constipation, nausea, dizziness, and headache 1.
- Ranolazine prolongs the QTc interval in a dose-related manner, but QTc prolongation requiring dose reduction was comparable with ranolazine and placebo in the MERLIN-TIMI 36 trial 1.
- Aspirin, clopidogrel, and other anti-platelet agents are recommended for patients with chronic coronary syndrome, with or without a history of MI or revascularization 2.
From the FDA Drug Label
Ranolazine Extended-Release Tablets may be used with ... anti-platelet therapy Ranolazine (Ranexa) is not an anti-platelet agent, as the label suggests it may be used with anti-platelet therapy, implying it is a separate entity 3.
From the Research
Ranolazine Mechanism and Classification
- Ranolazine is a novel antianginal and anti-ischemic agent 4, 5, 6, 7, 8
- Its exact mechanism of action is unknown, but it is thought to improve ischemic symptoms by reducing myocardial cellular sodium and calcium overload via inhibition of the late sodium current (I(Na)) of the cardiac action potential 5, 6, 8
- Ranolazine does not have significant effects on heart rate or blood pressure, unlike other available antianginal drugs 4, 7
Anti-Platelet Agent Classification
- There is no evidence to suggest that ranolazine is an anti-platelet agent 4, 5, 6, 7, 8
- Ranolazine's mechanism of action is unique and does not involve anti-platelet activity 5, 6, 8