Ranexa: Effective Chronic Angina Management for Stable Symptoms
Ranexa
| Product dosage: 500mg | |||
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Ranexa (ranolazine) is an FDA-approved antianginal medication indicated for the treatment of chronic angina pectoris. It is used in combination with other antianginal agents such as amlodipine, beta-blockers, or nitrates when these agents alone do not provide adequate symptomatic control. Unlike many traditional antianginal therapies, Ranexa works via a unique mechanism—inhibition of the late sodium current in cardiac cells—which helps reduce calcium overload in myocardial tissue during ischemia, thereby decreasing myocardial oxygen demand and improving coronary blood flow without significantly affecting heart rate or blood pressure. This makes it a valuable option for patients who may not tolerate hemodynamic side effects of conventional treatments.
Features
- Active ingredient: Ranolazine
- Available in extended-release tablet formulations: 500 mg and 1000 mg
- Unique mechanism of action: selective inhibitor of late sodium current
- Does not cause clinically significant changes in heart rate or blood pressure
- Designed for twice-daily oral administration, with or without food
- Metabolized primarily by CYP3A enzymes; caution advised with concomitant CYP3A inhibitors/inducers
Benefits
- Reduces frequency of angina attacks and need for sublingual nitroglycerin use
- Improves exercise tolerance and time to onset of angina in patients with chronic stable angina
- Offers an alternative for patients who cannot tolerate hemodynamic effects of beta-blockers or calcium channel blockers
- May be used safely in patients with hypertension, diabetes, or heart failure (with preserved ejection fraction)
- Does not typically cause reflex tachycardia or hypotension
- Provides additive anti-ischemic effects when combined with other antianginal agents
Common use
Ranexa is commonly prescribed for the management of chronic angina in adults who continue to experience symptoms despite treatment with other antianginal medications. It is not indicated for the treatment of acute anginal episodes. Clinical use often involves patients with comorbidities such as diabetes mellitus, hypertension, or a history of heart failure with preserved ejection fraction, where its hemodynamically neutral profile is particularly advantageous. It is typically integrated into a comprehensive cardiovascular risk reduction plan that may include lifestyle modifications and management of underlying conditions.
Dosage and direction
The recommended starting dose of Ranexa is 500 mg taken orally twice daily. Based on clinical response and tolerability, the dose may be increased to a maximum of 1000 mg twice daily. Tablets should be swallowed whole and must not be crushed, chewed, or broken, as this alters the extended-release properties and may increase risk of adverse effects. Ranexa may be taken with or without food, though consistency in administration relative to meals is advised to maintain stable plasma concentrations. Dose adjustments are necessary in patients with hepatic impairment, moderate-to-severe renal impairment, or when co-administered with certain CYP3A inhibitors.
Precautions
Patients should be advised that Ranexa may cause QT interval prolongation, although the clinical significance of this effect at therapeutic doses is not fully established. Regular monitoring of electrocardiograms may be considered, particularly in patients with known congenital long QT syndrome, or those taking other QT-prolonging drugs. Use with caution in patients with moderate to severe hepatic impairment (Child-Pugh Class B or C), as ranolazine exposure is significantly increased. Renal function should be assessed prior to and periodically during treatment, especially in patients with pre-existing renal insufficiency. Patients should be informed that Ranexa is not for abortive treatment of acute anginal attacks.
Contraindications
Ranexa is contraindicated in patients with clinically significant hepatic impairment (Child-Pugh Class C cirrhosis). It is also contraindicated in patients taking strong CYP3A inhibitors, such as ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir, as well as CYP3A inducers like rifampin, phenobarbital, phenytoin, carbamazepine, and St. John’s wort. Concomitant use with Class Ia (e.g., quinidine) or Class III (e.g., dofetilide, sotalol) antiarrhythmic agents that prolong the QT interval is also contraindicated.
Possible side effect
Common adverse reactions (≥4% and more frequent than placebo) include dizziness, headache, constipation, and nausea. QT prolongation has been observed in a dose-related manner. Less frequently, patients may experience vomiting, dry mouth, abdominal pain, peripheral edema, or palpitations. Syncope, asthenia, blurred vision, diplopia, confusion, and hallucinations have been reported in post-marketing experience, though causal relationship is not always established. Any persistent or severe side effects should be reported to a healthcare provider.
Drug interaction
Ranexa is primarily metabolized by CYP3A4 and to a lesser extent by CYP2D6. Concomitant use with strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin) or inducers (e.g., rifampin) is contraindicated. Moderate CYP3A inhibitors (e.g., diltiazem, verapamil, erythromycin) may increase ranolazine levels; dose reduction of Ranexa may be necessary. Ranexa itself is a moderate inhibitor of CYP3A and CYP2D6 and may increase concentrations of simvastatin, digoxin, and certain antidepressants (e.g., paroxetine). It may also potentiate the effects of drugs that prolong QT interval. Dose adjustments and monitoring are recommended when used with P-glycoprotein substrates like digoxin.
Missed dose
If a dose of Ranexa is missed, the patient should take it as soon as remembered, unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended, as it may increase the risk of adverse effects.
Overdose
In case of suspected overdose, supportive measures should be initiated, including ECG monitoring for QT prolongation and possible arrhythmias. There is no specific antidote for ranolazine overdose. Hemodialysis is unlikely to be effective due to high protein binding and extensive tissue distribution of the drug. Management should focus on symptomatic treatment and maintaining vital functions.
Storage
Ranexa tablets should be stored at room temperature (20°–25°C or 68°–77°F), with excursions permitted between 15°–30°C (59°–86°F). Keep the medication in its original container, tightly closed, and away from excess moisture, light, and heat. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Do not disregard professional medical advice or delay in seeking it because of something you have read in this product card.
Reviews
Clinical studies and post-marketing surveillance indicate that Ranexa is generally well-tolerated and effective in reducing angina frequency and improving exercise tolerance in patients with chronic stable angina. Many patients report a significant decrease in the use of sublingual nitroglycerin and an improved quality of life. Some users note mild gastrointestinal side effects initially, which often subside with continued use. Healthcare providers appreciate its utility in patients who cannot tolerate beta-blockers or calcium channel blockers due to hypotension or bradycardia. Overall, it is regarded as a valuable addition to the antianginal armamentarium.