Antianginal Agent

Question 1

Brand Name for Ranolazine

Answer 1

Ranexa

Question 2

dosage form for Ranolazine (Ranexa)

Answer 2

Oral tablet, ER 12h : 500mg and 1000mg

Question 3

Indication for Ranolazine?

Answer 3

Chronic angina

(sig: initial 500 mg po bid, may titrate to max dose of 1000mg bid

Question 4

Ranolazine MOA?

Answer 4

Ranolazine inhibits the late phase of the inward sodium channel during cardiac repolarization reducing intracellular sodium concentrations and thereby reducing calcium influx via Na+-Ca2+ exchange that in turn reduces ventricular tension and myocardial oxygen consumption.

Question 5

Ranolazine contraindication?

Answer 5

Hepatic cirrhosis, strong CYP3A4/5 inducers or inhibitors, P-gp inhibitors

Question 6

Common ADR?

Answer 6

None

Question 7

Less Common ADR?

Answer 7

Dizziness, headache, bradycardia, hypotension, edema, constipation, nausea, xerostomia, blurred vision

Question 8

Serious ADR?

Answer 8

Angioedema, pancytopenia (lower than normal of RBC and WBC and platelets in the blood), pulmonary fibrosis, arrhythmia, renal failure, syncope, QTc prolongation

Question 9

Ranolazine Monitoring Parameters?

Answer 9

Efficacy: Improvement in angina symptoms, improved exercise tolerance

Toxicity: Baseline and follow-up ECG to evaluate QTc if concerns for prolongation; monitor BP and renal function at baseline and periodically.

Question 10

Key counseling points?

Answer 10

Do not crush or chew but may be taken with or without meals. There are multiple significant drug interactions so talk to HCP before starting any new medications or herbal supplements. Ranolazine will not stop an acute angina episode.

may use in combination with beta-blockers or alone in pt who do not respond to or tolerate beta-blockers