Ranolazine

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Contents

Introduction

Clinical Use

Antianginal agent

Indications

  • Add-on therapy to patients refractory to standard therapy
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NHS All Wales Medicines Strategy Group (AWMSG) does not recommend use for the treatment of stable angina pectoris as unproven cost effectiveness[1]

Administration

Oral 500mg bd to max 1000mg bd.

Clinical Issues

Contra-indications

  • Mild hepatic dysfunction
  • Pre-existing QT prolongation or risk

Cautions and Interactions

Side effects

Special advice

Pharmacology

  • Piperazine derivative with intriguing partial fatty acid oxidation inhibitor properties[3].
  • It may mprove HbA1c levels and recurrent ischaemia in patients with diabetes mellitus[4]
  • It appears to have anti-arrhythmic properties[5]

References

  1. [http://www.wales.nhs.uk/sites3/Documents/371/ranolazine_Ranexa_%20FAR.pdf Ranolazine as add-on therapy for symptomatic treatment of stable angina pectoris Advice No: 1909 – December 2009]
  2. Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Murphy SA, Budaj A, Varshavsky S, Wolff AA, Skene A, McCabe CH, Braunwald E. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA : the journal of the American Medical Association. 2007 Apr 25; 297(16):1775-83.(Link to article – subscription may be required.)
  3. Bhandari B, Subramanian L. Ranolazine, a partial fatty acid oxidation inhibitor, its potential benefit in angina and other cardiovascular disorders. Recent patents on cardiovascular drug discovery. 2007 Jan; 2(1):35-9.
  4. Morrow DA, Scirica BM, Chaitman BR, McGuire DK, Murphy SA, Karwatowska-Prokopczuk E, McCabe CH, Braunwald E. Evaluation of the Glycometabolic Effects of Ranolazine in Patients With and Without Diabetes Mellitus in the MERLIN-TIMI 36 Randomized Controlled Trial. Circulation. 2009 Apr 6.(Epub ahead of print) (Link to article – subscription may be required.)
  5. Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM, Molhoek P, Verheugt FW, Gersh BJ, McCabe CH, Braunwald E. Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation. 2007 Oct 9; 116(15):1647-52.(Link to article – subscription may be required.)