Recommended Dosage of Ranolazine for Chronic Angina
The recommended dosage of ranolazine for chronic angina is to start with 500 mg orally twice daily, which can be increased to a maximum of 1000 mg twice daily based on clinical response and symptom control. 1, 2
Dosing Guidelines and Titration
- Initial dose: 500 mg orally twice daily 1
- Maximum dose: 1000 mg orally twice daily 1, 2
- Titration: Increase dose based on clinical symptoms and patient response 1
- Formulation: Extended-release tablets only 1
Special Dosing Considerations
Medication Interactions
- With moderate CYP3A inhibitors (e.g., diltiazem, verapamil, erythromycin): Limit ranolazine to 500 mg twice daily 1
- With P-gp inhibitors (e.g., cyclosporine): Titrate ranolazine based on clinical response 1
Contraindications
- Strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin, nelfinavir) 1
- CYP3A inducers (e.g., rifampin, phenobarbital, St. John's wort) 1
- Liver cirrhosis 1
Clinical Efficacy and Position in Therapy
Ranolazine is indicated as:
- Monotherapy for chronic angina 1
- Add-on therapy when symptoms are inadequately controlled with beta-blockers and/or calcium channel blockers 2
The European Society of Cardiology recommends ranolazine as add-on therapy for patients with inadequate control of angina symptoms while on treatment with first-line agents 2.
Monitoring Requirements
- Baseline assessment: ECG to evaluate QTc interval, renal function, hepatic function 2
- Follow-up monitoring:
Common Side Effects
Clinical Pearls
- Ranolazine provides antianginal effects without reducing heart rate or blood pressure 3
- Long-term studies show that ranolazine is generally well-tolerated in high-risk coronary heart disease patients 4
- Ranolazine has been shown to reduce angina attacks by approximately one per week compared to placebo 5
- Advanced age (≥64 years) may predict higher withdrawal rates due to adverse events 4
By following these dosing recommendations and monitoring guidelines, ranolazine can be effectively and safely used to manage chronic angina symptoms in appropriate patients.