From the Guidelines
Ranolazine is indicated for the treatment of chronic stable angina pectoris in patients who have not achieved adequate symptom control with other antianginal medications. The most recent and highest quality study, published in 2018 in Nature Reviews Cardiology 1, supports the use of ranolazine as an effective treatment for reducing symptoms of chronic stable angina. The recommended initial dose is 500 mg orally twice daily, which can be escalated as needed to a maximum of 1000 mg twice daily, as stated in the 2013 guidelines published in Circulation 1.
Key Points for Ranolazine
- Ranolazine is effective in reducing symptoms of chronic stable angina, with a neutral hemodynamic profile, making it useful in cases of bradycardia and/or hypotension 1.
- It does not improve outcomes of patients with chronic stable angina, independently from the ventricular function, as shown in the RIVER-PCI trial and the MERLIN trial 1.
- Ranolazine might be effective in patients with microvascular angina, with some small studies suggesting a possible benefit 1.
- The 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes also supports the use of ranolazine for treatment of 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 1.
Important Considerations
- Ranolazine should be used cautiously in patients with liver cirrhosis, kidney impairment, or those taking medications that inhibit CYP3A4 enzymes, as dose adjustments may be necessary in these populations.
- It works by inhibiting the late sodium current in cardiac cells, which reduces calcium overload and improves myocardial relaxation, thereby decreasing oxygen demand without affecting hemodynamics.
- Ranolazine is available as extended-release tablets that should be taken with or without food and swallowed whole, not crushed or chewed.
From the FDA Drug Label
Ranolazine Extended-Release Tablets is an antianginal indicated for the treatment of chronic angina. ( 1) Ranolazine Extended-Release Tablets are indicated for the treatment of chronic angina. INDICATIONS AND USAGE Ranolazine Extended-Release Tablets is an antianginal indicated for the treatment of chronic angina. ( 1)
The indication for Ranolazine (generic name) is the treatment of chronic angina 2, 2, 2.
- Key points:
- Ranolazine is an antianginal medication
- It is used for the treatment of chronic angina
- It may be used 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
Indication for Ranolazine
- Ranolazine is indicated for the treatment of chronic stable angina, particularly in patients who have not responded to standard anti-anginal therapy 3, 4, 5, 6, 7.
- It can be used as monotherapy or in combination with other antianginal agents, such as beta-blockers, calcium channel blockers, or long-acting nitrates 3, 6.
- The drug is effective in improving exercise duration and reducing the frequency of angina episodes and nitroglycerin consumption 3, 6.
- However, its use is restricted to patients with stable angina pectoris, and it is not approved for the treatment of unstable angina, silent ischemia, or cardiac arrhythmias 5, 7.
Patient Selection
- Patients who fail optimal therapy with standard-of-care antianginal agents are the best candidates for treatment with ranolazine 6.
- The efficacy of ranolazine in other populations, such as women and non-Caucasian patients, is unknown due to limited data 3.
Safety and Efficacy
- Ranolazine is generally well tolerated, with common adverse effects including dizziness, nausea, asthenia, constipation, and headache 3, 4, 5, 6, 7.
- The drug has been shown to be safe and effective in clinical trials, with no significant increase in the incidence of death or arrhythmia 3, 7.
- However, caution must be taken in patients with impaired hepatic or renal function, as ranolazine is metabolized mainly in the liver and cleared by the kidney 7.