From the Guidelines
Ranexa (ranolazine) is primarily used to treat chronic angina, with a recommended initial dose of 500 mg orally twice daily, which can be uptitrated to a maximum of 1000 mg orally twice daily, as indicated in the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes 1. The medication works by inhibiting the late inward sodium current, reducing the deleterious effects of intracellular sodium and calcium overload that accompany myocardial ischemia, thereby improving blood flow to the heart without significantly affecting heart rate or blood pressure.
- Key benefits of Ranexa include: + Reduced incidence of recurrent ischemia, particularly in women and patients with prior chronic angina + Lower primary composite endpoint, including cardiovascular death, MI, or recurrent ischemia + Increased exercise duration
- Common side effects of Ranexa include constipation, nausea, dizziness, and headache, with a dose-related QTc interval prolongation, although this was comparable to placebo in the MERLIN-TIMI 36 trial 1.
- Ranexa is usually well tolerated and is a valuable treatment option for patients who continue to experience angina despite other treatments or who cannot tolerate traditional anti-anginal medications due to their effects on heart rate or blood pressure.
From the FDA Drug Label
Ranolazine Extended-Release Tablets are indicated for the treatment of chronic angina. Ranolazine Extended-Release Tablets may be used with beta-blockers, nitrates, calcium channel blockers, anti- platelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers.
The use of Ranexa (ranolazine) is for the treatment of chronic angina. It may be used in combination with other medications such as beta-blockers, nitrates, calcium channel blockers, anti-platelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers 2.
From the Research
Use of Ranexa (Ranolazine)
- Ranolazine (Ranexa) is a new antianginal agent approved for the treatment of chronic stable angina pectoris for use as combination therapy when angina is not adequately controlled with other antianginal agents 3, 4.
- The exact mechanism of action of ranolazine is not known, but its antianginal and anti-ischemic effects do not appear to depend upon changes in blood pressure or heart rate 3, 5, 4.
- Ranolazine is effective as adjunctive therapy in patients with chronic stable angina whose condition is not controlled adequately with conventional antianginal therapy 3, 4, 6.
- The drug is well tolerated, with no overt effects on cardiovascular hemodynamics or conduction, apart from a modest increase in corrected QT interval (but no torsades de pointes) 3, 4, 7.
Indications and Usage
- Ranolazine (Ranexa) is indicated for patients with chronic stable angina who have not responded to standard anti-anginal therapy 6.
- It is used as an adjunctive treatment to beta-blockers, calcium channel blockers, or long-acting nitrates 6.
- Ranolazine is effective in reducing anginal symptoms in patients with chronic stable angina, and it can be used as monotherapy or add-on therapy 7.
Safety and Tolerability
- The most common adverse effects reported in clinical trials during ranolazine treatment are dizziness, headaches, constipation, and nausea 5, 6, 7.
- Ranolazine treatment is associated with QTc-interval prolongation, but this does not appear to have clinical consequences 5, 7.
- Ranolazine is hemodynamically neutral, exerting its antianginal effect without significantly impacting patient heart rate or blood pressure 7.