From the Guidelines
Ranexa (ranolazine) is recommended as an add-on therapy for chronic angina when other medications, such as nitrates and beta-blockers, are not providing adequate relief, due to its ability to improve blood flow to the heart without affecting heart rate or blood pressure, as supported by the 2024 ESC guidelines for the management of chronic coronary syndromes 1.
Key Differences Between Ranexa and Imdur
- Ranexa works by improving blood flow to the heart without affecting heart rate or blood pressure, making it useful as an add-on therapy for chronic angina when other medications aren't sufficient.
- Imdur is a nitrate that dilates blood vessels, reducing the heart's workload and improving blood flow, used for both prevention and treatment of angina.
Usage and Dosage
- Ranexa is typically taken twice daily at doses of 500-1000 mg.
- Imdur is usually taken once daily at 30-120 mg in extended-release form.
Side Effects and Considerations
- Ranexa may cause dizziness and constipation.
- Imdur commonly causes headaches and lightheadedness.
- Patients should never stop either medication suddenly without medical guidance, as stated in the expert consensus document: a 'diamond' approach to personalized treatment of angina 1.
Clinical Guidelines and Recommendations
- The 2024 ESC guidelines 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 1.
- The 2019 ESC guidelines suggest nicorandil, ranolazine, ivabradine, or trimetazidine as second-line treatment to reduce angina frequency and improve exercise tolerance in subjects who cannot tolerate, have contraindications to, or whose symptoms are not adequately controlled by beta-blockers, CCBs, and long-acting nitrates 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Ranexa and Imdur
- Ranexa (ranolazine) is a novel antianginal agent that has been shown to be effective in reducing symptoms of chronic stable angina without affecting heart rate or blood pressure 2, 3, 4, 5.
- Imdur (isosorbide mononitrate) is a long-acting nitrate that is commonly used to treat angina pectoris.
- The mechanism of action of Ranexa is thought to be related to the inhibition of the late sodium current in cardiac myocytes, which reduces sodium and calcium overload that follows ischemia 2.
- In contrast, Imdur works by relaxing vascular smooth muscle and decreasing myocardial oxygen demand.
- Clinical trials have shown that Ranexa is effective as monotherapy or adjunctive therapy in patients with chronic stable angina, and is generally well tolerated with a low incidence of adverse effects 3, 4, 5, 6.
- The efficacy and safety of Ranexa have been established in several randomized controlled trials, including studies that have compared it to placebo or other antianginal agents 2, 3, 4, 5, 6.
- However, there is limited information available on the direct comparison of Ranexa and Imdur in terms of their efficacy and safety in patients with chronic stable angina.
- Further studies are needed to determine the optimal use of Ranexa and Imdur in the treatment of chronic stable angina, and to establish their relative efficacy and safety in different patient populations.
Key Differences
- Ranexa does not affect heart rate or blood pressure, whereas Imdur can cause changes in blood pressure and heart rate.
- Ranexa has a novel mechanism of action that is distinct from other antianginal agents, whereas Imdur works through a more traditional mechanism of action.
- Ranexa has been shown to be effective in patients with chronic stable angina who have not responded to standard anti-anginal therapy, whereas Imdur is often used as a first-line treatment for angina pectoris.