Ranolazine (Ranexa)

Indicated for the treatment of chronic angina.

May be used with beta-blockers, nitrates, calcium channel blockers, anti-platelet, therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers.

Decrease angina episodes in individuals with coronary artery disease on maximal doses of amlodipine, and increase exercise tolerance in individuals taking concomitant atenolol, or diltiazem.

Does not significantly alter either the heart rate or blood pressure, and is of great value in individuals with angina that is refractory to maximal tolerated doses of other anti-anginal medications.

No benefit for patients with non-ST elevation acute coronary syndromes or acute myocardial infarction.

Can increase the QT interval on the electrocardiogram, with a mean increase in the QTc of approximately 6 msec.

About 5 percent of individuals may have QTc prolongations of 15 msec or longer, and this may result in a higher risk of sudden cardiac death.

Prolongs QTc interval in a dose related manner.

Should be used with caution in combination with other medications that increase the QT interval.

It is contraindicated in the setting of mild, moderate, or severe liver disease, as it is metabolized in the liver.

Contraindicated in patients taking strong inhibitors, or inducers of CYPA3A.

Not associated with increased risk of sudden death or arrhythmia.

Beginning dose 500 mg BID, with increases 1000mg BID.

Causes minimal changes in pulse rate or blood pressure.

The MERLIN-TIMI36 trial, the NSTEMI coronary syndromes  that were stabilized , ranolazine did not significantly reduce the primary endpoint of cardiovascular death, MI, or recurrent ischemia compared with placebo.


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